Bone Erosion and Gout

Gout and Bone Erosion

Gout sufferers are all too familiar with the symptoms. The excruciating pain, the swelling, the redness. It’s not hard to recognize that what you’re having is a gout flare. But what most sufferers might not know is the damage that’s happening when they’re not in pain. This is called bone erosion and it can slowly affect your mobility without you knowing it. What happens is that crystal deposits interact with the bone and joint cells which lead to bone erosion.

Diagnosing Bone Erosion

Thankfully, there’s plenty of technology to help detect bone erosion. X-ray is the most basic tool that can identify bone erosion but there are other advanced machines as well such as ultrasound, MRI, and CT scan which can accurately detect bone erosion. If you visit the clinic, you may be checked using an ultrasound since it’s a readily available machine that can be operated by your radiologist.

Risks of Bone Erosion

There are not that many studies focusing on the risk of bone erosion on gout patients. The most recent one was conducted by Dr. Mian Wu from the Shanghai Jiao Tong University Affiliated Sixth People’s Hospital. Before the study, each participant was required to answer a questionnaire which documented their age, gender, duration of disease, comorbidities, medications, frequency of flares, and pain score, The study involved 980 patients who then underwent an ultrasound to check for bone erosions. Out of the 980, 431 or 44% were found to have signs of bone erosion. Of the 431, 338 had the erosion in the first metatarsophalangeal joint. This is the joint that connects your toe to your feet.

Furthermore, they found that 62.4% patients had detectable tophi. Those who had more than 2 tophi increased their risk by 15 times more. The size of the tophi did not affect one’s risk. Tophi is an advanced form of gout where deposits of uric acid crystals are so evident that it forms lumps on the skin. It’s already so severe that in some cases, surgery is required to remove the tophi.

In the study, they also found that age had a huge factor in one’s risk. The older the patient was, the higher their risk for bone erosion. The study shows that patients over 40 years old had double the risk of bone erosion. Those over 60 had almost a three times the risk for an eroded joint.

Based on the data gathered from the study, we can conclude that one’s risk for bone erosion related to gout can be traced back to four factors: duration of the gout condition, age, the number of tophi surrounding the gout, and the existence of synovial hypertrophy. Those who had bone erosion also had similar conditions including high blood pressure, high blood sugar, and kidney disease. If you have any of these conditions, you need to pay special attention to your bone health.

Gout can also lead to bone spurs. This is because inflammation on the joint can stimulate the lining of the bone next to it to grow. This protrusion can grow to as long as 5cm causing pain and numbness in the area. What’s scary is that most of these bone spurs are undiagnosed so you can go on growing an abnormal bone until it damages your nerves.

If your doctor detects a bone spur, they will have you undergo a simple operation to chisel it off. After that, you will be advised take allopurinol so the nerve can recover and the abnormal growth doesn’t come back.

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How To Avoid Bone Erosion

Bone erosion related to gout can be avoided. The earlier the diagnosis, the better since this allows you to take the proper steps to prevent gout from getting worse. Your doctor will recommend that you lower your uric acid using a variety of strategies which include drinking lots of water, exercising regularly, eating a low-purine diet, and taking urate-lowering drugs.

Gout medication can be divided to two types: short term and long term. Short term medication is used only during gout flares while long term medication is used permanently. This helps sufferers manage their uric acid levels so it doesn’t reach a point where a the patient experiences another flare.

Speaking of flares, you need to avoid getting flares as much as possible. It’s extremely uncomfortable and it’s a sign that your uric acid levels are high. Not only that but certain medications used to treat a flare often lead to long-term risks to your bone health. Corticosteroids and colchicine are examples of drugs that can affect the bones resulting in bone thinning, infection, and inability to produce blood cells.

If you have been good with your lifestyle, you may be tempted to stop medication. But doing so might only make uric acid build up more likely. It’s best to stick to your long-term gout medication since it’s the only sure way that your uric acids remain low and you can prevent bone damage. It should not exceed 6.0mg/dL. If it does, consider tweaking your diet. Speak with a doctor and dietician if you must as they can give you advice on how to lower your uric acid.

Can Bone Erosion Be Reversed?

In young individuals, it’s easy to reverse bone erosion since their body creates new bones faster. However, the older you get, the harder it will be do so since the body creates less new bones and absorbs nutrients from old bones which are not really that great anymore. However, if you maintain your health well into your old age, it may be easier to regenerate new bones although it will be at a much slower pace.

