Dr and female consult

Women’s risk for gout doubles after menopause

August 14, 2023

3 min read


Peterson JR. Gout in menopause. Presented at: Association of Women in Rheumatology annual conference; Aug. 10-13, 2023; Orlando, Florida (hybrid meeting).

Peterson reports no relevant financial disclosures.

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Post-menopausal women demonstrate a risk for gout that is two times that of women who have not yet reached menopause, according to a presenter at the 2023 AWIR annual conference.

“As women get older, the incidence of gout goes up,” Jeff R. Peterson, MD, a rheumatologist at Western Washington Medical Group, in Seattle, told attendees.

Dr and female consult

“I try to get to 3.5 mg/dL if I can,” Jeff R. Peterson, MD, told attendees. “If I can get there, I am out of the risk of new crystals forming.” Image: Adobe Stock

Although the rate of gout among men is higher through most of life, by the time post-menopausal women reach 80 years, the incidence is equal, according to Peterson. The relative risk for women in early transition to menopause is 1.18 compared with women who have not begun menopause.

“By the time you are post-menopausal, the risk is two times,” Peterson said.

The issue is the change in estrogen levels. Meanwhile, hormone replacement therapy can only “help a little,” according to Peterson.

However, he stressed that this information is based on a small body of evidence, much of which comes from South Korea.

“I scoured the planet to find information on this, and there is not much,” Peterson said.

As there are so little data, many physicians fail to diagnose gout in older women, for a number of reasons.

One reason is that the physical manifestations of gout in the hands and feet can resemble arthritis. Peterson showed a photo of an older woman with significant nodes.

“I thought these were just regular old osteoarthritis nodes,” he said. “It happens to us all.”

A companion point is that women often do not experience flares in the same way that men do. However, there are some clues to finding and managing gout in post-menopausal women, he said.

Peterson described BMI as a “big player” in gout development, although the mechanism remains uncertain.

“As we get heavier, we get more gout,” he said. “I don’t think anybody knows the answer to this.”

Additionally, there is a common misperception that diet can “cure” gout, according to Peterson. He noted that the so-called DASH (dietary approaches to stop hypouricemia) diet is “the best we have available,” but comes with a trade-off.

“It is really hard to follow,” Peterson said.

Moreover, this diet, and the equally challenging low purine diet, can only lower serum uric acid by around 1 mg/dL, according to Peterson.

“The Mediterranean diet only drops it by 0.34 mg/dL,” he said. “Diet can help, but not that much.”

Although alcohol of any kind can have a negative impact on gout or gout flares, Peterson said that beer is “a little worse” than distilled spirits, which, in turn, are slightly more problematic than wine.

“Alcohol is dehydrating,” he said. “You need to melt those crystals.”

As with the strict diets, Peterson does not counsel absolute abstinence in his patients. He said that telling patients to quit all unhealthy foods and alcohol can lead to other kinds of adverse consequences. Rather, he encourages moderation and management.

“If it is your birthday and you know you are going to have a lot of drinks, take a colchicine beforehand,” he said.

Beyond alcohol, high fructose corn syrup can be hugely problematic for most gout patients.

“It is in almost everything,” Peterson said. “My advice is to cook for yourself, cook from scratch. At least you know what is going into what you are making.”
eanwhile, although many patients swear by tart cherry juice as a way to improve their gout, Peterson warned against the thinking of this is a kind of miracle treatment.

“You are helping yourself, but is not going to cure you,” he said.

If there is good news, it is that gout is drawing attention in both the research and clinical arenas.

“Gout is becoming more popular,” Peterson said. “As we learn more about it, you guys will be at the forefront of the research.”

Keys management include imaging.

“If you have access to [dual energy] CT scan or ultrasound, use them,” Peterson said.

Peterson’s final point pertained to treatment targets.

“I go lower than the ACR recommends,” he said.

For post-menopausal women, Peterson recommended a serum uric acid level of 4 mg/dL.

“I try to get to 3.5 mg/dL if I can,” he said. “If I can get there, I am out of the risk of new crystals forming.”

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