Caffeine intake increases risk for recurrent gout attacks

Drinking caffeinated beverages may raise the risk for recurrent gout attacks, according to research presented at the Nov 2010, American College of Rheumatology Annual Scientific Meeting in Atlanta.

Gout is a painful and potentially disabling form of arthritis that has been recognized since ancient times. Initial symptoms usually consist of intense episodes of painful swelling in single joints, most often in the feet (especially the big toe). Although treatments are available to manage gout, they are not always successful in preventing recurrent gout attacks.

Long-term caffeine intake has been associated with a decreased risk for gout attacks. However, in the short-term, caffeine has been found to increase uric acid, which can potentially trigger an attack. Based on this conflicting information, researchers recently evaluated whether drinking caffeinated beverages is associated with the risk of repeated gout attacks.

In a study, funded in part by the ACR Research and Education Foundation, researchers turned to the Internet to recruit 633 participants (obtaining 486 medical records to date confirming a gout diagnosis) who had experienced a gout attack within one year of the study to compare the amount of caffeinated beverage consumption during periods of gout attacks to periods without attacks. They noted the amount of caffeine (e.g., coffee, tea, other caffeinated beverages) and non-caffeinated beverages (e.g., non-caffeinated coffee, tea, sodas, juices) each participant consumed during a 24-hour period before a gout attack as well as during a 24-hour period without a gout attack.

With this information—and after adjusting the results to consider a participant's diuretic use, alcohol consumption, purine consumption, and the consumption of other fluids—researchers looked at the connection between the amount of caffeinated beverages consumed (zero, one, two, three, four, five to six, or greater than six servings per 24 hours) and the risk of recurrent gout attacks. Then, to round out the study, they repeated the same analyses for non-caffeinated beverage consumption.

Among these participants with gout—who were predominantly Caucasian (89 percent), male (78 percent), and college educated (58 percent)—both with irregular daily caffeinated beverage consumption and increased intake of caffeinated beverages in the prior 24 hours were at a higher risk for recurrent gout attacks. The increased risk was present even after accounting for other fluid intake.

For example, consuming three or four more servings of caffeinated beverages in the prior 24 hours was associated with 40 to 80 percent increased risk of recurrent gout attack. This led researchers to believe that episodic increased caffeinated beverage consumption can cause a short-term increased risk for gout attacks.

"In this study, we found that intermittent increased caffeinated beverage intake—such as caffeinated coffee, tea, or soda—was associated with an increased risk of gout attacks even after taking into account all other fluid intake," says Tuhina Neogi, MD, PhD, FRCPC; associate professor of medicine at Boston University School of Medicine and lead investigator in the study. "In contrast, non-caffeinated coffee, tea, soda or juices were not associated with an increased risk of gout attacks. These findings suggest that episodic increases in consumption of caffeinated beverages can trigger gout attacks in the short-term. Persons with gout should discuss disease management with their rheumatologists, and should keep in mind that there are lifestyle factors that can be modified to potentially help reduce their risk for recurrent gout attacks," says Dr. Neogi.