Epidemiology of gout in women: Fifty‐two–year followup of a prospective cohort

Abstract

Objective. Despite the recent doubling of the incidence of gout among women and its substantial prevalence particularly in the aging female population, the risk factors for gout among women remain unknown. We undertook this study to evaluate purported risk factors for incident gout among women and to compare them with those among men.Methods. Using prospective data from the Framingham Heart Study, we examined over a 52-year period ) the relationship between purported risk factors and the incidence of gout in 2,476 women and 1,951 men.Results. We documented 304 incident cases of gout, 104 of them among women. The incidence rates of gout for women per 1,000 person-years according to serum uric acid levels of <5.0, 5.0-5.9, 6.0-6.9, 7.0-7.9, and >8.0 mg/dl were 0.8, 2.5, 4.2, 13.1, and 27.3, respectively (P for trend < 0.0001). The magnitude of this association was lower than that among men (P for interaction ‫؍‬ 0.0002). Multivariate relative risks conferred by increasing age (per 5 years), obesity (body mass index >30 kg/m 2 ), alcohol intake (>7 ounces of pure alcohol/week), hypertension, and diuretic use were 1.24, 2.74, 3.10, 1.82, and 2.39, respectively (all P < 0.05), for women.Conclusion. These prospective data with longterm followup provide evidence that higher levels of serum uric acid increase the risk of gout in a graded manner among women, but the rate of increase is lower than that among men. Increasing age, obesity, alcohol consumption, hypertension, and diuretic use were associated with the risk of incident gout among women.Gout, a common and excruciatingly painful inflammatory arthritis (1), has historically been considered a male disease, and most gout research has focused on men (2-9). However, growing evidence suggests a substantial disease burden of gout among older women, whose representation in the general population has grown with increasing longevity. The prevalence of self-reported physician-diagnosed gout based on the Third National Health and Nutrition Examination Survey (NHANES-III) was 3.5% in women ages 60-69 years, 4.6% in women ages 70-79 years, and 5.6% in women ages Ն80 years (10). The incidence of gout has doubled among women over the past 20 years, according to the Rochester Epidemiology project study (11). Despite this substantial and increasing disease burden, the risk factors for gout among women remain unknown.Given the significant role of estrogen in serum uric acid levels as well as the substantial sex difference in the incidence of gout and perhaps in uric acid metabolism (12), extrapolation of data on the risk factors for gout from men to women should be done with caution. The serum uric acid level, which is the most prominent predictor and precursor of gout, has been prospectively studied in relation to the risk of incident gout among men (2), but no corresponding data among women are

Impact of obesity and hypertriglyceridemia on gout development with or without hyperuricemia: A prospective study

“…As expected, an enhanced combined effect was noted for gout development as compared with individual effect. Furthermore, the impact of metabolic syndrome on gout development was significant in men, which is comparable to previous reports (3,16,17). In addition, metabolic syndrome noted at baseline can predict a future gout event, even if the urate is unsaturated for precipitation.…”

Gout and Association with Erectile Dysfunction

“…These include rapidity of onset, crescendo escalation of joint pain and swelling, association with gluttony and excessive consumption of high purine foods and alcoholic beverages, and predilection for involvement of the first metatarsophalangeal joint (i.e., podagra) at onset of disease 1,2 . Similarly, demographic aspects about gout are well known: the predominant involvement among men and the abrupt rise in disease incidence among women in the postmenopausal phase of life 3,4,5 . In contrast, what is relatively new to the field of gout epidemiology is the increasing number of comorbid disorders that are associated with gout incidence and prevalence.…”

Lifestyle and dietary habits of patients with gout followed in rheumatology settings

“…Alcohol consumption is a well-recognized risk factor for hyperuricemia and gout (13)(14)(15). Recent studies have clarified that the impact on the risk of gout varies depending on the type and amount of alcoholic beverage consumed (14).…”