Risk Factors and Comorbid Conditions
What makes an individual susceptible to hyperuricemia that leads to gout? Several risk factors are associated with the development of gout, including:
Family History of Gout
Patterns of gout within families ranging from 11%-80% have been reported. Two large series found that 40% of gout patients had a family history of gout. There are also specific rare forms of hyperuricemia and gout that have a genetic basis.
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Overeating of Certain Foods and Alcohol Consumption
Because gout is a result of mechanisms involving purine metabolism, a high-purine diet may be seen as a cause. In particular, substances found in certain types of meat and seafood may raise serum urate. Though dietary purines and metabolism of purines do contribute to the body’s uric acid pool, in most cases ingestion of purines plays a relatively small role in hyperuricemia.
An exception to this general principle is a diet rich in purine content. Several popular low-carbohydrate diets promote consumption of large amounts of meat and seafood. This raises concerns that ketosis and purine consumption could result in a worsening of hyperuricemia and gout.
While dietary modification may be beneficial to patients with gout, traditional “low-purine” diets are unappealing to many people and generally result in only a marginal (1 mg/dL) decrease in serum urate levels. A more reasonable, and achievable, approach is to reduce consumption of foods with high purine levels.
Dietary modifications should also encourage weight reduction in obese patients and the management of comorbidities such as hyperlipidemia and hypertension. However, due to the increasing popularity of low-carbohydrate diets and their potential risks, it is also important to remain cognizant of each patient’s individual weight loss program.
Gout and dietary considerations:
- Higher levels of consumption of meat (especially organ meats such as liver, kidney, and brain and as well as meat extracts and gravies), dried beans and peas, sardines, anchovies, and seafood are associated with an increased risk of gout.
- Higher levels of consumption of dairy products are associated with a decreased risk of gout.
- A diet containing purine-rich vegetables or protein is not associated with an increased risk of gout.
- Although not confirmed by controlled clinical studies, there is limited evidence that cherry juice may lower serum urate levels. In one study of 10 healthy women, cherry consumption was found to correlate with lower serum urate levels.
Alcohol consumption has long been noted to be tied to an increased risk of gout. However, this risk may vary considerably by type of alcoholic beverage. A 2004 study by Choi et al found that among three beverage types considered, beer consumption carries the largest risk, spirits a lesser risk, and moderate wine drinking shows no increased risk at all.
While certain dietary changes may contribute to some reduction in serum urate, another important component of gout management is the long-term pharmaceutical treatment of hyperuricemia.
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Use of Medication
Certain medications may worsen or precipitate gout by either reducing net renal urate excretion or increasing purine release. Drugs that can influence serum urate levels and exacerbate gout include:
- Aspirin, low-dose
- Cyclosporin
- Cytotoxic antineoplastic agents
- Diuretics (especially thiazides)
- Ethambutol
- Ethanol
- Levodopa
- Nicotinic acid/niacin
- Pyrazinamide
- Tacrolimus
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Illness and/or Hospitalization
Acutely ill or hospitalized patients are prone to acute gout attacks. In these cases, the trigger may be found in specific biochemical changes associated with uric acid production.
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Lead Exposure
Lead-induced gout is rare, but there is some evidence that low-level exposure to lead may be related to primary gout. This may be an occupational exposure, or exposure related to a hobby.
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Comorbid Conditions
Gout is often accompanied by other health problems (comorbidities), such as:
- alcohol abuse
- diabetes mellitus
- dyslipidemia
- hypertension
- obesity
- renal dysfunction
Hypothyroidism also has been associated with hyperuricemia and gout.
Hyperuricemia correlates closely with the level of insulin resistance, suggesting that hyperuricemia may be related to syndrome X (the metabolic syndrome).
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Read more about Gout Progression