The key is to feed your body with minerals that support bone health. The most obvious is calcium which helps make new bones and keep them strong. When supplementing with calcium, make sure to complement it with vitamin D to allow the body to absorb the calcium. Also add calcium-rich foods to your diet such as milk, cheese, and yogurt. Not only are they great for your bones, they also help lower uric acid.

Exercise is also another great way to fight the nasty effects of bone erosion. Certain exercises such as weight-training and muscle strengthening help improve bone density, stimulate the production of new cells in the bones, and slow down bone loss. You can choose from a variety of exercise which include fast walking, jogging, dancing, weight lifting, and push ups.

Have you experienced bone complications due to gout? Share your stories in the comments below.

Posted by Spiro Koulouris

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3 Comments

  • Metin

    Reply Reply March 25, 2019

    Hello Spiromou, I’ll start by telling you about myself/story and would like some advice on what to do.

    I’m 39 years old
    I weigh 107kg
    I’m a London taxi driver (not a healthy/active job)

    Coming from a Mediterranean background we simply love our food but I don’t really drink. In the past I’ve never been shy of a burger challenge or two, indulging in fast food, kebabs, Chinese, Indian etc from time to time. There’s always a reason to celebrate an occasion once a month with friends but I’m no different to the next man but I’m the one that got this shit! With all the crap I’ve eaten in my life I’ve also eaten plenty good nutritious home cooked meals.

    I first had my gout attack 3 years ago, did not have a clue why my left foot was hurting, after going to my GP she told me it’s gout (still didn’t know what it was) she sent me packing with painkillers & told me I need to change my lifestyle in order to not get any repeat attacks.
    After getting to know about gout and what it actually is I kinda carried on with my life as normal.

    I’m not the most active guy due to my work but by no means I see myself a lazy guy. I run 2 times a week & play golf & football when I can due to my foot.

    My 2nd attack was a year later I simply managed it with painkillers as I was clued up with it now. But the last 12 months have been horrible getting repeated attacks every 3/4 months on my left foot only.

    I had to do another GP visit, this time it was very different she said the advice they’re getting now is lifestyle changes are not working & they’re being advised to prescribe tablets for gout. After doing a blood test I was told my uric acid levels was borderline or little high 4. something i can’t actually remember. She prescribed me 100mg allopurinol. This was in early December. I already decided in my head before leaving the room I’m not taking these tablets & was ready to go in hard with a major lifestyle/dietary change and try to beat it myself.

    For the last 3 months I’ve been as good as gold, eating, drinking doing the right things, running 3/4 times a week, feeling good & gout free and lost a stone in weight , until last week my right foot has flared up out of nowhere. My problem has only ever been my left foot. I have been as strict as you can be because I was ready to do this proper. Not touched anything I shouldn’t have then my right foot flairs up after my left foot is now feeling better than ever. Its left me wondering about allopurinol or is it the crystals breaking up why I’m getting another attack?

    My question to you is can I beat this without taking tablets ? Ive been on this lifestyle & dietary change as good as anyone can do it because I really want to not for the sake of it.

    Hope to hear from you soon!

    • Spiro Koulouris

      Reply Reply March 25, 2019

      Hi Metin!

      Thank you for your comment!

      Yes some do beat it without medication but its a personal risk you must decide to take or not.

      A probable trigger of your most recent gout attack can be the fact that you are exercising lots and losing weight fast. Losing weight is a gout trigger and many gout sufferers report it.

      Best to do a blood test every 2 months or so if you want to see if your gout diet and exercise program is working to keep uric acid levels low so you avoid taking any medication.

      See if your doctor approves to follow you on that.

      Good luck!

  • John K.

    Reply Reply March 18, 2019

    Dear Spiro,

    Thanks for the excellent website, as a gout suffer intermittently since 27 years old the information on your site has really helped me understand my disease better.

    Most recently I have come across a method that seems to ease my Gout/Uric acid sensations in my body, I have done no tests yet but I intend to do so but thought I would share it with you and potentially other suffers if you feel it merits it.

    The Wim Hof method is a breathing technique combined with some mediation and stretching and cold therapy (cold showers in essence) – I am only really doing the breathing technique at present but it makes you body and blood alkaline reducing uric acid when doing it (there are other benefits as well) was and it takes only 15 mins a day although I do it in the morning and evening before sleeping

    You can download many videos on this from YouTube – if you are interested please take a look and share with others – I have pasted a link below
    Apologies if others have already raised this topic with you

    https://youtu.be/zM_HHhcu2u4

    Kind regards

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