Health

Gout in Women

 

Dr. Theodore Fields Responds:

May 22nd  of every year has been set aside as “Gout Awareness Day.”

Women are often surprised when told they have gout. They think of gout as something that men get, and they think gout is confined to people who are overweight and eat or drink the wrong things.  However, gout is really not that rare in women. Men are more likely to get gout earlier in life, even in their 20s, but women start to “catch up” with  gout after menopause.

Gout is a condition that is caused by too much uric acid in the system. Crystals of uric acid can then deposit in the joints, and this causes inflammation and pain.  It’s very common, with more than 8.3 million people in America having this condition. Almost always, this is on a genetic basis.  This means that people that don’t have a genetic tendency to gout are very unlikely to get it, no matter what they eat or drink. For people who do have a genetic tendency to gout, certain things can make them get gout flares sooner.  This includes alcohol of all kinds, although beer seems to be especially bad. It also includes red meat, shellfish, and high fructose corn syrup (as in regularly-sweetened sodas). Also, if someone is started on a diuretic (a common drug for controlling high blood pressure), such as hydrochlorothiazide, this could raise the uric acid level and set off a gout flare.

For Eileen, the main reason she has gout is likely genetic. She may well find that someone in her family had gout. Even if she doesn’t know anyone in the family with this history, but it’s likely that it was present at some point in her genetic background.

Women who have gout can get flares in joints that are unusual for men. For example, women are more likely to get gout in the finger joints nearest the fingernails.  Women are less likely than men to get gout in the first toe, although a hot and red first toe is still common in women with gout.  Women, on average, are 10 years older than men when they first develop gout. It is felt likely that estrogen is what delays the onset of gout in women, because it causes more uric acid to come out in the urine and keeps the blood uric acid lower than in men.

It’s very important for people with gout to know that they really don’t have to continue to suffer with this forever.  Our treatments, fortunately, are excellent. We have medications such as allopurinol which can decrease the production of uric acid in the body and lower the uric acid in the blood. This will end up pulling the crystals out of the joint. Once a person stays on a medication that lowers the uric acid for a period of time, in some people 6 months and in some a year or more, gout attacks will generally stop happening.  They will need to stay on the medication essentially forever, but fortunately medications for gout tend to be well-tolerated.

We also have many medications to use when someone has a gout flare.  These are different medications than we use to lower the uric acid. For a gout flare, we use non-steroidal anti-inflammatory drugs, such as naproxen.  We can also use colchicine orally. Another option is using a corticosteroid, such as prednisone, or local steroid injection into the joint. The appropriate medication for the individual person is picked based on what other medical conditions they might have.  If they have a kidney problem, for example, we might avoid naproxen, and if they had diabetes we might avoid prednisone.

Research is continuing to look for even better treatments for gout. A new medication that helps more uric acid come out in  urine was released about a year ago.  Several other medications are under study now that take different approaches to lowering the uric acid.  We presently have a medication that can be given intravenously to dramatically lower the uric acid in very severe gout patients, and a different form of this medication is presently being studied.

All in all, in spite of how painful gout is, we are fortunate that the current treatments are very good. For people who have gout, it’s really important that they speak to their physician about finding their optimal treatment and then sticking with it for the long-term.  We use the term “cure” for gout carefully, since it does require long-term medication along with lifestyle changes. However, the vast majority of people with this condition can ultimately be completely gout-free and consequently, free of symptoms.

 

Dr. Theodore R. Fields has had a special clinical and research interest in gout, dating back to basic research on uric acid crystals during his fellowship and more recent clinical study of unusual presentations of gout and on gout treatment. He is especially interested in and has published several articles on how to best educate people about gout. He is a Professor of Clinical Medicine at Weill Cornell Medical College and an Attending Rheumatologist at Hospital for Special Surgery in New York.

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