In this context, there is a need to determine the impact of diuretics on gout management in clinical prac. Focused summary of gout relevant to primary care significance. A group of australian researchers have examined the clinical and genetic features of diureticassociated gout in a casecontrol study design comparing gout patients on diuretics vs. Eating guidelines for gout gout is atype of arthritis. Publication bias can exist if studies that do not confirm an increased risk of gout with diuretic use are not published. Ace inhibitors and nonlosartan angiotensin ii receptor blockers increase serum urate. Tolerability, safety, and quality of life and hyperteneive therapy. Diuretics reduce urate excretion by both directly and indirectly increasing urate reabsorption and decreasing urate secretion. Other pills called colchicine and prednisone treat the pain, swelling, and. The extreme pain, swelling and redness are due to crystals of a chemical called uric acid that collect in the joints. Some pills, such as diuretics water pills also cause gout.
Diuretics, such as loop agents and thiazides, do not have a significant effect on managing gout, according to findings published in arthritis. In a prospective study, researchers determined incidence of diureticassociated gout in nearly 6000 hypertensive patients with no histories of gout at baseline. Recent diuretic use and the risk of recurrent gout attacks. If you are receiving loop or thiazide diuretics, the diuretic might be swapped to another. The retention of salts and water in the body is responsible for hydration of tissues with the formation of edema accompanying renal diseases, cardiovascular insufficiency, some forms. Foods rich in purines, high alcohol intake, and drugs like immunosuppressants and diuretics can raise your risk of gout. Systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia dinesh khanna,1 john d. Diuretics increase urinary excretion of water and electrolytes and are used to relieve oedema associated with heart failure, nephrotic syndrome or hepatic cirrhosis. It has been noted that hyperuricaemia occurs when diuretics produce sufficient salt and water loss as to result in volume contraction. A possible connection between the use of diuretics and the sudden development of gout was first identified more than 25 years ago but the medical. Management of gout effective health care program ahrq. Osmotic diuretics are mainly used to treat cerebral oedema, and also to lower raised intraocular pressure. In patients who are at higher risk for ahs eg, koreans with stage 3 or worse ckd egfr. To determine the incidence of gout in patients who use diuretics, taking into account concurrent hypertension and cardiovascular diseases.
Sugary drinks and alcoholic beverages are also linked to gout. A potential side effect of this activity is that they may cause electrolyte imbalances. Uric acid, blood pressure, and gout management maastricht. The aim of the present study was to assess the impact of the diuretics on the response to uld in patients with gout. Optimizing care for patients with chronic kidney disease. Since the text i was reading says that thiazide decreases uric acid excretion no explanation though but it did not mention other diuretics for instance loop, so i figured that mechanisam must be unique to thiazide, which is not shared by all diuretics. Hyperuricemia is a relatively common finding in patients treated with a loop or thiazide diuretic and may, over a period of time, contribute to newonset gouty arthritis or, more promptly, recurrence of established gout. Lecturer cristina ghiciuc, md, phd 3 nephrogenic diabetes insipidus induced by lithium doses are adjusted, as thiazides decrease. It occurs when high levels of uric acid cause crystals to form in your joints and soft tissues, leading to inflammation, pain and swelling.
Treatment of asymptomatic hyperuricemia is not recommended in most countries. Hyperuricaemia and gout also occur as a result of the ingestion of different drugs such as ciclosporin 20 or low dose aspirin, 21 and of which, diuretics are the most widely prescribed. Formation of the crystals requires high serum uric acid levels. Thiazide and loop diuretics were associated with increased gout risk, an association mediated by a change in serum urate. Diuretics, or water pills, can cause you to get what is termed secondary gout, which is caused by the use of diuretics. A person with gout will have sudden attacks that come back. If diureticinduced gout occurs, it is usually treated with a uratelowering drug such as allopurinol. During 9 years of followup, 37% of patients received diuretics. Previous eular recommendations for gout were written in 2006. Druginduced hyperuricaemia and gout rheumatology oxford. Diureticinduced hyperuricemia and gout time of care. Precipitating factors are antihyperuricemic therapy probenecid, allopurinol, diuretics, iv heparin, cyclosporine. Gout is a chronic, progressive, inflammatory disease requiring appropriate longterm management. We examined the relation of all diuretic use and use of specific diuretics, i.
