Dr Louise Johnson explains what triggers a gout attack and explains how it may be connected to diabetes.
What is gout?
Gout is a systemic disease that results from the deposition of urate crystals in tissue, such as the big toe and other joints.
In normal conditions, the urate crystals are passed into the urine. In certain circumstances, there is abnormality of urate handling. There are two categories:
- Increased production
- Diet consistent with too much purines that cause urate crystals, such as red meat (beef, pork, lamb), seafood and beer.
- Decreased clearance
- Kidney failure
- Diuretics (medication use to make you pass more urine).
The gout attack
Deposition of urate crystals in the joint cavity triggers a gout attack. The affected joint is red, swollen and very tender. It resolves within hours to days. A drug (colchicine) will limit inflammation and symptoms. This can usually be obtained from the pharmacy as a gout cocktail.
It’s important to know that gout can become a chronic disease. It’s estimated that 85% of people who have a first attack will have one again within three years.
This is the result from recurrent acute attacks and causes chronic inflammation in the joint with cartilage damage and tophi formation.
The impact of systemic disease on uric acid
Gout seems to affect osteoarthritis joints more often. High blood pressure is a known risk factor for gout. Diabetes is also a risk factor for hyperuricemia (urate build-up in the blood) and gout.
The gout-diabetes link
People with Type 2 diabetes are more likely to develop hyperuricemia and people with gout and high uric acid may be more likely to develop diabetes. Not everyone with hyperuricemia will get gout but your chances go up as the uric acid levels rise.
In a 2010 study in The American Journal of Medicine, thousands of adults and their children were examined. The researchers found that those with higher uric acid levels were more likely to get Type 2 diabetes.
A 2014 study in the Annals of Rheumatic Diseases found that the gout-diabetes connection was especially strong in women. Researchers found that women with gout were 71% more likely to get diabetes than women without it.
Other factors that also play a role
Almost 90% of people with Type 2 diabetes are overweight or obese. People who are obese are four times more likely to get gout than a person of normal weight. Carrying extra kilograms slow down your kidneys’ ability to remove uric acid.
About 80% of people with diabetes also have hypertension (high blood pressure). This raises uric acid levels and is also linked to insulin resistance. Gout and diabetes are also linked to kidney disease and heart disease.
If you are older than 45 years, you have an increased risk of diabetes and gout especially if you have metabolic syndrome features.
Metabolic syndrome according to the ATP 111 criteria
- Increased waist circumference. More than 80cm in a female and more than 94cm in a male.
- High blood pressure.
- Abnormal blood lipids: low HDL (good cholesterol) and increased triglycerides (blood fat).
- Abnormal blood glucose.
High uric acid doesn’t only cause inflammation, it can also trigger insulin resistance. Insulin resistance is when your body doesn’t respond well to insulin, causing too much blood glucose to circulate in the bloodstream.
What triggers gout?
- Heavy alcohol uses especially beer and hard liquor.
- Foods high in purine, such as red meat, liver and seafood.
- Sugary cold drinks, such as sodas, fruit juice, and candy.
- Certain drugs that are used to decrease swelling of feet called diuretics.
- Fasting and dehydration.
- High doses of vitamin A and niacin.
There are two categories:
- Uricosuric agents helps the body to pass more uric acid.
- Xanthine oxidase inhibitors help the body produce less uric acid.
Managing an acute attack
- Colchicine taken within 12 hours of the onset of the flare has been shown to be effective. Remember that colchicine can cause diarrhoea, nausea and vomiting if the dosage is too high.
- Non-steroidal anti-inflammatory drugs; these are analgesics such as Voltaren or Brufen. Remember not to take aspirin since this can make the pain worse.
- Corticosteroids can give fast relief given as a tablet or injection. Remember that steroids will temporary push up blood glucose.
Managing gout and diabetes
Lifestyle changes is important for both conditions.
Watch what you eat
Diet is a key to managing both conditions well. In addition to your diabetes friendly diet, avoid certain foods and add others.
- Cut out or limit red meat and seafood including mussels, anchovies and sardines.
- Add dairy products like skim milk and low-fat yoghurt which may protect against gout.
Regular exercise helps control blood glucose and can help with losing weight. This will help with reducing uric acid levels.
Plenty of water can help flush out uric acid and keep your kidneys working well. A rule of thumb is 250ml (a glass) of water for every 10kg. Remember to drink more when it is very hot, or you are exercising.
Control other health problems
High blood pressure, kidney disease and obesity raise the uric acid levels and can bring on a gout flare.
Make sure you see your doctor regularly for a treatment plan and uric acid levels.
MEET THE EXPERT
Dr Louise Johnson is a specialist physician passionate about diabetes and endocrinology. She enjoys helping people with diabetes live a full life with optimal quality. She is based in Pretoria in private practice.
Header image by Adobe Stock