From the Guidelines
Aspirin is generally not recommended for patients with gout as it can worsen the condition by increasing uric acid levels in the blood. For acute gout attacks, NSAIDs like naproxen (500mg twice daily), indomethacin (50mg three times daily), or ibuprofen (800mg three times daily) are preferred over aspirin, as they are effective in reducing pain and inflammation without increasing uric acid levels 1. Aspirin, especially at low doses (75-325mg daily), can reduce the excretion of uric acid through the kidneys, potentially triggering or worsening gout attacks.
Key Considerations
- If you're currently taking low-dose aspirin for heart health, don't stop it without consulting your doctor, as they can help balance your gout management with cardiovascular protection 1.
- Instead of aspirin for gout pain, consider colchicine (0.6mg once or twice daily) or the NSAIDs mentioned above, as they are more effective and safer options for gout management 1.
- For long-term gout management, medications that lower uric acid levels like allopurinol (starting at 100mg daily) or febuxostat (40mg daily) are typically prescribed, and the decision to initiate these therapies should be made after discussing benefits, harms, costs, and individual preferences with patients 1.
- Always consult with your healthcare provider before starting or changing any medication regimen for gout, as they can help determine the best course of treatment based on individual needs and medical history.
From the Research
Aspirin and Gout
- The use of low-dose aspirin has been associated with an increased risk of recurrent gout attacks, with an adjusted odds ratio (OR) of 1.81 (95% CI 1.30 to 2.51) for ≤325 mg/day of aspirin use on two consecutive days 2.
- However, high-dose aspirin and salicylates may have a urate-lowering effect, potentially reducing the risk of gout attacks 3.
- Concomitant use of allopurinol may nullify the detrimental effect of aspirin on gout attacks 2.
- Low-dose daily aspirin does not significantly interfere with the uricosuric effects of probenecid in patients with gouty arthritis 4.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and Gout
- NSAID use is overall associated with a 12% decreased odds of a cardiovascular event (OR = 0.88,95% CI: 0.85-0.91) in patients with gout 5.
- Ibuprofen and naproxen appear to have better cardiovascular risk profiles than diclofenac 5.
- NSAIDs, such as ibuprofen, sulindac, and indomethacin, may be effective in treating acute gout 6.