Ask the Doctors April 2007 Issue

Ask The Doctors: 04/07

Iíve been diagnosed with gout, and am told that the elevated level of uric acid that brought it about may also increase my risk of heart attack. Is this true?

For many years both gout and elevated levels of uric acid have been suspected as risk factors for heart attacks, but this had not been confirmed until fairly recently.

A large-scale study examined the impact of blood uric acid and gout on heart attacks in approximately 13,000 men. On its own, each risk factor was associated with only a small increase of the likelihood of a heart attack óblood uric acid raised heart attack risk by 11 percent and gout by 26 percent, but together they can increase your risk of heart attack.

Inflammation is an important contributor to atherosclerotic plaques that lead to heart attacks, and it appears that chronic joint inflammation in people with gout accelerates the development of atherosclerosis.

Although decreasing your levels of uric acid has not been proven to reduce the risk of heart attack, it will help avoid attacks of gout. Uric acid levels can be reduced by not overindulging in meats and seafood, which contain purines, substances known to raise uric acid levels, and by limiting alcohol intake.

I have osteoarthritis in several joints. Two weeks ago, I went through a period of several days in which my pain inexplicably went away. I hadnít changed my medication, diet, or daily routineóthe pain just vanished. Then it returned with a vengeance. Can remissions occur with OA?

Not usually. Some people get worse with increased activity, some get better with rest. Some patients get worse with weather changes, others fare better in warm, dry weather.

Osteoarthritis is usually not a disease that will go completely away. Wish we could determine why pain and stiffness suddenly subsides and bottle it to prescribe to others.

How do you evaluate a joint with rheumatoid arthritis or osteoarthritis to determine if joint damage is getting worse?

X-rays remain the best method for evaluating the condition of your bones and joints. Magnetic resonance imaging (MRI) is helpful in detecting damage, disease, or inflammation of soft tissues, such as ligaments and muscles, but usually is not helpful in evaluating advanced arthritic conditions. MRI is believed to be better at early diagnosis of rheumatoid arthritis, but this is still in question. MRI also is quite expensive and, in general, does not provide as much information for following the progression of arthritis than does conventional X-ray.

As a patient with osteoporosis, Iím aware that excessive amounts of vitamin A, especially in the form of retinol, can contribute to bone thinning. However, Iím unable to find multivitamins with low vitamin A and little or no retinol. Can you advise?

Several epidemiological studies have suggested that the long-term intake of more than 5,000 IU/day of preformed vitamin A (retinol) is associated with decreased bone-mineral density and increased risk of osteoporosis and fractures in older men and women. Only high intakes of retinolónot beta-caroteneówere associated with adverse effects on bone health. Although 5,000 IU is considerably higher than the recommended dietary allowance for vitamin A (3,000 IU for men, 2,333 IU for women), it is not uncommon for multivitamin supplements to contain 5,000 IU of retinol. Look for multivitamin supplements that contain no more than 2,500 IU of vitamin A or multivitamin supplements that contain 5,000 IU of vitamin A, of which at least 50 percent is derived from beta-carotene. Do not take high-potency vitamin A supplements.