Vitamin D and Gout

Gout is a form of arthritis. Those who suffer from it can experience severe and sudden pain in a range of joints, although pain in the big toe is most common. Preventing gout is, by and large, down to nutrition. Vitamin D is becoming an increasingly interesting treatment method for gout, not in the least because it is so vital to overall bone health.

What Is Gout?

Gout is most common in men, although post-menopausal woman may also experience it. Classic symptoms include redness and inflammation in a joint and severe, sudden pain that generally happens at night. The joint at the big toe’s base is most commonly affected, but it can also appear in the knees, feet, hands, wrists, and ankles. Usually, within 12 to 24 hours of the flare-up, the pain is most intense.

Causes of Gout

Gout happens when small crystals form in the joints. This leads to swelling, tenderness and severe pain. The crystals are formed because of high levels of uric acid, which is one of the body’s waste products.

Uric acid forms when the body breaks down ‘purines’, which are natural substances found in most plants and animals although certain foods have a substantial amounts of this. The kidneys are responsible for filtering out as much uric acid as possible, but they sometimes cannot cope. As a result, microscopic crystals start to form around the joints. While it is not clear why they do this specifically in the joints, it is believed that the body temperature is slightly lower there, which can encourage growth. If the crystals managed to wedge into the space found between the joints, inflammation occurs.

Some people have high levels of uric acid and never develop gout, so it is not clear exactly why some people suffer from it, when others don’t. However, the table below does highlight some of the factors believed to play a role.

Some people have high levels of uric acid and never develop gout, so it is not clear exactly why some people suffer from it, when others don’t. However, the table below does highlight some of the factors believed to play a role.

Factor  Examples
Medical conditions ·         Diabetes

·         High blood pressure

·         High cholesterol levels

·         Kidney disease

·         Metabolic syndrome

·         Obesity

·         Osteoarthritis

·         Psoriasis

Medication ·         Water tablets (diuretics)

·         ACE inhibitors

·         Beta blockers

·         Aspirin

·         Niacin

·         Ciclosporin

·         Chemotherapy drugs

Diet ·         Red meat – pork, lamb, beef

·         Seafood – oily fish and shellfish

·         Offal – heart, kidneys, liver

Alcohol ·         Fortified wines

·         Beer

·         Spirits

Sugary drinks ·         High fructose drinks
Family history  

Gout and Vitamin D

There are a number of reasons to believe that gout and vitamin D are associated. These reasons include:

• Gout is seasonal and most common during periods of time when sun exposure is low. Highest incidents are in spring (32%), when levels of vitamin D are the lowest.
• Clinical trials have found a link between kidney and blood vessel functioning and vitamin D.
• Vitamin D is known to lower rheumatoid arthritis.
• Vitamin D is a known pain killer.
• Vitamin D is known to reduce inflammation.
• Elderly people, who have more gastric acid and less vitamin D, are more likely to develop gout.
• People who live at higher latitude have more chance of developing gout.
• People who consume soda pops have a higher chance of developing gout.
• Dark skinned people are more likely to develop gout.
• There is a complex, but documented relationship between gout, vitamin D and calcium.
• Gout is on the rise, while sun exposure is on the decline.

Signs and Symptoms of Gout

Gout is characterized by a number of symptoms, but the most common one is severe, sudden pain in the joints, most often the big toe. Other common symptoms include:

• The joint feeling tender and hot, even to the touch.
• The joint swelling up.
• The joint turning red and shiny.
• The skin peeling, flaking and itching when the swelling reduces.

The pain can be so severe that quality of life is reduced. This is because touching the area, even by something as light as a bed sheet, can be unbearable.

Gout can affect all joints, but it is most common towards the extremities. If untreated, it often becomes worse and flare-ups become more common. Most sufferers start to recognize a pattern of symptoms, particularly the following five things:

1. Flare-ups start most frequently at night.
2. It takes just a few hours for gout to develop.
3. The flare-up lasts between three and 10 days. The longer someone waits with treatment, the longer it lasts.
4. Attacks come back frequently.
5. If untreated, the frequency of flare-ups increases.

