MONDAY, June 3, 2019 (HealthDay News) — Older age raises the odds of many ills, but for adults with gout, it’s the younger ones who have the highest risk for developing a serious blood clot, new research indicates.
Gout patients of any age have a 25% greater risk of developing a blood clot deep in the veins in the first 10 years after diagnosis, the British study found.
But “the risk was 79% higher in gout patients, compared to those without gout, in the under-50 age group,” explained study lead author Alyshah Abdul Sultan.
Gout is the most common form of inflammatory arthritis, affecting more than 4% of U.S. adults, according to the Arthritis Foundation. It develops in people who have high levels of uric acid in the blood. The acid can cause painful crystals to form in the joints.
In this study, researchers compared roughly 62,000 gout patients with an equal number of gout-free adults. The investigators found that the raised blood clot risk was largely confined to gout patients under the age of 50.
“We did not observe much higher risk in the older population,” added Sultan, a fellow at Keele University’s arthritis research center in Staffordshire, England. But, he noted, because blood clot risk increases with age regardless of gout status, “it may have obscured the effect of gout in the older population.”
Blood clot risk rose, said Sultan, whether or not younger patients had their gout under control by means of standard uric-acid lowering medications, such as allopurinol (Zyloprim). Such drugs can dramatically lower the incidence of painful gout attacks, by tamping down the abnormally high uric acid concentrations.
Still, Sultan and other experts stressed that the bottom-line risk for developing a blood clot remains low for someone with gout. This suggests that proactive treatment to reduce clot risk might not be necessary.
According to Dr. Gregg Fonarow, “The overall risk was modest in absolute terms.” Fonarow is co-director of the preventative cardiology program at the University of California, Los Angeles.
“As the absolute increased risk is small, the presence of gout alone would not warrant use of anticoagulation [blood-thinning] therapy,” Fonarow said.
Sultan said the study findings were “not very surprising, as we already know that chronic inflammation increases the risk of blood clots through various mechanisms. Previous research has already highlighted rheumatological conditions, such as rheumatoid arthritis and lupus, as important risk factors for blood clots,” he noted.
Still, while blood clot risk may not be sufficient to warrant preventive intervention on its own, he said there may be need for clinical vigilance, particularly in younger adults with newly diagnosed gout.
For the study, the researchers reviewed primary care information collected by the England-based Clinical Practice Research Datalink.
The investigators first identified patients diagnosed with gout between 1998 and 2017, and matched them with roughly the same number of gout-free adults.
The team concluded that clot risk rose significantly among gout patients under 50 in the decade following diagnosis. Also, risk appeared to rise equally among males and females, and whether or not they took allopurinol.
“However, the results of our analysis of urate-lowering therapy may be generalizable only to those prescribed 300 milligrams of allopurinol or less, a dose level widely used in U.K. primary care,” Sultan noted.
Research is needed to determine the impact, if any, of higher doses, he added.
As to why gout might lead to a higher clot risk, Sultan said the risk association may be due to various inflammatory pathways. Although this process isn’t fully understood, he noted that uric acid “can initiate, amplify and sustain inflammatory response.”
However, Fonarow said many factors can drive up clot risk. These include a history of smoking, obesity and use of estrogen. People who are immobile or undergoing surgery are also at elevated risk of venous blood clots.
The report was published in the June 3 issue of CMAJ (Canadian Medical Association Journal).
For more about blood clot risk, visit the American Society of Hematology.
SOURCES: Alyshah Abdul Sultan, research fellow, epidemiology and applied statistics, Arthritis Research U.K. Primary Care Centre Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, U.K.; Gregg Fonarow, M.D., director, Ahmanson-UCLA Cardiomyopathy Center, and co-director, preventative cardiology program, University of California, Los Angeles; June 3, 2019, CMAJ (Canadian Medical Association Journal)Copyright ©2017 HealthDay. All rights reserved.
What is gout?
Gout is a health problem that causes inflamed, painful joints. The symptoms are caused by deposits of urate crystals at the joints. Gout used to be associated with kings who overindulged in rich food and wine. In truth, anyone can get gout. Gout affects more men than women. It is often linked with obesity, high blood pressure, high levels of lipids in the blood (hyperlipidemia), and diabetes.
What causes gout?
Gout is caused by monosodium urate crystal deposits in the joints. This is due to an excess of uric acid in the body. Too much uric acid may be caused by several things. It may be caused by the body making too much uric acid. Or the kidneys may not get rid of enough uric acid. It may also be caused by eating a lot of foods that are high in purines. Purines turn into uric acid in the body.
Foods high in purines include:
- Alcoholic drinks and sugary drinks high in fructose
- Certain meats, such as game meats, kidney, brains, and liver
- Dried beans and dried peas
- Seafood, such as anchovies, herring, scallops, sardines, and mackerel
Gout attacks may be triggered by any of the following:
- Drinking alcohol
- Eating a lot of protein-rich foods
- Emotional stress
- Minor surgery
Who is at risk for gout?
You are at higher risk for gout if you:
- Are a man
- Are a postmenopausal woman
- Have kidney disease
- Have high blood pressure, high cholesterol, or diabetes
- Have family members with gout
What are the symptoms of gout?
Gout causes sudden, recurrent attacks of symptoms that often occur without warning. Severe, chronic gout may lead to deformity. Symptoms can occur a bit differently in each person. Common symptoms include:
- General feeling of illness
- Hard lumps of urate crystal deposits under the skin (tophi)
- Severe, sudden pain in one or more joints, most often the joint in the big toe
- Skin that is red or purple, tight, and shiny over the joint
- Swollen joint(s)
- Warmth in the joint area
Some symptoms of gout can be like other health conditions. Make sure to see your healthcare provider for a diagnosis.
How is gout diagnosed?
The process starts with a medical history and a physical exam. A fluid sample may be taken from the joint and checked for urate crystals.
How is gout treated?
Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is. Treatment may include:
- Avoiding alcoholic drinks
- Colchicine, an oral or IV medicine to relieve pain and inflammation
- Corticosteroids to reduce inflammation
- Drinking more nonalcoholic fluids
- Eating less protein-rich foods
- Medicine to block production of uric acid in the body
- Medicine to lower the uric acid level in the blood
- Nonsteroidal anti-inflammatory medicines to relieve pain and inflammation
- Surgery to remove extremely large tophi
- Weight loss, if obesity is an issue
Talk with your healthcare provider about the risks, benefits, and possible side effects of all medicines.
What are the complications of gout?
People with gout have a higher risk for kidney stones, due to crystal deposits in the kidneys. They can also have kidney damage. Crystal deposits in the joints can cause some disability due to stiffness and pain.
Living with gout
You can reduce the risk of future flare-ups of gout and decrease their severity by taking medicine as prescribed. If you are given medicine to take when a flare-up occurs, it is best to start taking it at the first sign of symptoms. Or get medical attention at the first sign of symptoms. To help prevent episodes of gout:
- Talk with your healthcare provider before taking any new medicine, including over-the-counter medicines
- Drink plenty of water
- Don’t drink alcohol
- Exercise regularly
- Lose weight if needed
- Don’t eat foods that are high in purines
When should I call my health care provider?
If your symptoms get worse or you have new symptoms, let your healthcare provider know.
Key points about gout
- Gout causes inflamed, painful joints due to urate crystal deposits at the joints.
- Gout can also cause urate crystal deposits that cause lumps under the skin.
- Gout can be triggered by eating foods high in purines and drinking alcohol.
- Treatment of gout is aimed at reducing pain and the risk of future flare-ups.
- Gout can be managed with medicines and lifestyle changes.
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