If you have gout, a type of inflammatory arthritis characterized by a buildup of uric acid in the joints (especially the big toe), you know how much an attack hurts. What you might not know is that underlying damage may be occurring even when you aren’t in pain.

According to a new study, published in Arthritis Care & Research, as many as 44 percent of people with gout have bone erosions.

The researchers, from Shanghai, conducted ultrasounds on 980 gout patients. Study participants were most apt to have evidence of bone damage if they were older (on average, age 55 versus 47), had been living with the disease for longer (nine years versus five), and had had more frequent attacks (nine versus four in a year).

High blood pressure, high blood sugar, and kidney disease were also associated with an increased likelihood of having bone erosions among gout patients. People whose imaging tests showed visible evidence of tophi — a deposit of uric acid crystals around a joint — were much more apt to have bone deterioration, too.

According to the authors, this is the first study of its size to assess how common bone erosions are in gout patients. While pain from a gout attack usually abates within a few days, these findings suggest that more people may need to be on long-term medication (such as allopurinol) to decrease levels of uric acid in order to decrease the number of future attacks as well as avoid or limit bone damage.

The authors concluded: “These results suggest that an early diagnosis of gout, controlling the [uric acid] level and decreasing local urate crystal deposition may be the most effective way to prevent bone erosion in patients with gout.”

If you have gout, don’t ignore it. Talk to your doctor and discuss gout treatment options, which include different types of medication as well as dietary and other lifestyle changes.

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