Calcium Supplementation During Acute Gout
Yes, calcium supplementation can be safely given during an acute gout attack and may actually provide modest benefit by lowering serum uric acid levels.
Evidence for Calcium Use in Acute Gout
The available evidence suggests calcium supplementation does not worsen acute gout and may be beneficial:
Calcium supplementation (770 mg/day from dairy or calcium citrate) significantly reduced serum urate concentrations by approximately 14-17% in a randomized controlled trial, suggesting a urate-lowering effect that could theoretically benefit gout patients 1.
The gout-protective effect of low-fat dairy products appears to be at least partly attributable to calcium's urate-lowering properties, as demonstrated in controlled studies where calcium supplementation reduced baseline serum urate levels 1.
There is no evidence in gout management guidelines contraindicating calcium supplementation during acute attacks 2. The guidelines focus on anti-inflammatory therapy (NSAIDs, colchicine, corticosteroids) but do not identify calcium as problematic 2, 3.
Important Distinction: Calcium Pyrophosphate vs. Calcium Supplementation
A critical caveat is distinguishing between:
- Calcium pyrophosphate deposition disease (CPPD), which is a completely different crystal arthropathy from gout caused by calcium pyrophosphate crystals 2
- Oral calcium supplementation, which provides elemental calcium that does not cause crystal deposition in joints
These are entirely separate conditions—calcium supplementation does not cause or worsen CPPD 2.
Practical Recommendations
Continue or initiate calcium supplementation during acute gout attacks without concern, as there is no evidence of harm and potential urate-lowering benefit 1.
Prioritize standard acute gout treatment with colchicine (1.8 mg maximum in first 12 hours), NSAIDs (if no contraindications), or corticosteroids (prednisone 0.5 mg/kg/day for 5-10 days) 2, 3.
For patients with cardiovascular disease, systemic corticosteroids are preferred over NSAIDs, and calcium supplementation poses no additional cardiovascular risk 3, 4.
Calcium from low-fat dairy sources may be preferable to calcium citrate supplements, as dairy products have additional gout-protective effects beyond calcium content alone 1.
Monitoring Considerations
Avoid calcium supplementation only in the rare context of severe hypercalcemia, which has been exceptionally reported in chronic tophaceous gout but is not caused by dietary calcium 5.
Standard calcium supplementation doses (500-1000 mg/day) are safe and do not require special monitoring during acute gout management 1.