Gout, medication & diving

[vmf]

I and a friend of mine suffer now and then from gout.
Does diving worsen / lessen the effects of gout? My experience is that there is no change.
Does any one know the effects of anti gout medication such as Colgout (Colchicine 0.5 mg) or Arthrexin (Indomethacin 25mg) if taken prior to diving???

Regards,

vmf

 

[ScubaBaby]

Ermmm....ok....probably being a dump essex girl again...but what on earth is gout?!

 

[terrydarc]

Gout is a metabolic disease caused by deposits of cystaline urate of sodium in the joints (ouch!). Ever ready to provide a link, here's one from the New Zealand Rheumatologists:

http://www.rheumatology.org.nz/nz08003.htm

I didn't know people still got gout, but it's a form of joint inflammation or arthritis, apparently. Hmmmm... where's a doctor when you need one? Treatment is with NSAID's, however, I wonder about the formation of N2 bubbles about the crystals. OTOH, swimming around slowly might actually be therapeutic FAIK.
Terry

 

[vmf]

I posted the same query on an Australian dive web site discussion board, [http://www.diveoz.com.au] (By the way, a great dive website!)

Dr Simon Mithell responded with

"The questions is, does gout or its medication have any special significance in diving? There are several issues which I raise in no particular order.

First, it has been suggested that damage or inflammation in a joint might predispose to bubble formation, or the adverse effects of any bubbles that do form in association with that joint. However, this assertion is based on theoretical consideration and is not supported by data or even convincing case reports.

Second, post-dive discomfort in a joint produced by gout could be misinterpreted as a symptom of decompression illness. I have encountered this situation in one of my own patients, who was able to reassure me that the nature of his pain (which arose the day after diving) was highly typical of one of his gout attacks. This does remain a potential problem however. A similar, but related problem, is that the gout sufferer may inappropriately attribute the pain of decompression illness to his or her gout. Pain in a new location, or of unusual quality following diving should be treated with suspicion.

Third, I have previously been asked if diving is likely to precipitate gout. I have not seen any convincing demonstrations of this.

Fourth, gout can be very painful, and during an acute attack the diver's agility and perhaps even their ability to fin might be impaired (the big toe is the classic location for acute attacks).

Finally, with regard to medication, neither non-steroidal anti-inflammatory drugs (like indomethacin) nor colchicine are likely to produce adverse effects while diving. However, both of these agents are usually used during acute attacks, and for the reasons outlined in my fourth point above (and to a lesser degree my second point), diving with an acute attack is probably best avoided. Some gout sufferers use a preventative medication called allopurinol between attacks. Provided this does not cause any adverse effects under normal circumstances, it is probably OK to dive while taking this medication. It has not, however, had any formal testing in the hyperbaric environment.

In summary, provided there is no major joint destruction nor any chronic pain which impairs performance in the water, it is probably OK to dive between attacks of gout. Atypical pain, or pain in new locations following dives should not be attributed to gout."

I would appreciate any other opinions.

Regards,

vmf

 

[BillP]

Hi vmf:

Terrydarc has already posted a good link on what gout is for those that didn't already know, and Dr. Mithell's response to your question on the diveoz site looks good. I'll see what I can add.

I'm not aware of any specific risks or benefits when diving with gout. Dr. Mithell has already addressed the general concerns about diving with any condition, like gout, that could impair a diver's performance or could mask or mimic a decompression injury. Let me go on and see what I can add to your medication questions.

Indomethacin is a non-steroidal anti-inflammatory drug (NSAID). As Dr. Mithell mentioned, it is used to fight the pain and inflammation of acute painful attacks of gout. The primary concern with taking an NSAID when diving is probably its antiplatelet activity. Platelets are cells in your blood that help form clots and control bleeding. NSAIDS interfere with the ability of platelets to clump together to stop bleeding. If a diver suffers barotrauma or a decompression illness that causes bleeding, the bleeding could be worse if they're taking an NSAID and the resultant injury increased. Conversely, if a diver suffers a decompression injury that does not cause bleeding, but does cause abnormal clotting in blood vessels, antiplatelet activity could be beneficial. Some prohibit the use of NSAIDs when diving, others promote their routine use. One man's meat is another man's poison?

