What are risk factors for gout?
Since gout is directly related to uric acid levels in the blood, these risk factors are primarily associated with the production and excretion of uric acid:
Diet: Foods such as red meat, certain seafoods (i.e., shrimp and oily fish), alcoholic beverages (especially beer), sugar, and fructose (often found in soft drinks) can all increase uric acid levels.
High blood pressure: High blood pressure and some medications used to treat high blood pressure (diuretics) increase the risk of gout. Taking low dose aspirin also increases uric acid levels.
Obesity: People with high body weight are more likely to develop gout and at a younger age than those with lower body weight. Over the past twenty years, the incidence of gout has nearly doubled, likely connected to an increase in obesity in the general population.
Medication: Some medications block the excretion of uric acid in the kidney. In general, diuretics and certain medications that suppress the immune system can increase risk of gout.
Trauma: Gout can be brought on by surgery, heart attack, or other physical and even emotional trauma.
Kidney disease: Even mild kidney disease can result in reduced excretion of uric acid from the body.
Heredity: If someone in your family has gout, you have a higher chance of developing the disease since gout does run in some families. However, many people who develop gout do not have a family history of the disease.
Dehydration: Dehydration can contribute to gout attacks.
How common is gout?
As many as 1 million Canadians are estimated to have gout, about 2-4% of the population. Gout is the most common form of inflammatory arthritis and affects more males than females (about 4% vs. 1%). The number of people who have gout has been increasing globally over time, as well as the number of new diagnoses. Gout is more common as people get older.
While these gout statistics likely reflect a primarily cisgender population, limited research indicates that the use of long-term hormone therapy by trans people is associated with changes in uric acid levels, which could have implications on gout development. Further research is needed.
If you have concerns about a possible change in uric acid levels due to hormone use or have other conditions that may increase your risk of gout, consult with your doctor about how to best monitor your risk.
What happens during a gout attack?
Gout attacks can only happen if there are uric acid crystals within the joint, which only occurs if there is too much uric acid in the bloodstream.
Once the crystals are inside the joint, the immune system will sometimes try to get rid of the crystals. Under certain circumstances, white blood cells, which are part of our immune system, can migrate from the bloodstream into the joint where the uric acid crystals are present. Those white blood cells, called neutrophils, will try to destroy the uric acid crystals. In the hope of getting rid of the crystals, the neutrophils will multiply within the joint, which leads to inflammation, swelling, redness and pain in the affected joint. This is known as a gout attack.
The neutrophils are not strong enough to eliminate the uric acid crystals in the joint, and after a couple of days they will die off, and the gout attack will be over. However, the uric acid crystals within the joint will remain, leaving the person at high risk of subsequent gout attacks if measures are not taken to reduce them.
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This gout resource was reviewed in October 2022 with expert advice from:
Dr. Jean-Philip Deslauriers
Clinical Professor at the University of Sherbrooke
Rheumatologist
Bathurst, New Brunswick