- Diseases, Disorders & Conditions
Why Aspirin and Gout Isn't a Good Combination
Aspirin and Gout
Ever popular aspirin is a non-steroidal anti-inflammatory drug (NSAID) and analgesic. It's available over-the-counter in doses that are considered safe to use without a prescription as long as you follow the included safety instructions. It's sold under brand names like Anacin and Acuprin as well as "Aspirin."
Gout is one of the most painful, if not THE most painful, forms of arthritis. It's caused when needle-like microscopic uric acid crystals form in the joints as a result of having high uric acid levels in the blood. The symptoms of a gout attack -- inflammation, redness, swelling, tightness, hot to touch, and great pain -- are caused by the body's natural inflammatory response to these crystal invaders.
Unlike other anti-inflammatory medications out there, aspirin should not be taken to relieve the inflammation and pain of a gout attack. Here you'll discover why...
The Kidneys and Uric Acid
In order to understand why aspirin shouldn't be taken for gout, it's important to have a basic understanding of your kidneys' role in processing and excreting uric acid.
Uric acid is produced in the blood as a result of the body's natural metabolic process. The kidneys process the uric acid and flush it out of the body via urine. Not all of it is excreted however; some is reabsorbed by the kidneys and recirculated in the blood stream.
Normally, the kidneys work to excrete enough excess from the body to leave a healthy amount of uric acid in the blood. This is important since uric acid is a very powerful antioxidant; in fact it accounts for over 50% of the antioxidant capacity of blood.
The problem occurs when there is just too much uric acid being produced for the kidneys to process properly, or, the kidneys are unable, for some reason, to handle even normal levels of acid production. When this happens too-high amounts of uric acid circulate in the bloodstream leading to gout as well as other conditions such as diabetes and kidney stones.
Effect of High Doses of Aspirin on Gout
Studies have shown that high doses of aspirin (the adult dose you would normally have to take to combat gout pain and inflammation -- up to a max. 3 grams per day in divided doses) can actually lower blood uric acid levels. This happens because high-dose aspirin hinders uric acid reabsorption by the kidneys, thus allowing more to be excreted, and less to be retained in the blood.
On the face of it then, taking high-dose aspirin to reduce gout pain and inflammation during an attack would seem to be a very good thing to do: you're not only addressing the pain and inflammation of an attack, you're also reducing your uric acid to help it even more.
Unfortunately, life isn't as simple as that; at least not in this case. It isn't known why exactly, but rapid variations in uric acid levels at the onset of, or during, an attack have been shown to make the attack much worse and even prolong it. It doesn't matter whether uric acid increases or decreases, the variation alone is enough.
So, taking high doses of aspirin for a gout attack should be avoided.
Effect of Low-Dose Aspirin on Gout
If taking high dose aspirin for gout is to be avoided, what about lower doses? Would taking low-dose aspirin (75 mg to 325 mg per day) be any different? Again, unfortunately not...
The kidneys react differently to high and low-dose aspirin: high-dose aspirin lowers uric acid levels in the blood (for the reason described above). But low-dose aspirin actually increases uric acid by impeding the kidneys' ability to excrete uric acid efficiently, thereby retaining more in the blood.
So, low-dose aspirin, if taken during an attack, will also vary uric acid levels (albeit in the opposite direction), thus making the attack worse.
Therefore taking low dose-aspirin should also be avoided during an attack of gout.
Low-Dose Aspirin for Medical Reasons
Patients who have had a heart attack or stroke, or have a heart disease, are increasingly being advised to take low-dose aspirin to inhibit platelet aggregation; in laymen terms, to stop blood clotting in the arteries.
Given that low-dose aspirin increases uric acid, how are these people affected in terms of their risk for getting gout and it's treatment should they get it?
A study published in 2014 answered that question; it concluded that patients on a low-dose aspirin regimen were at an increased risk of recurring gout attacks.
However, the authors were at pains to point out that, rather than stop the medical use of aspirin, doctors should monitor their patients' uric acid levels regularly and utilize uric-acid-lowering medication -- such as allopurinol, probenecid and febuxostat -- to reduce and manage their uric acid levels.
Aspirin and Gout - Conclusion
You've seen that, although aspirin is a very popular, cheap, and effective anti-inflammatory and pain-killer, it is largely unsuitable for the treatment of gout attacks, especially since there are other effective NSAIDs like ibuprofen, indomethacin, and naproxen, that won't affect your uric acid levels in the same way.
There are also natural ways to get rid of your gout you can read about here.
If you have to take low-dose aspirin for medical reasons, although your risk of gout is higher, you still need to keep taking your aspirin. Your doctor can prescribe uric-acid-lowering medication to help manage the risk. In addition, in the event that you suffer a gout attack, they can prescribe the appropriate anti-inflammatory for your particular case.
Note: If you take daily aspirin for a medical condition, you should talk to your doctor before trying any natural gout remedies since they may interfere with the effectiveness of the aspirin.
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