Epidemiology, risk factors, and lifestyle modifications for gout

Abstract

Gout affects more than 1% of adults in the USA, and it is the most common form of inflammatory arthritis among men. Accumulating data support an increase in the prevalence of gout that is potentially attributable to recent shifts in diet and lifestyle, improved medical care, and increased longevity. There are both nonmodifiable and modifiable risk factors for hyperuricemia and gout. Nonmodifiable risk factors include age and sex. Gout prevalence increases in direct association with age; the increased longevity of populations in industrialized nations may contribute to a higher prevalence of gout through the disorder's association with aging-related diseases such as metabolic syndrome and hypertension, and treatments for these diseases such as thiazide diuretics for hypertension. Although gout is considered to be primarily a male disease, there is a more equal sex distribution among elderly patients. Modifiable risk factors for gout include obesity, the use of certain medications, high purine intake, and consumption of purine-rich alcoholic beverages. The increasing prevalence of gout worldwide indicates that there is an urgent need for improved efforts to identify patients with hyperuricemia early in the disease process, before the clinical manifestations of gout become apparent.

Figure 1

Cumulative incidence of gouty arthritis by prior urate levels. Reproduced from [1]. Copyright 1987 with permission from Excerpta Medica Inc.

Figure 2

Dietary influences on the risk for gout and their implications within a Healthy Eating Pyramid. Data on the relationship between diet and the risk for gout are primarily derived from the recent Health Professionals Follow-Up Study [15,32,33]. Upward solid arrows denote an increased risk for gout, downward solid arrows denote a decreased risk, and horizontal arrows denote no influence on risk. Broken arrows denote potential effect but without prospective evidence for the outcome of gout. Adapted from [48]. Copyright 2005 with permission from American College of Physicians.