Diuretics Cause Gout

This is a review of a study which indicates that diuretics cause gout. It is one of a growing number of gout studies that provide evidence for causes of gouty arthritis.

I have extracted the main ideas from the published gout investigation to present these in a more readable format suitable for unqualified gout sufferers. Inevitably, such scientific reporting will still include technical references. I will refer to my gout glossary for further explanation. If you encounter a term you do not understand, you should search for it using the search box above. If that does not provide an adequate explanation, then please ask in the gout forums, preferably by clicking the “Please tell me” button at the top or bottom of this page.

Diuretics Cause Gout Report Abstract

This is a layman’s summary of:

Title
Recent diuretic use and the risk of recurrent gout attacks: the online case-crossover gout study.
Authors
Hunter DJ, York M, Chaisson CE, Woods R, Niu J, Zhang Y.
Published
J Rheumatol. 2006 Jul;33(7):1341-5. Epub 2006 Jun 1.

Objective

To assess several supposed risk factors, including thiazide and loop diuretics use, thought to trigger recurring gout attacks.

Methods

We conducted an internet-based case-crossover study involving subjects who had a gout attack within the past year. Patients were recruited online and asked to provide access to medical records. Data were obtained on specific diuretic use on each day over the 2-day period prior to a gout flare (hazard period) and on each day of 2 days between gout attacks (control period). We examined the relation of all diuretic use and use of specific diuretics, i.e., thiazide and loop, to the risk of recurrent gout attacks using a conditional logistic regression model adjusting for alcohol consumption and purine intake.

Results

One hundred ninety-seven subjects completed both control and hazard period questionnaires. Participants were predominantly male (80%) and over half had a college education. The average time between onset of gout attack and logging on to the website was 2 days. Adjusting for alcohol consumption and purine intake, the odds ratio (OR) for recurrent gout attacks from all diuretic use over the last 48 h was 3.6 (95% confidence interval 1.4–9.7). OR of recurrent gout attacks were 3.2 and 3.8 for use of thiazide and loop, respectively.

Conclusion

Recent use of diuretics is associated with a significantly increased risk for recurring gouty arthritis. The increased risk of gout attacks from either thiazide or possibly loop diuretic therapies represents an important modifiable risk factor in patients with gout.

Diuretics Cause Gout Report

Background

The report starts with background explanation of increasing incidence of gout, affecting around 1% of Americans[1 - 2]. It notes that gout often recurs, with progressive disability and joint damage[3 - 5]. Many previous studies have investigated risks of the onset of gout [3],[6 - 10], but this one focuses on recurring attacks. In particular, it raises the known issues concerning medicines typically supplied for high blood pressure, especially thiazides and loop diuretics[11 - 22].

Study Design

The gout research team recruited qualifying gout patients[23] via the Internet. Subjects completed questionnaires for one year during gout attacks and gout-free (intercritical) periods. I.e. each case crosses over from one condition to another, eliminating variables introduced by having separate groups of subjects.

In addition to several gout questions, the questionnaires asked about use of other medications:

Did you take any of the following diuretics (‘water pills’) yesterday or the day before yesterday?

For high blood pressure
Hydrochlorothiazide or thiazide. Brand names including:
  • Dyazide
  • Esidrix
  • Hydrodiuril
For heart failure
furosemide (“loop” diuretics). Brand names including:
  • Lasix
Other
amiloride, spironolactone, or triamterene. Brand names including:
  • Midamor
  • Aldactone
  • Dyrenium

Other factors, such as purine and alcohol intake, were included. This may cloud the issue, but as this is a statistical study, their inclusion is valid[24 - 25].

Results

Diuretics Cause Gout Chart

Click for Diuretics Cause Gout Chart data


The results show a big rise in the number of gout attacks when gout patients were taking diuretics compared to periods when they did not take them. The report includes odds ratio data, but my view is that such a detailed statistical view is not necessary here. We can see clearly that these diuretics can cause gout, therefore, it makes sense to ask your doctor for an alternative treatment.

Discussion

The report ends with a discussion of the points raised by the investigation. Most of these are of interest to the scientific community, but not valuable to the gout sufferer[26 - 28]. The significant point is that the problem of diuretics for gout sufferers is easily overcome because there are widely available alternatives.

The gout report concludes:

In summary, we found that recent use of thiazide and possibly loop diuretics was associated with a significantly increased risk for recurrent gouty arthritis. Despite the well known association of gout and diuretics, a relatively large proportion of our patient population with preexisting gout was prescribed this class of antihypertensive therapy. Given the wide availability of alternative effective agents for the treatment of hypertension and congestive heart failure, clinicians have ample ability to individualize management for this population, and could reduce risk of recurrent gout attacks by avoiding the use of thiazide and possibly loop diuretics in persons with preexisting gout.

Diuretics Cause Gout: Next Steps

As you can see, diuretics are bad for gout. In extreme cases, they may be the sole cause of your gout, and changing your medication may be the only thing you need to do.

Do not stop taking them without consulting your doctor. There are many alternatives to diuretics for treating high blood pressure and heart disease. It is important to get your uric acid tested and ensure that you get it down to 5mg/dL (0.30 mmol/L) or below. If switching diuretics to something else does not lower your uric acid low enough, then you should arrange for uric acid lowering treatment. Details are in the Gout Treatment pages, and if you need personal help to understand your options, please ask in the gout forum.

Leave Diuretics Cause Gout to browse more evidence for causes of gouty arthritis


Diuretics Cause Gout References

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[Total purine content in selected foods.] Wolfram G, Colling M. Z Ernahrungswiss 1987;26:205-13.
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