How Does Having Gout Affect My Bones and Joint Health?

joint damage from gout hand in a green cast

Gout is a painful form of inflammatory arthritis that is caused by excess uric acid in the bloodstream.1 If you have gout, your doctor may have recommended that you reduce your uric acid level. Reducing your uric acid level is important because it can help decrease your risk of gout flares and the potential for bone and joint damage from gout.1,2

 

What is the connection between uric acid and gout flares?

Uric acid is made by your body when it breaks down chemicals in certain foods.1,3 In people with gout, excess uric acid in the bloodstream can form urate crystals around the joints.1 These sharp, needlelike crystals can cause sudden episodes of intense pain, redness, swelling and/or tenderness known as gout “attacks” or “flares.”1,4 

Gout flares tend to come on suddenly, often in the middle of the night.4 The most intense pain can last anywhere from four to 12 hours.4 Once the worst pain is over, some discomfort may linger for a few days or even as long as a few weeks.4

 

What can trigger a gout flare?

Eating foods such as steak, organ meats (such as liver) and certain kinds of seafood can trigger a gout flare.1 Other potential dietary culprits are alcoholic beverages and sugary drinks.1

Gout flares can also be brought on by the use of medications such as:

  • Diuretics5
  • Low-dose aspirin5
  • Anti-rejection medicines (given after organ transplant)5
  • Urate-lowering therapy (ULT)6

It is important to note that, if you have been prescribed any of these medications, do not stop taking them without first talking with your doctor.

 

How can I tell if my gout is getting worse?

Adults who have had gout for many years typically have more frequent flares that last longer and affect multiple joints.2 They may also develop bumps under the skin called tophi.2

Tophi are hard, whitish urate crystal deposits that can appear under the skin around the joints affected by gout.2 Tophi can show up in the fingers, hands, feet, elbows or Achilles tendons.4 They can even form in the curve of the upper ear.2 Although tophi generally are not painful, they can become tender and swollen during a gout flare.4

 

How can I get bone and joint damage from gout?

Research has shown that, left untreated, tophi can contribute to bone erosion and joint damage.2,7 But the good news is that tophi are not necessarily permanent.2 If the uric acid level is reduced and remains normal for an extended period of time, it is possible for tophi to dissolve and eventually disappear.2

 

How can I help prevent bone and joint damage from gout?

If you have gout and are concerned about the long-term effects of the disease, talk with your doctor. He or she may be able to prescribe medicine and/or recommend lifestyle changes that can help manage your uric acid level. If you are already taking ULT, be sure to ask your doctor about medicine to prevent gout flares.

 

NOTE: This article was not written by a medical professional and is not intended to substitute for the guidance of a physician. These are not Hikma’s recommendations for gout flare prevention, but rather facts and data collected from various reliable medical sources. For a full list of resources and their attributing links, see below.

References

  1. Hainer BL, Matheson E, Wilkes RT. Diagnosis, Treatment, and Prevention of Gout. Am Fam Physician. 2014;90(12):831–836.
  2. Treatment of Gout. Johns Hopkins Arthritis Center website. Available at: https://www.hopkinsarthritis.org/arthritis-info/gout/gout-treatment/. Accessed June 1, 2018.
  3. Healthy Lifestyle/Nutrition and healthy eating/Gout diet: What’s allowed, what’s not. Mayo Clinic website. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/gout-diet/art-20048524. Accessed June 1, 2018.
  4. Diseases and Conditions/Gout/Symptoms & causes. Mayo Clinic website. Available at: https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897. Accessed May 23, 2018.
  5. NIH Medline Plus website. What Causes Gout? Available at: https://medlineplus.gov/magazine/issues/winter12/articles/winter12pg20.html. Accessed June 1, 2018.
  6. Khanna D, Khanna PP, Fitzgerald JD, et al. 2012 American College of Rheumatology Guidelines for Management of Gout. Part 2: Therapy and Antiinflammatory Prophylaxis of Acute Gouty Arthritis. Arthritis Care Res (Hoboken). 2012;64:1447–1451 and 1456–1459.
  7. McQueen FM et al. Bone erosions in patients with chronic gouty arthropathy are associated with tophi but not bone oedema or synovitis: new insights from a 3 T MRI study. Rheumatology. 2014. 53(1):95–103.

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.
  • Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.
  • Blood dyscrasias such as myelosuppression, leukopenia, granulocytopenia, thrombocytopenia, and aplastic anemia have been reported with colchicine used in therapeutic doses.
  • Monitor for toxicity and if present consider temporary interruption or discontinuation of colchicine.
  • Drug interaction with dual P-gp and CYP3A4 inhibitors: Co-administration of colchicine with dual P-gp and CYP3A4 inhibitors has resulted in life-threatening interactions and death.
  • Neuromuscular toxicity and rhabdomyolysis may occur with chronic treatment with colchicine in therapeutic doses, especially in combination with other drugs known to cause this effect. Patients with impaired renal function and elderly patients (including those with normal renal and hepatic function) are at increased risk. Consider temporary interruption or discontinuation of Mitigare®.
  • The most commonly reported adverse reactions with colchicine are gastrointestinal symptoms, including diarrhea, nausea, vomiting, and abdominal pain.

Indication

Mitigare® is indicated for prophylaxis of gout flares in adults. The safety and effectiveness of Mitigare for acute treatment of gout flares during prophylaxis has not been studied.

Mitigare® is not an analgesic medication and should not be used to treat pain from other causes.

For Full Prescribing Information please CLICK HERE and for Medication Guide CLICK HERE.

You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Manufactured by: West-Ward Columbus Inc., Columbus, OH 43228

Important Safety Information for Mitigare® (colchicine) 0.6 mg capsules

  • Colchicine 0.6 mg capsules are contraindicated in patients with renal or hepatic impairment who are currently prescribed drugs that inhibit both P-gp and CYP3A4. Combining these dual inhibitors with colchicine in patients with renal or hepatic impairment has resulted in life-threatening or fatal colchicine toxicity. Patients with both renal and hepatic impairment should not be given Mitigare®.
  • Fatal overdoses have been reported with colchicine in adults and children. Keep Mitigare® out of the reach of children.