By April Cashin-Garbutt, BA Hons (Cantab)
Gout has been described by the Daily Mail as something, “usually associated with port-swilling, over-fed elderly men of the 19th century”. (1) Recent research carried out at the Boston University School of Medicine, however, has found that the incidence of gout in the US is on the rise. (2) Thus, the condition is clearly not something that only affects this stereotype.
But what actually is gout and why is the incidence of the condition increasing?
What is gout?
Gout is a rheumatic disease, which means it involves inflammation (such as redness, swelling and pain) of the joints, tendons, ligaments and so forth. (3, 4)
Philip Conaghan, Consultant Rheumatologist, Chapel Allerton Hospital, Leeds, explains what gout is, what causes it and how it can be treated. Source: NHS
The condition usually affects the base of the big toe. The toe may swell and cause severe pain in the joint. Symptoms can, however, affect any joint in the body. (5, 8)
Other commonly affected joints include:
- Fingers and small joints in the hand
- Insteps/mid-foot (6, 7, 8)
Gout may come in so-called “attacks”. This is where the symptoms rapidly worsen in 6-24 hours and continue for around 3-10 days. (5)
Is the incidence of gout increasing?
Several researchers have suggested that gout is on the rise in the US.
Most recently, researchers at the Boston University School of Medicine have stated that the incidence of gout has risen significantly in the US over the last 20 years. (2)
The increase may have been going on much longer than this. Earlier research published in the Journal of Rheumatology compared 1995-1996 with 1977-1978 and found that there had been a significant increase over this period. (10)
This increasing trend may not, however, be universal to all countries. For example, research published in the Annals of the Rheumatic Diseases showed that the incidence of gout in the UK seemed to remain stable during the 1990s. (9)
Thus, whether the incidence of gout is increasing seems to be dependent on where you are referring to and over what timescale.
Researchers, publishing work in the Current Rheumatology Reports, did, however, generalise that “taken together, epidemiologic investigations suggest that gout frequency is on the rise worldwide”. (11)
What is responsible for this increase?
Several factors have been suggested as being responsible for the increasing incidence of gout. These include:
- Dietary changes
- Alcohol consumption
- Medications (12)
Dietary changes and incidence of gout
Dietary changes have been suggested to be associated with the increasing incidence of gout. Specifically, consuming large amounts of certain foods have been suggested as being associated with increased risk for gout:
In contrast, high levels of consumption of other substances have been suggested as being associated with lower risk of gout. These include:
- Low-fat dairy products
- Vitamin C (13)
Research has been carried out on the incidence of gout and the consumption of fructose in particular. The research was published in the British Medical Journal and states that prospective data suggests that fructose consumption is strongly associated with an increased risk of gout in men. (14)
This means that consumption of sweetened soft drinks, and may even fructose rich fruit juices, may be increasing the risk of gout. The researchers also found that diet soft drinks were not associated with this risk. (14)
Alcohol consumption and incidence of gout
The association of consumption of alcohol and incidence of gout seems to be one that has been engrained in our minds for centuries, but is alcohol really responsible for the increase in the incidence of gout? (15)
According to research published in the American Journal of Medicine, alcohol consumption does trigger recurrent gout attacks. Moreover they found that even light-to-moderate consumption of alcohol can trigger recurrent gout attacks. (16)
Other researchers have found that the type of alcohol drunk also influences your risk of gout. Specifically, they found that beer drinkers are at a heightened risk of gout. In contrast, they said that spirits and wine were not as associated with risk of gout. This means that it may not be the alcohol itself that is associated with gout risk; but the other non-alcoholic components present in the drinks. (17)
Medications and incidence of gout
Certain medications have been associated with an increased risk of gout. These include:
- Diuretics, which are prescribed to control high blood pressure
- Beta-blockers, which are prescribed for several different conditions such as angina, atrial fibrillation and so forth
- Niacin, which is prescribed to treat high cholesterol
- Angiotensin converting enzyme (ACE) inhibitors, which are used to treat hypertension, heart failure and to reduce kidney damage in diabetes patients
- Non-losartan angiotensin II receptor blockers (ARBs) also used to treat heart failure (18, 19, 20, 21, 22)
Overall, why is the incidence of gout increasing?
Overall, it seems like we might be able to learn something about the increasing incidence of gout from the stereotypical gout patient after all. Although sufferers may not technically be “port-swillers,” alcohol consumption does seem to be associated with the incidence of gout. Similarly, sufferers may not be described as “over-fed”; yet dietary factors also seem to play a role in the incidence of gout.
- Mikhuls, Farrar et al. (2005) Gout epidemiology: results from the UK General Practice Research Database, 1990-1999. Ann Rheum Dis 64: 267-272: http://ard.bmj.com/content/64/2/267.abstract
- Arromdee, Michet et al. (2002) Epidemiology of gout: is the incidence rising? J. Rheumatol, Nov; 29 (11) 2403-6: http://www.ncbi.nlm.nih.gov/pubmed/12415600
- Saag and Mikuls (2005) Recent advances in the epidemiology of gout. Current Rheumatology Reports, Volume 7, Number 3, 235-241: http://www.springerlink.com/content/c25nnm1rp7422w87/
- Doherty (2009) New insights into the epidemiology of gout. Rheumatology Vol. 48, Issue suppl 2, ii2-ii8: http://rheumatology.oxfordjournals.org/content/48/suppl_2/ii2.full
- Choi and Curhan (2008) Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ; 336-309: http://www.bmj.com/content/336/7639/309.full
- Zhang, Woods et al. (2006) Alcohol Consumption as a Trigger of Recurrent Gout Attacks. The American Journal of Medicine, 119, 800.e13-800.e18: https://dcc2.bumc.bu.edu/goutstudy/Documents/alc_gout.pdf
- Choi, Soriano et al (2012) Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study. BMJ 344:d8190: http://www.bmj.com/content/344/bmj.d8190