More Americans Suffer from Gout

< Nov. 10, 2010 > -- Chalk up another possible consequence of the obesity epidemic: more gout.

According to a new study, the number of Americans affected by gout, an exquisitely painful form of arthritis, has jumped to 3.9 percent of the general adult population. That’s a substantial increase from the number affected just two decades ago – 2.7 percent – and a continuation of a trend that started in the 1960s.

Researcher Yanyan Zhu, Ph.D., at the Boston University School of Medicine, says that the increase was mostly seen in men and older adults. (Women are at higher risk for gout after menopause.) She pointed to the overall rise in obesity and high blood pressure in the U.S. as a possible contributing factor to the increase in gout.

The study, presented this week at the annual meeting of the American College of Rheumatology, also found that the number of cases of “pre-gout” – called hyperuricemia – was also on the rise.

Joint inflammation

Gout is a type of inflammatory arthritis that most often affects the joint of the big toe. It can also affect other joints, including the feet, ankles, and hands, the Arthritis Foundation says. Gout is caused by a buildup of uric acid in the blood. The uric acid forms crystals, which collect in the fluid that lubricates the joints. The crystals cause sudden, severe pain, swelling, and tenderness in the joint.

Dr. Zhu and her team analyzed two National Health and Nutrition Examination Surveys, one conducted between 1988 and 1994 and involving nearly 19,000 adults, and the other done in 2007-08 with more than 5,700 participants.

Caffeine's effect on gout

Another group of researchers, also at the Boston University School of Medicine, explored the possible link between caffeine and gout attacks.

"We know there are some factors that can trigger gout attacks, such as consuming alcohol, red meat, and certain seafoods,” says Tuhina Neogi, M.D. "And although a previous study found that, over the long-term, caffeine intake seems to actually lower the body's uric acid level and decrease the risk for developing gout among those who have never experienced an attack, we wanted to see what the impact of caffeine might be for patients who already have a history of gout."

This second study looked not only at coffee, but also at other caffeinated beverages, including tea, soft drinks, and products like Red Bull.

According to Dr. Neogi, the study found that caffeine "binges" might help spur an attack of gout in people who already had the condition. A person with gout who usually had no more than two caffeinated beverages a day, for example, and then switched to three to four servings, raised the risk for an attack by 40 to 80 percent.

The chemical structure of caffeine is similar to that of a standard chronic gout medication, allopurinol, which controls the condition by lowering uric acid levels. Allopurinol is effective in the long-term, but in the short term, it can actually trigger a flare-up among people taking it for the first time, Dr. Neogi says. Caffeine might have a similar short-term effect.

Sugary drinks increase risk

A third study out of the Boston University School of Medicine and also slated for presentation at this week’s American College of Rheumatology meeting found a connection between higher consumption of soft drinks and other fructose-sweetened beverages and a rise in gout risk for women.

Researchers led by Hyon Choi, M.D., looked at data on nearly 79,000 women over a 22-year period. They found that women who consumed one serving per day of sugar-sweetened soft drinks and/or orange juice were nearly twice as likely to develop gout as women who drank less than one serving per month. Risk more than doubled among those women who drank two or more such servings per day.

Certain Foods Tied to Gout

Several factors can increase your risk for gout. It’s more common in men than in women, and more common in people who are overweight, drink more than moderate amounts of alcohol, or take certain medications, such as aspirin or diuretics, the National Institute of Arthritis and Musculoskeletal and Skin Diseases says.

If you already suffer from gout, you can help prevent a gout attack by avoiding foods high in purines, which raise the level of uric acid in your body. The Arthritis Foundation says that the following foods have high amounts of purines:

• Liver and other organ meats

• Fish eggs

• Beer

• Sardines

• Gravies and broths

• Mussels

• Wine

• Anchovies

• Herring

Foods with a fair amount of purines include red meat, chicken and other fowl, peas, cauliflower, lentils, beans, whole-grain cereals, mushrooms, and spinach. You may need to limit your consumption of these.

These foods have few purines and so don’t trigger a gout attack: all vegetables not listed above, fruit, milk, eggs, nuts, moderate amounts of butter and other fat, and moderate amounts of sugar.

Always talk with your doctor to find out more information.