Unfortunately, it is not possible to predict the next flare-up.

 

Types of Gout

There are a number of different types of gout, as described in the table below.

Type Symptoms
Acute gout This is the classic gout, in which intense, severe pain suddenly comes up, usually in one joint. It often starts at night and peaks around 24 to 48 hours later. Without treatment, it generally lasts around a week. Joints are visibly affected.
Chronic tophaceous gout This is when gout attacks become recurrent and chronic. The uric acid crystals in sufferers are often deposited in the finger joints, over the tip of the elbow and in the ear. If untreated, the joint can start to erode and even be completely destroyed. It is often hard to distinguish between chronic tophaceous gout and rheumatoid arthritis, as they have similar symptoms. However, no crystals are deposited with rheumatoid arthritis, which means that a fluid test can generally determine the difference. If acute gout is left untreated, it will often develop into chronic tophaceous gout within ten years
Podagara This is a very common type of gout that occurs solely in the big toe. It is the most common form of gout, occurring in 60% of patients. The big toe will swell and become very painful, often to the point that any type of contact is unbearable.
Pseudogout This is a type of arthritis that often presents as gout, as it comes with a painful, sudden swelling in specific joints. A flare-up can last several weeks. Pseudogout is most common in the knee. It is technically called CPPD (calcium pyrophosphate deposition disease), which is a type of crystal. It is for this reason that many relate it to gout. Age is said to be the main risk factor.

Diagnosis of Gout

Usually, medical professionals will examine the symptoms to determine whether or not gout is present, although a number of tests can be performed to confirm it. Generally, your physician will ask you about your diet and alcohol consumption as well, as these are closely linked. A number of tests may be requested, including:

• A joint fluid test, in which the fluid will be checked for the formation of crystals, but also to rule out septic arthritis, a serious infection.
• A blood test, which is the serum uric acid test. This measures how much uric acid is present in the blood. Generally, this test will be performed around four weeks after the attack. This is because, during an attack of gout, the levels are actually at their lowest.
• X-ray, which is very rarely used but can determine whether the issue is not actually damage, wear and tear or chondrocalcinosis. It is more common for an x-ray to be requested after multiple attacks, as recurring gout can further damage the joints.
• Ultrasound scan, which offers a safe way to determine whether any crystals are present, particularly those that are deep in the tissue where a physical examination can’t find them.

Hope for Gout – Vitamin D

When your body is exposed to sunlight, it produces vitamin D. There are also a number of foods that contain it naturally, or that have been fortified with vitamin D. This vitamin is essential to help your body absorb calcium, maintaining the right balance between calcium and phosphorus. The link between gout and vitamin D is only just becoming apparent, but a significant study has now found that it helps in treating arthritis. It is also known that having sufficient levels of vitamin D helps to prevent the development of deposits of calcium in the body, including the heart and lungs.

Getting Help with Gout

Vitamin D deficiency is now believed to be closely related to gout. Exposing yourself directly to the sun, with no sun block, just 10 to 15 minutes per day, three to four times per week, is all you need to replenish your levels of vitamin D. If this is not possible, you may want to consider supplementation. The exact levels vary depending on your age. Those between the ages of 14 and 50 should take 5 micrograms daily, whereas those over the age of 70 need 15 micrograms.

The role of vitamin D in gout may not be obvious, but it is known to play at least a small role. Similarly, having too much vitamin A will increase your chances of developing the condition, as will taking a number of medications. Making sure you drink plenty of water every day is equally important to help lower the risk of developing gout and to lower the chances of flare-ups in the future.

Resources and References:

Study of Vitamin D and Uric Acid Lowering on Kidney and Blood Vessel Function – Vitamin D effect of reducing uric acid. (ClinicalTrials.gov)
Association between Vitamin D Insufficiency and Elevated Serum Uric Acid among Middle-Aged and Elderly Chinese Han Women – Vitamin D deficiency can lead to increased uric acid levels. (NIH.gov)