Colchicine is also an anti-inflammatory that specifically works for gout and not other forms of arthritis. Like indomethacin, it is also used to treat acute attacks of gout. It does not treat the cause of gout, but rather just some of the effects of gout. It does not prevent the progression of the arthritis that gout can cause. Its mechanism of action is unclear, but one theory is that it prevents migration of white blood cells into the affected joint reducing the pain and inflammation.

Colchicine can cause stomach and intestine upset, it lowers body temperature, increases the sensitivity to central nervous system depressants, depresses the respiratory center, enhances the response to sympathomimetic agents, and constricts blood vessels.

Each of these effects of colchicine could affect a diver. For example, stomach and intestine upset could lead to dehydration and a possible increased risk of DCS. Hypothermia is a concern in diving, and colchicine could theoretically increase the risk. The effects of those beers, the sleeping pill last night, or the seasickness pill that makes you groggy could be increased. You might retain more CO2 than if not taking colchicine. The Sudafed (pseudoephedrine) a diver takes to help them clear their ears is a sympathomimetic agent that might increase the risk of O2 toxicity- combined with colchicine the effects could be further increased. Constricted blood vessels could alter blood flow and change nitrogen absoption and elimination.

I haven't seen any information on the clinical relevance of any of these potential effects of colchicine in divers, but I suspect that Dr. Mithell is right that the risk is relatively low. And again, like Dr. Mithell said, a diver with an acute attack of gouty arthritis is unlikely to be diving.

HTH,

Bill

The above information is presented for informational and discussion purposes only and is not meant as specific medical advice for any individual. Any questions concerning medical conditions or medications and diving should always be discussed between the diver and their personal physician.

 

[Bob3]

As a commercial diver, I've been diving during gout attacks. On occasion where I needed to be free swimming, I just used 1 flipper.
Colchicine & allopurinol are part of my regular diet & I've never observed any ill effects & my dive doc says there's no record of any adverse hyperbaric reactions with those drugs.
I always make it a point to stay well within the NDLs because of the relative difficulty to easily differentiate between arthritic pain & a DCS incident.
Your mileage may vary.

 

[vmf]

Thanks for the info BillP & Bob3.

Regards,

vmf

 

[ghof]

I have gout. I take Probenecid daily. I have been to 175 feet with no signs of problems. I am also willing to take the risks for the bends, and I don't think the type diving I do will cause any concerns for my buddies for the hour or two that we will be in the water. I would not dive with an acute attack either. As any one who knows it hurts like heck.

 

[FritzCat66]

OK, I know I'm performing a bit of necromancy reviving this old thread, but it's the only one I could find here directly addressing gout and diving and I figured it would be better to keep it all in one place.

The information above was from 2001 - anyone know of any updates since then vis-a-vis gout and diving?

I understand the risks of gout mimicking a DCS hit, but given that 1) I can usually sense gout coming on a day or so before the full attack and 2) in my case anyway the gout is strictly limited (so far) to just one area (the classic big toe joint), I'm not too worried about that.

Concerns would be: Could diving while having an acute gout attack worsen it (by forcing more uric acid out of solution, for example)? What about dive interaction with common gout meds like colchicine and allopurinol?

>*< Fritz

 

[diverdoug1]

Of the common triggers for an acute gout attack, none are caused by diving. There are 2 common triggers which my be seen more often on a dive holiday.
1. excessive alcohol intake, especially beer; or a drinking "binge"
2. Consumption of large quantities of purine-rich foods, especially meat products

Subjecting a gout patient to a hyperbaric environment is not known to trigger an attack. Hope this helps.