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Drug And/Or Alcohol Induced Gout

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

January 29, 2019

Alcohol abuse and certain prescribed medications can alter the body’s chemistry and leave the user susceptible to numerous health-related consequences, one of which is a painful condition called gout.

What Causes Gout?

A form of acute arthritis, gout affects 8.3 million people within the United States and it appears to be on the rise. Though at times referred to as hyperuricemia, a condition caused by excess uric acid flowing through the blood, gout will not necessarily form in every case of hyperuricemia.

Gout is caused by uric acid, a compound the body normally eliminates through the kidneys and urine; however, if this process is impeded, too much uric acid builds within the body, creating needle-like crystals within the soft tissues, organs, and joints, leading to the symptoms associated with gout. Uric acid results from the breakdown of certain substances called purines, compounds that are valuable sources of energy for the body.

When the breakdown or metabolism of purines occurs, in certain cases an excess of uric acid is still present, which may lead to gout. There are two types of purines, those which occur naturally within your body’s cells (endogenous purines) and those which are obtained from your diet (exogenous purines). The latter is what presents concerns for those who use certain drugs or consume alcohol.

Humans lack a critical enzyme called uricase, which is responsible for breaking down uric acid so that it can be easily flushed out of the body. Unfortunately, due to this, uric acid isn’t quite as easy to get rid of, and as a result, it can build up in various tissues and locations within the body. Normally, uric acid flows into the bloodstream, where it is then processed by the kidneys and later excreted in the urine. At this point, should any remain, the rest of it moves into the intestines where bacteria aid in the breakdown of it; however, in some cases, the body will pump out far too much uric acid or fail to remove enough of it, thus presenting increased risks of gout.

Typically, if these processes remain efficient, uric acid maintains levels below 6.8 mg/dL; however, should these levels increase to 7 mg/dL or more, hyperuricemia results. At this time, monosodium urate (MSU), the specific type of salt crystals responsible for gout may form. The more the uric acid rises, the greater the likelihood of these gout-causing crystals. When theses crystals formulate in joints, it can trigger severe inflammation and intense pain in the body. A gout attack may happen suddenly, and most often the attacks start at night, lasting up to a week. In extreme cases, gout may be severely disabling and/or cause kidney failure.

Here are some symptoms of gout, as explained by both the University of Maryland Medical Center and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS):

  • Joint fluid tests positive for uric acid
  • Sudden arthritis, occurring in one day or in only one joint
  • Swelling or warmth in a joint, most commonly in the knee, ankle, or toe (the toe is the most common region affected)
  • Swelling may go beyond the joint area
  • Skin may appear red and shiny and eventually peel at the site of the pain
  • Pain “may feel like “crushing” or a dislocated bone”
  • Any physical activity, including even light touch may create intolerable pain
  • Pain may be so severe that it wakes you
  • General state of malaise: poor appetite, chills, or low-grade fever

Various factors may increase the levels of uric acid in a person’s blood, as reported by the University of Maryland Medical Center, including age, obesity, the prevalence of certain medications, such as diuretics (water pills); and various dietary and lifestyle concerns. In regards to the latter, alcohol use has been linked to an increased risk of gout.

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Alcohol’s Role In Gout

What is alcohol’s role in gout? Various research suggests that consuming certain types of alcohol may increase your risk of developing this condition. Harvard Health Publications notes that when beer is involved, particularly in a man’s life, it has the potential to double a person’s chances of one day experiencing gout. They continue to note that though we have long been consciously aware of the connection between alcohol and gout, it is only fairly recently that medical studies have backed this belief up with solid research. Specifically, the Harvard report notes the following links found within a study published by The Lancet medical journal.

All results are in regards men and the daily consumption of alcohol:

  • Beer drinkers experienced a 50 percent increase for each additional serving
  • Hard liquor drinkers were found to have a 15 percent increase for each additional serving
  • Those who drank wine appeared to have no increased risk; however, these men usually had less than two glasses of wine, so results may be fairly inconclusive.

When beer is consumed on a daily basis, researchers suspect that it leads to gout because of the high levels of exogenous purines in it. In addition to this, the presence of alcohol heightens your body’s natural production of uric acid and partially inhibits your kidney’s ability to effectively excrete it. Patterns of binge drinking and alcohol addiction especially put a person at risk for developing gout or experiencing an attack.

When beer is processed in the body, the purines start breaking down and form uric acid; however, in instances of excess purine, as may be caused by larger amounts of beer, your body may not be able to process all the uric acid. If the kidneys are struggling and failing to keep up with these levels, the uric acid becomes far too high in the bloodstream, creating the damaging crystal deposits in the joints and tissues responsible for gout. It has been reported that alcohol consumption in young adults holds particular concern in regard to the risk of gout. On the other hand, elderly patients, especially women, witness less concern of alcohol-related gout risks.

Drugs And Gout

Illicit drug use has not been shown to typically lead to gout. Instead, various prescription drugs have been linked to an increased risk of developing this condition. In example, to reduce high blood pressure, diuretics such as Thiazine and others have been used to help excrete water from the body. These drugs work by encouraging the kidneys to get rid of water from the blood— though these results can be helpful in many ways, they may often be the cause of gout. In pharmacological literature, diuretics are pegged for creating a rise in uric acid in the body, as are certain medications used to treat tuberculosis. When gout is caused by certain medications, the condition is called “secondary gout.”

If uric acid levels aren’t determined before a diuretic is prescribed, some people may be at risk of receiving them when they already face a heightened chance of developing gout. When using a diuretic, a person’s uric acid levels need to be watched on a regular basis, but even so, gout can still happen with a medium level of uric acid. It is important you speak with your medical practitioner to fully ascertain if your blood pressure requires a diuretic before deciding to take one, if you are presently at risk for gout. Beyond prescription drugs, certain over-the-counter medications may also cause this risk, including aspirin or niacin.

Treatment And Prevention For Gout

There are medications which are geared toward treating attacks of gout by helping to reduce inflammation and pain in the joints and tissues. The University of Maryland Medical Center lists the following as treatments for a gout attack:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Colchicine
  • Corticosteroids
  • Medicine to lower uric acide [sic] level in the blood

If you suffer from a gout attack, it is helpful to try to rest the afflicted joint, while also icing it to help suppress the inflammation. In certain cases, as outlined by NIAMS, a physician may “prescribe NSAIDs or colchicine in small daily doses to prevent future attacks.” They also tell us that there are other medications that work towards lowering the risk of future attacks by keeping uric acid low in the body.

Looking at your lifestyle is important to help prevent or manage gout. Losing weight, controlling the intake of purine-containing foods and drinks, and keeping watch on your alcohol intake will help to steer you away from the disease or attacks. Even though there are ways to handle gout with medications, it can be much easier to avoid or greatly lower your potential of getting the disease by monitoring your drinking habits. This includes being mindful about what you are choosing to drink and avoiding binge drinking.

If you’re concerned your drinking habits may become patterns of abuse, we urge you to consider your alcohol abuse risk factors and to instill preventative measures to protect your health and wellness. If you suffer from alcohol addiction, we urge you to seek treatment to optimize your chances of a more healthy and sober life.

Help Your Body Achieve Better Health

If you or a family member has suffered from gout or any other health concerns from drug use and/or alcohol abuse, contact us at Dealing with the symptoms of gout is no easy matter, and we are here to help give you more information on the treatment options that are best for you.

National Institute of Arthritis and Musculoskeletal and Skin Diseases - What Is Gout?

Harvard Health Publication - Alcohol increases the risk of gout

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