Risk Factors & Triggers
There are a number of risk factors for gout. The more risk factors a person has, the greater the risk for developing gout. When examining a patient, take the following risk factors into consideration to ensure a proper diagnosis:
- Hyperuricemia – Classified as a serum uric acid above 6.8 mg/dL, hyperuricemia is the metabolic background for developing gout. For those with gout, the target goal is a serum uric acid level less than 6.0 mg/dL, and lower in those with advanced disease.
- Family History – Gout clusters in families and is more prevalent in certain Asian sub groups (e.g. Pacific Islanders, Māoris).
- Age – Gouty arthritis can occur in anyone at any age, but it typically develops in men over age 45 and post-menopausal women.
- Gender – Gout affects men more than women, although once women are post-menopausal, their rates of gout increase almost (but not quite) to the same level as men.
- Ethnicity – The incidence of gouty arthritis and comorbid conditions varies by ethnicity. For example, in the U.S., Hispanics and African Americans who have features of metabolic syndrome are more likely to develop gout.
- Obesity – Someone with a Body Mass Index (BMI) of 30 or higher is considered obese and is at higher risk for gout.
- Comorbidities – Gout is associated with other comorbidities, including cardiovascular disease, diabetes and renal disease.
- Joint Injury – Urate crystals are more likely to form in a joint that was previously damaged. Recent injuries can also bring on a flare.
- Use of Certain Medications – This especially includes diuretics or water pills and certain anti-rejection medications used in transplant patients.
Gout triggers can differ from one patient to another. Once a patient identifies specific triggers, gout can be easier to manage. Common triggers include:
- Alcohol consumption, especially beer
- Purine-rich foods, especially red meat and shellfish
- High-fructose laden foods
- Crash diets, including high-protein fad diets
- Starting uric acid-lowering therapy without anti-inflammatory coverage
- Bed rest, often post-operative