From the Guidelines
Yes, gout can increase white blood cell (WBC) count during acute flares. When a gout attack occurs, the body mounts an inflammatory response to the uric acid crystals that have formed in the joints, triggering the immune system to send white blood cells to the affected area. This inflammatory cascade can result in an elevated WBC count in blood tests, typically showing a moderate leukocytosis (increased white blood cells). The elevation is usually temporary and resolves as the gout flare subsides with appropriate treatment. This increase happens because the body treats the uric acid crystals as foreign invaders, prompting neutrophils (a type of white blood cell) to attempt to engulf and eliminate these crystals. The process releases inflammatory mediators that cause the characteristic pain, swelling, and redness of gout. It's essential to note that while an elevated WBC count during a gout attack is common, persistent elevation may suggest another concurrent condition such as infection. Proper gout management with medications like colchicine, NSAIDs, or corticosteroids helps resolve both the symptoms and the associated inflammatory markers, including the elevated WBC count, as supported by studies such as those referenced in 1.
Some key points to consider:
- Gout is a disorder characterized by an excess body burden of uric acid, leading to hyperuricemia and the deposition of monosodium urate monohydrate crystals in joints and other tissues 1.
- The American College of Physicians (ACP) and other organizations have developed guidelines for the management of gout, including recommendations for the use of corticosteroids, NSAIDs, and colchicine in treating acute gout attacks 1.
- The management of gout involves not only the treatment of acute attacks but also the long-term management of hyperuricemia to prevent future attacks and reduce the risk of complications such as kidney stones and chronic kidney disease 1.
- The diagnosis of gout is typically made based on clinical presentation and laboratory tests, including synovial fluid analysis for the presence of monosodium urate crystals 1.
Overall, the management of gout requires a comprehensive approach that takes into account the patient's overall health, the severity of their symptoms, and the presence of any underlying conditions that may be contributing to their gout. By following established guidelines and working closely with healthcare providers, patients with gout can effectively manage their symptoms and reduce their risk of complications.
From the Research
Gout and White Blood Cell (WBC) Count
- Gout can increase White Blood Cell (WBC) count, as evidenced by studies that have shown elevated WBC counts in patients with gout 2, 3, 4.
- The acute phase response in gout is characterized by elevated oral temperature, WBC count, and differential, platelet count, Westergren erythrocyte sedimentation rate (ESR), and serum levels of acute phase reactants 2.
- Markedly elevated intra-articular WBC counts have been reported in patients with gout, with counts as high as 168,500 white blood cells/µL and 500,000 white blood cells/µL in two separate cases 3.
- Cytokine levels in synovial fluid during acute gout have been shown to vary depending on the stage of the attack, with higher levels of IL-1β, IL-6, and TNFα in the early stages and higher levels of TGFβ1 in the resolution phase 4.
Mechanism of Gout-Induced WBC Count Increase
- The presence of monosodium urate (MSU) crystals in gout serves as a "danger signal" that triggers both innate and adaptive immune responses, leading to the production of cytokines and the activation of immune cells 5.
- The inflammasome, a multiprotein complex that activates inflammatory responses, has been shown to play a role in the pathogenesis of gout, leading to the increase in WBC count 5.
- Different cell subsets, cytokines, and pattern recognition receptors (PRRs) have also been implicated in the increase in WBC count in gout 5.