Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dear Dr. Pat,

It took over two years and lots of suffering before I found a specialist at the medical school and teaching hospital in my state to diagnose my painful and increasingly deformed joints caused by gout. The pain began in some of my middle finger joints accompanied by redness and swelling and lasted about ten days at a time at first. I was told that I had rheumatoid arthritis even though the blood tests for this disease were negative. I was treated with drugs with bad side effects for rheumatoid arthritis by my primary care doctor with no relief of pain while more joints became affected. I am 65 years old, long past menopause, overweight, and have had a problem with high blood pressure and social drinking. I don’t drink wine because it gives me a headache, I mostly drink beer. My father died young and I don’t know anything about his family. My mother’s family are all thin and healthy until old age and only have joint pains from “overuse.” I am not an obese man who eats only red meat and drinks a bottle of red wine a day—the classic description of a person with gout. Why don’t doctors know that both women and men get this disease so women can get a diagnosis earlier?

Eileen

Dear Eileen,

You are right that gout has been historically described as a condition that affects older obese men who have a diet high in red meat and red wine and who first develop a red swollen painful big toe. However, a recent national health survey found that about 4% of women in their 60s and 6% of those in their 80s had gout. In one of the first large studies to examine gout by gender, researchers found that in women, just as in men, older age, obesity, high blood pressure, alcohol, and use of diuretics are all risk factors for gout.

Not only is gender disparity in research responsible for the lack of awareness of gout in women, but clinical awareness has lagged as well. The good news is that you have a diagnosis and a treatment plan.  However, you now have to do your part. You are 65 years old with problems of over-eating, drinking too much and diseases that are worsened by these behaviors. You need to become part of the solution, Eileen. Stop the alcohol, find a weight loss plan that works for you to slowly achieve a healthy weight, begin an exercise program that does not cause pain in your affected joints, and take the medication for gout just as it is prescribed.  If you can lower your blood pressure with the weight loss, perhaps you won’t need a medication often given for this disorder that may exacerbate attacks of gout.

May 22nd, tomorrow, is Gout Awareness Day. We have asked  Dr. Theodore Fields, a rheumatologist at the Hospital for Special Surgery, and a member of the Women’s Voices for Change Medical Advisory Board to discuss your concerns.  He has a special interest in the diagnosis and treatment of gout and will provide more information to you and our readers about this painful disorder that is often misdiagnosed or is delayed in diagnosis in women.

Thanks for writing.

Dr. Pat