Gout Linked With Risk For Heart Attack And Stroke

Overview

Gout is a common type of arthritis that causes sudden, very painful attacks in a joint, most often the big toe. It happens when a waste product called uric acid builds up in your blood. When there is too much of it, tiny sharp crystals can form inside and around your joints, and your body reacts with pain, heat, redness and swelling. Research now shows that people with gout also have a higher chance of heart attack and stroke. This link does not mean gout causes these problems. It means the two often travel together, and looking after one helps you look after the other.

Yes. Gout is one of the most common forms of inflammatory arthritis worldwide, and rates have been rising. Part of the reason is that more people now live with obesity, high blood pressure and kidney disease, which all raise the chance of getting gout.

It is more common in men, especially from their 40s onward, and in women after menopause. It is also more common in people with kidney disease, high blood pressure or obesity, in people with a family history of gout, and in people who drink a lot of alcohol or sugary drinks.

Symptoms

Common symptoms

• Sudden, intense joint pain, often starting at night and reaching its worst within a few hours.
• The big toe is the classic spot, but the ankle, knee, wrist, fingers and elbow can also be affected.
• The joint looks red, warm, swollen and shiny, and it feels very tender to touch.
• The skin over the joint may peel or itch as the attack settles.
• Attacks usually ease over a few days to two weeks, even without treatment.
• Many people feel completely normal between attacks, while others get them more often.
• Over years, hard lumps called tophi can form under the skin near joints or on the ears.
• Some people get kidney stones, which can cause pain in the back or side and blood in the urine.

Symptoms in children

• Gout is rare in children. When it does happen, doctors look for an underlying cause such as a kidney problem, a genetic condition, or a medicine that raises uric acid.
• Any child with sudden, severe joint swelling or pain should be checked by a doctor, because other conditions can look similar.

Symptoms in older adults

• Older adults may get attacks in more than one joint at a time, and the pain can be less classic than the textbook big-toe attack.
• Many older people take water tablets (diuretics) for blood pressure or have kidney disease, and both raise uric acid levels.
• A joint that stays hot and swollen, or new confusion and feeling unwell, should be checked quickly, because joint infections and other conditions can look like gout.

Causes

Main causes

• Too much uric acid in the blood. Uric acid is a waste product made when your body breaks down purines, substances found in your own cells and in some foods and drinks.
• Kidneys that do not clear uric acid well enough. This is the most common reason for gout.
• Alcohol, especially beer and spirits, and drinks sweetened with fruit sugar (fructose).
• Some medicines, including water tablets used for blood pressure. Never stop a medicine without asking your doctor or pharmacist first.
• Sudden illness, injury, surgery, dehydration or crash dieting, which can all set off an attack.
• Genes play a part. Gout often runs in families.

Risk factors

• Being male, or being a woman past menopause.
• A family history of gout.
• Being overweight or living with obesity.
• High blood pressure, high cholesterol or type 2 diabetes.
• Kidney disease.
• Drinking alcohol regularly, or drinking a lot of sugary drinks.
• A diet high in red meat, offal and shellfish.
• Some medicines, such as water tablets and low-dose aspirin.
• Being dehydrated, or going through periods of fasting or very fast weight loss.

When to see a doctor

See a doctor urgently if:

• Any first attack of sudden, severe joint pain, so the cause can be checked.
• A hot, swollen joint with a fever or feeling generally unwell.
• Being unable to put weight on the joint.
• Attacks that keep coming back, or that are not settling.
• New symptoms you think may be a side effect of a medicine.

Book a routine appointment if:

• After a gout diagnosis, to plan a heart and stroke risk check.
• Between attacks, to review your uric acid level and your treatment.
• If you have high blood pressure, high cholesterol, diabetes or kidney disease, so these can be monitored together.
• If you would like help with diet, alcohol, weight or quitting smoking.
• Before starting any new medicine, including things you buy over the counter.

Diagnosis

Your doctor will ask about your symptoms and what sets them off, look at the joint, and may arrange blood tests. The most reliable test is finding uric acid crystals in a small sample of fluid taken from the joint. Uric acid levels in the blood can be normal during an attack, so a normal result does not rule gout out. Because of the heart link, your doctor may also check your blood pressure, cholesterol, blood sugar, weight and smoking status.

Tests that may be done

• Blood tests for uric acid, kidney function, blood sugar and cholesterol.
• Joint fluid test: a small sample of fluid is taken with a needle and checked under a microscope for crystals.
• Ultrasound or X-rays, to look for crystals, joint damage or other causes of pain.
• Blood pressure measurement, and a heart risk check based on your age, weight, smoking and family history.
• A heart tracing (ECG) if you have chest symptoms.

