Arthritis Today

Study Shows Gout Risks Differ Slightly for Women


One of the first large-scale studies to compare gout cases in men and women has found that many of the same things increase the risk of gout in both sexes – including older age, obesity, high blood pressure, and the use of a diuretic medication – though not always to the same degree.

Drinking alcohol, for example, particularly beer or spirits, seems to raise gout risk more for a woman than it does for a man

High blood pressure and the use of a diuretic, a drug that rids to body of water, seem to be riskier, at least when it comes to gout, for women than they are for men.

The study was published in the journal Arthritis & Rheumatism.

In both sexes, gout is caused by elevated blood levels of a metabolic by-product called uric acid. When uric acid builds up, it may crystallize in joints, tendons and surrounding tissues. This leads to excruciatingly painful, debilitating attacks of acute inflammatory arthritis, often affecting the joint at the base of the big toe.

Thanks to the hormone estrogen, which helps the body get rid of uric acid, women are relatively protected from gout, accounting for only 1 out of every 3 cases in people older than age 65.

But surveys suggest that the number of women with gout is growing, and researchers have begun to better characterize gout in women in an effort to better understand and treat the disease.

Researchers from the Boston University School of Medicine reviewed data on more 2,476 women and 1,951 men who were followed for 52 years as part of the Framingham Heart Study. They identified 304 cases of gout, 104 of which were in women, and they compared their health histories and lifestyles to the male gout cases.

Among heavy drinkers, those consuming more than five drinks a week, men saw their gout risk roughly double while women saw their risk triple.

The differences were even more pronounced when researchers looked at beer alone. In heavy beer drinkers, the risk of gout doubled for men but increased more than 7-fold for women.

Beer appears to be a kind of triple whammy for gout. It contains alcohol, which increases the body’s production of uric acid while simultaneously making it tougher for the kidneys to flush that compound. Beer is also a rich source of purines, compounds that break down into uric acid.

It is not known why beer may have a larger impact on gout risk for women than it does for men, however.

Among other risk factors, more women than men with gout had high blood pressure or were taking a diuretic, medications used to treat high blood pressure that rids the body of excess water and concentrates the blood.

Obesity was another major risk factor for gout in both sexes, roughly tripling the risk for both men and women.

Study author Hyon Choi, MD, a clinical epidemiologist at Boston University School of Medicine, says these results show that women do have the ability to minimize their gout risk.

“If you lose weight, you can reduce your risk substantially,” Dr. Choi says. “Or if you can avoid diuretics and use some other medicine as an alternative than you reduce your risk by half. Hypertension is difficult. If you have hypertension, you take care of it, but you cannot get rid of it completely. It’s a little difficult to modify. You can treat it and it might help. But weight and alcohol and diuretics are easier to modify. “

Unlike men, who often get gout around the age of 40, but can see attacks even younger than that, nearly all of the women with gout in this study had passed menopause, and researchers say that’s when women are generally affected by the condition probably because of decreasing estrogen levels.

“It pretty much says that women can get gout and they can get gout the same way men can get gout. But there’s an advantage of being a woman because you typically get it at an older age so you don’t have as many years of gout,” says Scott Zashin, MD, a Clinical Associate Professor of Medicine at the University of Texas’ Southwestern Medical School and an attending physician at Presbyterian Hospital in Dallas.

Dr. Zashin says for women who suffer from this condition, this study could be helpful.

“Women are much less likely to get gout than men. But this is yet another reason to not be overweight, avoid over-consumption of alcohol. And if you do have a gout attack, look at your medicines like aspirin and diuretics, which could increase your chances of getting gout,” Dr. Zashin says. “I would say, it’s probably not a bad idea to try to work on these things anyway and by doing it you are decreasing your chances of getting gout."