Intended for healthcare professionals

Rapid response to:

Clinical Review

Diagnosis and management of gout

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7553.1315 (Published 01 June 2006) Cite this as: BMJ 2006;332:1315

Rapid Response:

Re: Me and My Gout

I suffered from irregular recurrent attacks of gout (diagnosed by
polarizing microscope examination of aspirated joint fluid) every few
weeks for a period of 15 years. When my sleep apnea was diagnosed and
resolved 3 years ago, my gout attacks ceased immediately and completely.

Through my reading of medical journal literature, I was able to find
the physiological explanation for the connection of gout with sleep apnea.
The intermittent hypoxia from sleep apnea causes the cells to begin a
catabolic process in which the ATP disintegration begins a chain of
chemical transitions, the irreversible end product of which is the excess
generation of uric acid. The hypoxia also results in hypercapnia, causing
acidosis that makes the precipitation of monosodium urate more likely.
Although these processes were well-described over 15 years ago in medical
literature, it appears that no one connected them with gout attacks until
now.

During my fifteen years of suffering, I avoided eating foods with
high purine content. That regimen had little benefit for me. Now the foods
that I used to avoid, I eat with relish, and I have had no attacks. What
matters is not how I eat, but how I sleep.

Competing interests:
None declared

Competing interests: No competing interests

27 June 2006
Burton Abrams
engineer
self employed, Elkins Park PA 19027