Gout Presentation and Symptoms by Gender
Gout presentation and gout symptoms vary in distinct ways across genders. Specifically, the age of onset is the first difference in presentation with men often developing gout earlier in their lives, while women experience their first gout flares, usually, after menopause.2 In a different physical way, women are more likely than men to experience gout flares in joints other than the podagra (big toe), such as ankles, knees, wrists, or fingers.3 This atypical joint involvement can lead to misdiagnosis or delayed diagnosis of gout in women. Gout presentation and symptoms are heavily influenced by hormones, with estrogen levels in women tending to be protective against gout by promoting uric acid excretion through the kidneys. In turn, premenopausal women have lower uric acid levels compared to men, making for a less common diagnosis. However, after menopause, women’s uric acid levels increase as estrogen levels decline, leading to a higher risk of gout.4 Hormones are not the only thing distinguishing gout prevalence in women, “According to a 2023 analysis of more than 100,000 adults hospitalized with gout in Spain between 2005 and 2015, women were 10 years older than men and had very different co-existing conditions.”3 Beyond presentation of gout, treatment and management of the disease can also be impacted by gender.
Risk Factors of Gout Between Genders
General risk factors of gout include high uric acids levels in one’s blood, a diet high in purines, genetic predispositions, obesity and other health issues, as well as age, ethnicity, gender, medications, and joint injury. Due to these risk factors, men are traditionally more affected by gout than women, with a notable disparity before the age of 50. A recent study showed, “gout is more common in men than women, with only 5.1% of the US gout population being female.”1 Post-menopausal women see a significant increase in incidence, aligning more closely with men’s rates, due to the role of hormonal changes in disease dynamics. Although men are more frequently diagnosed with gout, the burden of the disease can be heavier on women due to later diagnosis and the likelihood of having multiple comorbid conditions. In terms of age, since gout is more common at younger ages for men and the gap narrows after women reach menopause, it is suggested that gender-specific biological and lifestyle factors contribute to the risk of gout.
Treatment and Management of Gout Between Genders
Gout treatment and management comes with its challenges when working with women, as comorbidities like obesity, concomitant hypertension, renal dysfunction, chronic kidney disease, and diabetes are 25% more common for women than men. Women also experience a greater disease burden due to gout than males. “While nonbiological causes may possibly contribute to this sex discrepancy in burden, this raises questions regarding whether current gout pharmacotherapies are as efficacious in females as they are in males.”5 When looking to manage gout in men and women, with different comorbidities and risk factors, urate-lowering therapies differ. A considerably large number of affected women compared to men require treatment with pain relievers during gout flares. This unequal burden experienced by female gout patients may stem from several factors. Women are less likely to be prescribed allopurinol and to receive a definite diagnosis of gout through synovial fluid crystal analysis compared to men. However, this gender gap in gout burden prompts the question of whether current gout treatments are as effective in women as they are in men.
Regarding management, current ACR guidelines recommend treating acute gout flares with NSAIDS, colchicine, and glucocorticoids (systemic or intraarticular), in addition to supportive care with topical ice. For the management of gout across age and gender, it is recommended to discuss treatment options case-by-case to decide which urate-lowering therapy is right for patients and their possible comorbidities.
References:
1. Evans PL, Prior JA, Belcher J, Hay CA, Mallen CD, Roddy E. Gender-specific risk factors for gout: a systematic review of cohort studies. Advances in Rheumatology. 2019;59(1). doi:https://doi.org/10.1186/s42358-019-0067-7
2. Singh JA. Racial and Gender Disparities Among Patients with Gout. Current Rheumatology Reports. 2012;15(2). doi:https://doi.org/10.1007/s11926-012-0307-x
3. Gout Affects Women Differently | Arthritis Foundation. www.arthritis.org. https://www.arthritis.org/diseases/more-about/women-not-immune-to-gout
4. Risk Factors of Gout in Women. www.midtownfootcare.com. Accessed May 15, 2024. https://www.midtownfootcare.com/blogs/item/104-risk-factors-of-gout-in-women#:~:text=Women%20are%20more%20likely%20to 5. Patel AV, Gaffo AL. Managing Gout in Women: Current Perspectives. Journal of Inflammation Research. 2022;Volume 15:1591-1598. doi:https://doi.org/10.2147/jir.s284759
