At Risk for Gout: It's Not Just Men
Study Shows Similar Risk Factors for Gout Among Men and Women
Nov.16, 2005 -- 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
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
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,"
"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
"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