Age, Drinking Raise Women's Gout Risk

Study Shows 5 Drinks or More a Week May Triple Risk of Gout in Women

By Salynn Boyles
WebMD Health News

Reviewed By Laura J. Martin, MD

March 30, 2010 -- Women have a lower risk of developing gout than men, even when they have the same blood levels of the chemical that causes the painful, inflammatory arthritis, new research shows.

Gout has traditionally been thought of as a disease of older men, but older women get it, too. A recent national health survey found that about 4% of women in their 60s and 6% of those in their 80s had gout.

In one of the first large studies to examine gout by gender, researchers found that in women, just as in men, older age, obesity, high blood pressure, alcohol use, and use of diuretics are all risk factors for gout.

Gout occurs when elevated blood levels of uric acid form crystals in the joints and surrounding tissue, leading to excruciatingly painful inflammation and swelling.

The big toe, knee, and ankle joints are the most common sites for gout, and attacks frequently start during the night. The painful swelling typically goes away in a few days, but more than half of people who have one attack will have others.

Older Age, Weight Raise Gout Risk

In an effort to better understand the impact of gender on gout, researchers from Boston University School of Medicine examined data on 2,476 female and 1,951 male participants in the ongoing Framingham Heart Study, which has followed residents of Framingham, Mass., since the late 1940s.

Over an average of three decades of follow-up, 304 cases of gout were reported, with one-third of those cases occurring in women.

For both sexes, gout incidence rose with increasing uric acid levels. But the association was stronger for men than for women.

Women with serum uric acid levels over 5 milligrams/deciliter had a significantly lower risk of developing gout than men with identical uric acid levels.

Other gender differences identified by the researcher include:

  • A higher proportion of women than men had high blood pressure and were being treated with diuretics. This finding suggests these two risk factors may be more important for women than men, the researchers say.
  • Drinking 7 or more ounces of spirits a week -- roughly five drinks -- doubled the gout risk in men and tripled it in women. Heavy beer drinking was associated with a doubling of risk among men and a sevenfold increase in risk among women.

Beer contains high levels of the chemical purine, which breaks down into uric acid in the body. But it is not clear why beer drinking would pose a higher gout risk for women than for men.

Obesity was associated with a roughly threefold greater risk for gout among both men and women in the study.

Finally, taking estrogen as hormone therapy appeared to lower gout risk in women, but the link was not statistically significant.

Estrogen is believed to lower uric acid levels in the blood, and previous studies have shown hormone therapy can protect against gout, study researcher Hyon Choi, MD, tells WebMD.

Gout Risk and Diet

Many people associate gout with eating large amounts of meat -- especially organ meats, which contain high levels of purine.

But diet was not among the major risk factors identified in the study.

Rheumatologist Patience White, MD, tells WebMD that women and men who want to avoid gout need to watch their weight, blood pressure, and alcohol consumption.

White is chief public health officer for the Arthritis Foundation and a professor of medicine and pediatrics at George Washington University in Washington, D.C.

"Diet plays a role, but it is a drop in the bucket," she says.

She says that more and more women are likely to get gout as the population ages. "Women need to understand that their gout risk goes up after menopause."

White adds that at the population level, women are heavier than they have ever been and they are drinking more alcohol.

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SOURCES: Bhole, V. Arthritis and Rheumatism, April 2010; vol 62: pp 1069-1076.

Hyon Choi, MD, DrPH, Section of Rheumatology and the Clinical Epidemiology Unit, Boston University School of Medicine.

Patience White, MD, chief public health officer, Arthritis Foundation; professor of medicine and pediatrics, George Washington University.

News release, American College of Rheumatology.

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