But over time, gout may appear more often and last longer if left untreated. Should patients with gout avoid questions thiazides for. Observational data have suggested that gout is associated independently with both hypertension and diuretic use. Associations of plasma uric acid and purine metabolites with. A low fractional excretion of urate has also been found in patients with high 24 h uric acid excretion. Diuretics 3 side effects loop diuretics act on the loop of henle in the kidney and prevent reabsorption of water and salt. Older people get gout more because their bodies cant get rid of the uric acid as well.
Diuretics are perhaps the most wellknown medications to be associated with gout. Diuretic abuse and electrolyte imbalancediuretic abuse and electrolyte imbalance natalie sinha is a 20yearold woman who presents to her gp complaining of weakness and lightheadedness. Diuretic use, increased serum urate and the risk of incident gout in. Gout is a monosodium urate crystal deposition disease. Tell your health care professional all of the medicines you take, and always talk with him or her before you stop taking any medicine. If not, its use would be preferential in patients with ckd or heart failure who are on diuretics, especially when diuretics cannot be discontinued. Other side effects include gout, which results from raised uric acid levels hyperuricaemia table 2, fig. It may be months or even years before the next attack hits. This may happen because diuretics increase urination, which reduces the amount of fluid in your body. Multiple clinical and lab and genetic assessments were recorded during. Moreover, hyperuricemia is the leading risk factor for gout 7. Relationships of quality of life measures to long term lifestyle and drug treatment in the treatment of mild hypertension study. Gout is the most common form of inflammatory arthritis est.
Gout is increasing in incidence and prevalence and is the most common cause of inflammatory arthritis in men over 40 years of age. Diuretics have been associated with precipitating acute attacks of gout. The amount of uric acid in your body depends on the following. Gout patients fulfilled the 1977 ara gout classification criteria. Request pdf on researchgate diureticinduced gout in elderly women summary during a 2. Hyperuricemia is a relatively common finding in people treated with a loop or thiazide diuretic and may, over a period of time, contribute to newonset gout or, more promptly, recurrence of established gout. The amount of uric acid your body makes and gets rid of.
Diuretics have been associated with impaired response and refractoriness in gout, but whether this effect is still present with new uratelowering drugs uld and treattotarget strategies is unknown. Diet, weight loss, and regular exercise help manage gout and reduce flare risk. You can stop gout by taking pills every day to keep your uric acid down. The pathogenesis, epidemiology, and an overview of treatment of diureticinduced hyperuricemia and gout are presented in this topic. Red meats such as beef, lamb, and pork and organ meats such as liver and kidney. Some diuretics are used at lower doses to reduce raised blood pressure.
Impact of diuretics on the urate lowering therapy in. Relative risks of getting gout for patients with hypertension or cardiovascular morbidity were highernamely, 2. Current guidelines for gout treatment caution about the association between diuretics and gout, 16,17 and hypertension guidelines in the us 7,8 and europe also warn about the risk of. From a primary care population all patients with a first gout registration 59 men, 11 women. Certain foods and drinks may also increase the risk of a gout attack. It has been known for awhile that diuretics can lead to an increased risk of gout. Shellfish, gravies, red meat, soups and organ meats, such as liver, are high in purines. A condition very similar to gout but caused by cppd deposits not msu gout pseudogout symptom duration 310 days longer comorbid diseases ckd hypothyroidism appearance under microscopy needleshaped rhomboid with blunt ends chronic treatment uratelowering therapy, colchicine, nsaids nsaids, colchicine. Some studies concerning the relationship between use of diuretics and the risk of gouty arthritis might be missed, for instance, because they were not published in english. Thus, it is reasonable to ask if we should avoid thiazides in patients with coexistent gout and hypertension. Pubmed 1950october 2009, embase 1974october 2009, and the. Obesity, hypertension, diuretic use each double risk for gout.