Q: I seem to be hearing about more people with gout than I used to. Is it just my experience or has something changed to make gout more common?
A: Gout is on the rise. According to the most recent estimates, nearly 4% of the adult population in the U.S. now has gout, while less than 3% had it 25 years ago. The increase is thought to be due to rising rates of obesity, use of certain medications, and the rising popularity of high-fructose corn syrup (as found in carbonated beverages and many other foods and drinks).
Gout develops when crystals of uric acid (a normal byproduct of our body's metabolism) deposit near joints and other parts of the body. This triggers inflammation in one or more joints and sometimes in other body parts.
Gout develops because the body makes too much uric acid, the kidneys don't get rid of enough of it, or a combination of both. For some, dietary factors — consuming foods and beverages that produce a lot of uric acid — seem to play a role. For others, the problem may be one or more medications that cause the level of uric acid to rise.
Genetic factors are also important; the way the body handles uric acid may vary based on the genes you inherit. The observation that gout sometimes runs in families supports a genetic contribution.
Gout used to be called "The disease of kings." This was supposedly because in ancient times, only those who were wealthy enough to consume a lot of alcohol, red meat, and organ meats (such as liver) tended to get gout. While Henry VIII reportedly had gout, it can no longer be considered the disease of kings. People of any socioeconomic status can have gout.
Diet may matter less than we thought. In a recent study, researchers analyzed dietary surveys, genetic analyses, and uric acid levels among more than 16,000 people in the U.S.. They found that dietary choices accounted for less than 0.5 percent of the variation in uric acid, while genetic factors accounted for about 24 percent. Since gout is caused by high uric acid, this study suggests that genetics matter much more than diet when it comes to the risk of gout.
Among all forms of arthritis, gout is among the most preventable and treatable. Some of the best ways to avoid gout include maintaining a healthy weight, moderating alcohol consumption, and maintaining a healthy blood pressure.
Although gout can be temporarily debilitating, excellent treatments are available. These include several medications (including corticosteroids, anti-inflammatory medications, and colchicine) to treat a sudden gout attack, and others (including allopurinol and febuxostat) that can prevent future attacks by lowering uric acid.
Robert H. Shmerling, M.D., is associate professor of Medicine at Harvard Medical School and Clinical Chief of Rheumatology at Beth Israel Deaconess Medical Center in Boston. For additional consumer health information, please visit www.health.harvard.edu.