Is Fatal Gout Killing You?

Gout sufferers often say “My gout is killing me!” Meaning that the pain of a gout flare is so severe that death seems the easier option. That might be an exaggeration. But, fatal risks of gout cannot be exaggerated. Because the answer to, "Can Gout Kill You?" is “Yes”!

Fatal Gout

In recent years, advances in imaging technology have allowed scientists to understand gout better. We can now see the uric acid crystals in our bodies long before we can feel them. Ultrasound and DECT show great promise for helping us assess the true damage caused by uric acid crystals. I’ve warned against allowing uric acid crystals to spread into the heart, kidneys, and other organs. We’ve known about uric acid kidney stones for a long time. But what of other organs?

There have been several cases of tophi being found in and around the heart. Commentators at the time have remarked that the incidence of heart attacks caused by uric acid crystals is probably higher than is generally thought. Now, a new report confirms this. Then, it calls for a change in pathology routines so that death from gout is recorded more accurately.

Fatal Gout Report

The report investigating fatalities due to gout is:

Title:: Prevalence of birefringent crystals in cardiac and prostatic tissues, an observational study.
Authors:: Park JJ, Roudier MP, Soman D, Mokadam NA, Simkin PA.
Published:: BMJ Open. 2014 Jul 16;4(7):e005308. doi: 10.1136/bmjopen-2014-005308.

This is a study of uric acid crystals in body tissues outside the joints. It explains how uric acid spreads throughout all body fluids, except cerebrospinal fluid (CSF or brain/spine fluid) and sweat. It notes that tophi in various organs have been perceived as “medical oddities.” However, recent advances in imaging techniques have revealed that uric acid crystal deposits outside joints are far more common than was once thought.

The study investigates heart and prostate. It reveals that over 10% of hearts, and almost 50% of prostates, contain uric acid crystals. These are surprisingly high figures for something that is rarely mentioned in medical journals. The reasons are clear – in normal circumstances, nobody looks for uric acid crystals in vital organs. Death might be attributed to heart disease, but postmortems rarely consider why heart disease occurred. And, if uric acid crystals are to blame, normal pathological routines won’t find them, unless tissue samples are fixed before analysis:

We are concerned that crystal-driven inflammation may cause plaque rupture and coronary thrombosis in some patients with gout, but confirmation of that hypothesis requires intracellular crystals at the site of a fatal lesion. To make that observation, the pathologist must fix the tissue in alcohol (since formalin may extract tissue urate deposits) and then must examine the sections under polarised light.

Neither alcohol fixation nor polarised microscopy is a standard procedure, but we hope that pathologists will use them as they evaluate the all too frequent lethal myocardial infarctions in gouty individuals.

Avoiding Fatal Gout

There’s only one way to avoid fatal gout – control uric acid to safe levels. Keep uric acid below 5 mg/dL, and avoid the risks of fatal gout.

Fatal Gout: Next Steps

If you come to GoutPal.com to learn about gout and uric acid, you’ve learned today that gout is very dangerous. You’ve learned that gout patients need to take gout seriously. So you should get an effective plan to lower uric acid to safe levels as soon as possible.

To get an effective plan, you must ask your doctor for help now. Agree on a safe target uric acid level, and get the right treatment to lower your uric acid before it does more damage. Do you know what questions to ask your doctor about your gout? Do you understand your doctor’s advice? If not, please ask in the gout forum now. Or use the feedback form below.

For more information about organs affected by gout, please see the Tophi Guidelines.

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Common Terms: Gout Is Deadly Set, kill