Aspirin use in gout patients can be challenging. Indeed, aspirin embodies the yin and yang of medical practice. At low-doses, it can be cardioprotective but it also blocks urate excretion by the kidneys. At higher doses, it is more likely to cause GI problems but it is uricosuric.<\/p>\n
While these factoids may fascinate physiologists and philosophers, do they have clinical implications in the real world?<\/p>\n
Well, yes and no. A recent study in the Annals of Rheumatic Diseases<\/i> looked at 724 gout patients over a one-year time period. Those taking aspirin for cardioprotection had twice the rate of gout attacks as those who did not take aspirin. And low-dose aspirin (81 mg) was associated with a higher rate of gout attacks than a dose of 325 mg daily. This is the yes<\/i> part. However, gout patients on aspirin and allopurinol did not experience more frequent attacks than aspirin-free gout patients. This is the no<\/i> part.<\/p>\n
The take-home lesson here seems clear. When you initiate cardioprotective aspirin dosing in a patient with an established diagnosis of gout, keep a close eye on their uric acid level. If it goes up, consider adding or increasing their dose of allopurinol. If your gout patient who is already on low-dose aspirin is experiencing attacks, check their med profile to make sure allopurinol is on the list and that they are getting it refilled regularly.<\/p>\n
In gout, prevention is particularly precious, not just to avoid the problematic pain of a gout flare, but because colchicine has become so costly, even in generic form.<\/p>\n
Richard Fleming, MD<\/p>\n","protected":false},"excerpt":{"rendered":"
Aspirin use in gout patients can be challenging. Indeed, aspirin embodies the yin and yang of medical practice. At low-doses, it can be cardioprotective but it also blocks urate excretion by the kidneys. At higher doses, it is more likely to cause GI problems but it is uricosuric. Continue reading