Two blood pressure drugs may cause sharp crystals to fuse in the joints – gout attack risk

Treatment with the two drugs could spell trouble for individuals at risk of arthritis, research suggests.


Arthritis describes a broad range of inflammatory diseases, some of which are more painful than others. In gout, a surplus of uric acid in the body coalesces into sharp crystals that build up and spur inflammation in the joints. Pain and swelling are common symptoms, but as attacks intensify the condition can become increasingly debilitating.

The Cleveland Clinic explains: “Gout is a type of arthritis that occurs when extra uric acid in the body forms crystals in the joints. The crystals cause pain and swelling.”

Some common risk factors for the conditions include being overweight, having diabetes or having high blood pressure.

Despite their favourable effects on blood pressure, certain drugs may also cause a build of sharp crystals in the joints.

According to the Mayo Clinic, this is why some diuretics “increase a person’s risk of developing gout”.

The health body adds: “This may happen because diuretics increase urination, which reduces the amount of fluid in your body”.

Hyperuricemia – a major contributor factor to gout attacks – is a common finding in people treated with the medication.

The body makes uric acid when breaking down purines – a compound found in different foods.

Though the exact mechanisms for hyperuricemia have yet to be elucidated in treatment with diuretics, some hypotheses have been made.

In 2006, a researcher writing in the Annal of Rheumatic Diseases theorized that diuretics may induce hyperuricemia by increasing the reabsorption of the waste product uric acid.

Once there is a surplus of uric acid in the body, the crystals build up in the joints, fluids and tissues within the body.

It should be noted, however, that not all individuals with high levels of uric acid will experience gout symptoms or require treatment.

“Many people with hyperuricemia never develop gout, and even when they do, they often have had high levels of uric acid in their blood for years without any symptoms,” explains Harvard Health.

The two diuretics carrying the greatest risk of gout are thiazide and loop diuretics due to the changes in serum urate, according to researchers writing in the journal of Arthritis and Rheumatology.

The scientists noted: “While hypertension is the main indication for diuretic use, it is also an independent risk factor for gout.”

This makes it difficult for studies to differentiate whether diuretic use is the cause of gout, or whether underlying hypertension is the cause.

For this research, studies of hypertensive patients that can control for changes in blood pressure due to treatment may be more suitable to quantify the link between diuretics and gout risk.

What are the symptoms of gout?

When symptoms of gout come on, they do so in a sudden manner and typically affect a single joint initially.

“Within hours, that joint becomes red, swollen, hot and painful,” explains Harvard health.

The joint at the base of the big toe is a common site for gout attacks, but the knees, and ankles are also often affected.

Patients with higher levels of uric acid in their blood may be coached to make lifestyle changes, but there are few treatments that can control uric acid levels in the blood.


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