Taking a diuretic or ‘water pill’ for heart failure or to lower blood pressure seems to more than triple the risk of suffering recurrent bouts of gout, according to a new report.

Gout is caused by deposition of urate crystals in joints, often the big toe joint. A link between diuretic use and excessive uric acid in the blood was established more than four decades ago, Dr. David J. Hunter, from Boston University School of Medicine, and colleagues note in The Journal of Rheumatology.

However, until now, no studies have specifically investigated whether taking diuretics actually raises the risk of recurrent gout attacks.

The present study involved 197 patients, recruited over the Internet, who had a gout attack in the past year and agreed to allow access to their medical records.

Eighty percent of subjects were male and most had a college education. The researchers focused on diuretic use in the two days preceding a gout attack.

Overall, recent diuretic use appeared to increase the probability of recurrent gout attacks by 3.6-fold, the report indicates.

The team suggests that the answer is to avoid prescribing diuretics to people prone to gout. “Given the wide availability of alternative effective agents for the treatment of hypertension and congestive heart failure,” they say, “clinicians have ample ability to individualize management for this population.”

SOURCE: Journal of Rheumatology, July 2006.