Though it is typically considered a disease of affluent and rotund middle-aged men, gout does not discriminate. The prevalence of gout in postmenopausal women approaches that of men and goes up with each decade of life, a study shows.
And what’s more, risk factors for gout -- such as being overweight and having high blood pressure -- are similar for the two sexes, according to new research presented at the annual meeting of the American College of Rheumatology in San Diego.
Affecting more than 5 million Americans, gout is a chronic arthritic condition characterized by “flares” marked by intense pain, redness, inflammation, and warmth in the affected joint. Typically, symptoms begin in the big toe, but gout may involve other joints.
In gout, there is generally a problem with either too much production of uric acid -- which is found normally in the body -- or problems in getting rid of the uric acid, or both.
Gout symptoms are the result of an acute inflammatory response to the presence of uric acid crystals in the joints. As the disease progresses, these attacks may become more frequent and patients may develop joint deformity and large deposits of crystals, which can become visible under the skin (tophi).
The Role of Obesity
In the new study, 10,000 women with no history of gout were followed for 24 years. Researchers assessed the women’s weight, body mass index, and use of medical therapies every two years. Every four years, they surveyed diet, alcohol intake, and other lifestyle factors thought to affect risk of developing gout. There were 444 new cases of gout identified during the study period.
Women who were overweight (BMI between 25 and 29.9) had three times the risk of developing gout as their thinner counterparts, the study showed. Obese women (defined as a BMI of 30 to 34.9) had a sixfold increased risk of developing gout, and women with a BMI of more than 35 had 10 times the risk of developing gout as their nonobese counterparts.
“Higher BMI increases risk of gout by increasing blood uric acid levels,” says researcher Hyon Choi, MD, a rheumatologist at Massachusetts General Hospital in Boston.
High Blood Pressure
High blood pressure and the use of diuretic medication (such as hydrochlorothiazide or HCTZ) also increased a woman’s chances of developing gout, according to the study. Diuretics are known to cause uric acid levels to increase and are often prescribed to treat high blood pressure.
“The growing epidemic of obesity and the increasing evidence of hypertension and diuretic use present challenges,” Choi says. But “modifying risk factors in both sexes can help reduce the incidence of gout and its associated morbidities, [and] I strongly suggest weight reduction,” he says.
“Because the risk factors for gout have not been previously studied in women, we have not had a clear indication of how to limit the growing prevalence of this disease in this population,” says John H. Klippel, MD, president and CEO of the Atlanta-based Arthritis Foundation, in a written statement. “This important study demonstrates that the risk factors for gout are identical in men and women and that similar prevention and treatment strategies should be encouraged in all people, regardless of gender.”
Elizabeth Karlson, MD, an assistant professor of medicine at Brigham and Women’s Hospital in Boston, says that the study augments the growing field of gender-specific medicine.
“We know for example that in heart disease, risk factors differ between men and women,” she says. The new study is “very important” for preventing, diagnosing, and treating gout and for women’s health in general.
By Denise Mann, reviewed by Louise Chang, MD
SOURCES: 2005 American College of Rheumatology annual meeting, San Diego, Nov. 12-17, 2005. John H. Klippel, MD, president and CEO, Arthritis Foundation. Elizabeth Karlson, MD, assistant professor of medicine, Brigham and Women’s Hospital, Boston. Hyon Choi, MD, rheumatologist, Massachusetts General Hospital, Boston.