What Causes Gout Flares? The Answer May Surprise You

By: | | Topics : About Gout, Gout Flare Prevention, Lifestyle Tips for Gout,

If you have been diagnosed with gout, your doctor has probably told you that it’s caused by excess uric acid in the bloodstream.1 But what triggers the sudden episodes of intense pain, swelling and redness known as gout flares? You may have heard that gout flares (also known as gout attacks) can be caused by eating red meat or drinking beer.1 This is true, but other lifestyle factors you may not suspect can cause gout flares as well. What else causes gout flares? The answer may surprise you. Read on to find out.

Stress

If you suffer with gout, make a point to avoid stress (or at least reduce its impact on your life).2 Research shows that emotional stress can raise the uric acid level in the bloodstream, potentially triggering a gout flare.2 If it’s too late for prevention and you find yourself in the midst of a gout attack, do your best to relax.3 Stress can aggravate gout.3 Try distracting yourself by watching television, calling a friend or listening to music.3

Medications

Medications may help you stay healthy, but some of them might also contribute to your risk of gout flares.4,5 Take urate-lowering therapy (ULT), for instance (many people with gout take a ULT called allopurinol).4 ULT is an important part of gout management because it can help to reduce the amount of uric acid the body makes.6 However, ULT can also cause gout flares—especially when a person first begins taking it.4 That’s why the American College of Rheumatology recommends that people with gout take colchicine (Mitigare® [Colchicine] 0.6mg Capsules or Generic Colchicine 0.6mg Capsules, for example) or a non-steroidal anti-inflammatory drug for the first six months of ULT.7 Other medications associated with an increased risk of gout flares include5:

  • water pills (diuretics)
  • aspirin
  • nicotinic acid
  • certain kinds of chemotherapy
  • certain treatments for low white blood cell count (neutropenia)
  • certain treatments for tuberculosis
  • certain medicines given to prevent the body’s immune system from rejecting a transplanted organ
  • certain treatments for psoriasis
  • certain treatments for HIV
  • certain treatments for Parkinson’s disease
  • certain treatments for hepatitis
  • certain treatments for erectile dysfunction
  • certain antiplatelet medications
  • testosterone replacement therapy
  • teriparatride
  • topiramate

If you suspect that your gout flares might be triggered by one of your medications, contact your doctor.

Dehydration

Dehydration can increase the risk of gout flares because it can raise the uric acid level in the bloodstream.2 If you suffer with gout, do your best to drink at least eight to 16 cups (1 cup = 8 ounces or about 250 mL) of fluids a day (at least half of these should be water).3 Be sure to drink even more when you exercise, especially if you’re sweating.2 (It’s probably a good idea to skip the post-workout sauna as well.2)

Crash dieting

The risk of gout is typically higher in people who are obese because their bodies tend to produce more uric acid than people who are not obese.8 If you want to lose weight, talk with your doctor first.8 Weight loss under a doctor’s supervision may help you to reduce your risk of flares.8 Crash dieting, on the other hand, can increase the amount of uric acid in your bloodstream and set you up for a gout attack.8

Surgery or trauma

According to experts at the Mayo Clinic, people who suffer with gout may be more likely to experience a gout attack after an injury or surgery.1 Receiving vaccinations can also cause flares for some people with gout.1

Sweets

When most people think of foods and beverages with the potential to trigger a gout flare, steak and beer come to mind.9 But it isn’t just alcohol and meat that bring on gout attacks—sweets can cause them as well.9 Sugar can increase the risk of gout flares because it contains fructose, and fructose generates uric acid when the body breaks it down.9 If you suffer with gout attacks, consume sugary foods and drinks in moderation.9

How to manage your gout flares

Gout is a serious medical condition that requires ongoing treatment and lifestyle changes.10 Left untreated, gout can eventually lead to the same level of physical disability and diminished quality of life as is experienced by people with advanced rheumatoid arthritis.10 If you are having frequent gout flares, make an appointment to see your doctor and ask to have your uric acid level checked.10 If you aren’t already taking ULT, your doctor may prescribe it.10 Your doctor may also recommend Colchicine therapy with a product such as Mitigare® or Generic Colchicine 0.6 mg Capsules to help prevent gout flares.10,11

 

Mitigare® is a registered trademark of Hikma Pharmaceuticals USA Inc.

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.

Please see the full Prescribing Information and Medication Guide for Mitigare® for complete product details.

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.

HK-2069v1

References

  1. Gout/Symptoms & causes. Mayo Clinic website. Available at: https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897. Accessed March 1, 2023.
  2. Kakutani-Hatayama M, Kadoya M, et al. Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. Am J Lifestyle Med. 2015;11(4):321-329.
  3. Managing a Gout Flare. Arthritis Foundation website. Available at: https://www.arthritis.org/diseases/more-about/managing-a-gout-attack. Accessed March 1, 2023.
  4. Aung T, Myung G, FitzGerald JD. Treatment approaches and adherence to urate-lowering therapy for patients with gout. Patient Prefer Adherence. 2017;11:795-800. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5403120/pdf/ppa-11-795.pdf
  5. Salem B, Slim R, Fathallah N, Hmouda H. Drug-induced hyperuricaemia and gout. Rheumatology. 2017;56:679-688.
  6. Gout/Diagnosis & treatment. Mayo Clinic website. Available at: https://www.mayoclinic.org/diseases-conditions/gout/diagnosis-treatment/drc-20372903.html.
  7. FitzGerald JD, Dalbeth N, Mikuls T, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res. Available at: https://onlinelibrary.wiley.com/doi/epdf/10.1002/acr.241802020;72(6):744–760./.
  8. Gout. Mount Sinai website. Available at: https://www.mountsinai.org/health-library/report/gout/. Accessed March 1, 2023.
  9. The Sweet Pain of Gout. Gout Education Society website. Available at: https://gouteducation.org/the-sweet-pain-of-gout/. Accessed March 1, 2023
  10. What Is Gout? Gout Education Society website. Available at: https://gouteducation.org/what-is-gout/. Accessed March 1, 2023.
  11. Mitigare® (Colchicine) 0.6mg Capsules [prescribing information]. Columbus, OH: West-Ward Columbus, Inc.; 2019.

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

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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.