What to expect at your appointment

Most of this can be done in a normal appointment at your GP surgery or clinic. Taking joint fluid is a quick procedure using a small needle and local numbing, and most people find it easier than they expect. Blood test results usually come back within a few days, and your doctor will explain what they mean and agree a plan with you.

Treatment

Treatment has two parts. The first is settling an attack when it happens. The second is lowering uric acid over the long term so that attacks stop coming. Alongside this, your doctor will want to check and protect your heart and blood vessels, because gout and heart problems so often appear together.

Self-care at home

• Rest the joint and raise it on a pillow where you can.
• Put an ice pack wrapped in a cloth on the joint for up to 20 minutes at a time.
• Drink plenty of water, and avoid alcohol while an attack is settling.
• Wear loose footwear, or keep the joint free of heavy bedding.
• Lose weight gradually if you need to. Crash diets and fasting can trigger attacks.
• Keep taking any medicine your doctor has prescribed for gout or your heart, unless you are told to stop.

Medical treatments

Doctors use anti-inflammatory medicines to calm an attack, sometimes as tablets and sometimes as an injection, along with pain relief. For long-term control, there are medicines that lower how much uric acid your body makes or help your kidneys remove it. These are usually started once an attack has settled and are taken every day. Your dose is adjusted with blood tests until your uric acid is in the target range. Because starting them can briefly set off an attack, doctors often give a short course of anti-inflammatory medicine at the same time. Your doctor will also review your blood pressure, cholesterol and blood sugar, and may suggest treatment for these too. Never start, stop or change a medicine without talking to your doctor or pharmacist first.

When is surgery considered?

Surgery is rarely needed for gout. It may be considered for very large tophi that press on nerves, limit movement or keep getting infected, or for joints that have been badly damaged. Most people never need an operation.

Living with this condition

Most people live a normal, active life with gout. Between attacks, keep taking your preventive medicine, stay well hydrated, and go for regular check-ups that include blood pressure and cholesterol. It can help to keep a simple diary of what seems to trigger attacks, such as alcohol, dehydration, rich meals or a sudden illness.

Lifestyle tips

• Keep to a healthy weight, losing weight slowly if needed.
• Cut down on beer and spirits, and swap sugary drinks for water.
• Stay active, and build up gradually if you have not exercised for a while.
• Eat regular meals, and avoid long fasts or crash diets.
• Include low-fat dairy, vegetables and fruit in your day.
• If you smoke, ask your doctor or pharmacist for help to stop.
• Have your medicines reviewed regularly, and mention any new symptoms.

Diet and exercise

There is no single gout diet, but a heart-healthy way of eating helps both conditions. That means plenty of vegetables and fruit, whole grains, low-fat dairy, beans and pulses, and less red and processed meat, alcohol and sugary drinks. Aim for about 150 minutes of moderate activity a week, such as walking, swimming or cycling, and build up slowly. Avoid very fast weight loss, because it can trigger an attack.

Mental health and emotional wellbeing

A painful condition that comes without warning can wear you down. Some people feel anxious about when the next attack will hit, and being told you have a higher heart risk can be worrying too. These feelings are common and worth mentioning to your doctor. If you ever feel overwhelmed, hopeless or unable to cope, please contact your doctor or a local crisis support service in your country straight away. You do not have to manage alone.

Prevention

Attacks can very often be prevented. Daily uric acid-lowering medicine, taken as prescribed, gets most people to a point where attacks stop. Heart-healthy habits such as a balanced diet, less alcohol and fewer sugary drinks, regular activity, not smoking and a healthy weight lower both gout attacks and the risk of heart attack and stroke.

Vaccines

There is no vaccine for gout. But if you have a heart or kidney condition, it is sensible to stay up to date with routine vaccinations, including flu and pneumonia jabs if your doctor recommends them. Ask your GP or pharmacist what is right for you.

Screening programmes

If you have gout, ask your doctor about a heart and stroke risk check. This usually means tests for blood pressure, cholesterol and blood sugar, plus a conversation about smoking, weight and family history. Regular kidney function tests are also important, because the kidneys handle uric acid.

Complications

If left untreated

• Attacks that become more frequent, last longer and affect more joints.
• Gradual joint damage, stiffness and reduced movement.
• Hard lumps of uric acid under the skin, called tophi, which can be painful or become infected.
• Kidney stones and, over time, kidney disease.
• A higher chance of heart attack and stroke, especially when blood pressure, cholesterol and blood sugar are also raised.
• Poor sleep, time off work and a lower quality of life during flare-ups.

Long-term outlook

The outlook is good. With the right treatment, most people have fewer attacks, and many have none at all. Some joints may take time to recover if gout has gone untreated for years, but this often improves once uric acid stays in the target range. The link with heart attack and stroke is a useful early warning, because the same steps that control gout also protect your heart. Most people with gout go on to live full and active lives.

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