Can diuretics trigger a gout attack?
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 community is unsure if the diuretic or the underlying hypertension is the main culprit. If you have high blood pressure and more importantly use diuretics which is a prescription drug commonly called water pills, to help lower your blood pressure; then studies now show that you are at risk of developing gout. Middle aged and elderly people are more prone to use diuretics, so they are in fact more at risk in the complication of developing gout with this type of drug.
Diuretics are a class of drugs that have been shown to increase your serum urate levels. Diuretics work to decrease the fluid volume of your blood thus lowering your blood pressure by having less blood flowing through your arteries and blood vessels. Since diuretics tend to have fewer side effects than other anti-hypertensive drugs, doctors tend to prescribe them more often. How diuretics work exactly for the high blood pressure sufferer, is that they cause you to produce more urine than normal in order to flush out the surplus fluid in your blood. They stimulate the kidneys to expel more water in the form of urine.
The evidence that water pills can cause gout
According to one study conducted by Mara A. McAdams DeMarco, PhD, of Johns Hopkins University in Baltimore and appeared in the January 2012 issue of Arthritis & Rheumatism, your chances of developing gout or a gout attack increased by 1.48 fold. The risk of gout was also increased with both thiazide and loop diuretics. This study followed 5789 participants who had hypertension but no gout for 9 years. Also noted was the fact that when using other anti-hypertensive drugs to treat high blood pressure, that this decreased the risk of developing gout. DeMarco and colleagues also stated: “Future studies should not only confirm the risk of gout associated with diuretic-induced hyperuricemia but also further elucidate the complicated relationship of hypertension, diuretics, uric acid, and gout.” Basically more work needs to be done to connect all the dots.
Taking diuretics or so called water pills can cause you to develop what is considered secondary gout and not primary gout which is more often hereditary or diet related. Secondary gout is usually due to the fact that gout occurs only after taking medications such as water pills to treat any other type of condition or disease. What water pills do is that they remove the excess water from your body and this causes uric acid levels to increase. Yes, if you have never had gout, nor a gout attack before and are using diuretics to treat your high blood pressure, you are at risk of developing gout. If gout does occur then discuss with your physician about changing to other types of anti-hypertensive drugs such as calcium channel blockers that do not lessen bodily fluid.
If you already have gout taking diuretics can increase your risk of developing gout attacks. Your doctor then will most likely prescribe you either allopurinol, colchicine, phobenecid or NSAIDs to get rid of uric acid before it crystallizes and causes you a painful gout attack. It is very important to get your uric acid tested and ensure that you get it down to 5mg/dL or lower.
Posted by Spiro Koulouris
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