From the Guidelines
Yes, white blood cell (WBC) count can be elevated during acute gout attacks. During a gout flare, the body mounts an inflammatory response to the uric acid crystals that have formed in the joints, which can cause the WBC count to rise, typically in the range of 10,000-15,000 cells per microliter. This elevation is part of the body's natural immune response to what it perceives as a foreign substance. The increase in white blood cells occurs as they are recruited to the affected area to help combat the inflammation. However, it's essential to note that not all patients with gout will have an elevated WBC count, and the degree of elevation can vary. If a patient with gout presents with a significantly elevated WBC count (above 15,000), other causes of inflammation or infection should be considered, as this could indicate a concurrent condition such as cellulitis or septic arthritis, which would require different treatment approaches. The WBC count typically returns to normal once the acute gout attack resolves, either spontaneously or with appropriate treatment such as colchicine, NSAIDs, or corticosteroids. Although the provided study 1 does not directly address the relationship between WBC count and gout, it is a comprehensive guideline for the management of acute and recurrent gout, and its findings on the inflammatory nature of gout support the notion that WBC count can be elevated during acute gout attacks.
Key points to consider:
- The elevation of WBC count in gout is a result of the body's inflammatory response to uric acid crystals.
- Not all patients with gout will have an elevated WBC count, and the degree of elevation can vary.
- A significantly elevated WBC count (above 15,000) may indicate a concurrent condition such as cellulitis or septic arthritis.
- The WBC count typically returns to normal once the acute gout attack resolves, either spontaneously or with appropriate treatment.
- The management of acute and recurrent gout, as outlined in the guideline 1, is crucial in preventing and treating gout flares, which can help minimize the elevation of WBC count.
From the Research
White Blood Cell Count in Gout
- The White Blood Cell (WBC) count is often elevated in gout patients, as indicated by studies on the acute phase response in gout 2.
- A study published in 1987 found that oral temperature, WBC count and differential, platelet count, Westergren erythrocyte sedimentation rate (ESR), and serum levels of acute phase reactants were all elevated in gout patients 2.
- Another study published in 2021 found that synovial fluid WBC counts in gout patients were higher than those in osteoarthritis patients, suggesting an inflammatory response in gout 3.
- Elevated WBC counts are associated with increased inflammatory activity in gout, as seen in normouricemic patients who had higher inflammatory activity than hyperuricemic patients 4.
Association with Disease Activity and Cardiovascular Risk
- Elevated neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios are associated with increased flares and elevated cardiovascular disease risk in gout patients 5.
- The neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are potential biomarkers to predict gout flare risk and cardiovascular disease morbidity 5.
- Studies suggest that WBC counts and ratios can be used to monitor disease activity and predict complications in gout patients, including cardiovascular disease risk 5.