It was once thought that gout, the so-called “disease of kings,” typically spared queens. But in the last 20 years, cases of gout have more than doubled among women. Today, 2 million women – and 6 million men – in the U.S. have this inflammatory form of arthritis that causes joint swelling and telltale pain at the base of the big toe.
Natural Gout Protection and Potential Triggers
Gout occurs when high levels of uric acid build up in the blood and form needle-shaped crystals in the joints, causing pain, swelling and redness. Estrogen, a female hormone, protects women. It naturally causes uric acid to be flushed out in their urine. When women lose estrogen after menopause, the level of uric acid in their blood starts to rise.
“The clock starts ticking after menopause in women,” says Brian F. Mandell, MD, rheumatologist at the Cleveland Clinic in Ohio and board member of The Gout & Uric Acid Education Society. “
That’s why, he says, it’s rare to see a premenopausal woman or a woman on estrogen replacement therapy with gout. When a woman comes in with gout before age 60, she usually has other risk factors, including taking diuretics or a history of kidney problems.
But there’s more at work than just hormones. A study published in 2017 in BMC Musculoskeletal Disorders found that in addition to being older, women with gout were more likely than men to have other conditions – including high blood pressure, diabetes, kidney disease and obesity. The research also showed that taking diuretics was more of a risk factor for women, while men had more dietary triggers.
These findings suggest ways to help manage gout in women in addition to uric acid-lowering drugs. For example, the study authors reported that weight loss has been shown to decrease gout flares and can improve the management of associated comorbid conditions, such as osteoarthritis and diabetes.
How Gout Manifests in Women
Women tend to develop gout in their knees, toes, wrists and ends of their fingers.
“In women, gout likes to travel to those distal finger joints where they may already have some osteoarthritis-related damage,” explains Theodore Fields, MD, a rheumatologist at The Hospital for Special Surgery in New York City.
Sudden and severe attacks of gout – that can wake you up in the middle of the night – are the most common first symptom. But in women gout is more likely to appear in multiple joints slowly over time as compared to men.
“In women, it seems there is a greater prevalence of the initial episode of gout being in multiple joints. It may not always be the typical swollen great toe. In the hands this is often misdiagnosed as inflammatory osteoarthritis when it may actually be attacks of gout,” Dr. Mandell says.
Treating Gout is Key to Overall Health
Atypical symptoms unfortunately can lead to misdiagnosis. But recognizing gout in women is critical for both heart and kidney health.
A 2010 study published in the Annals of Rheumatic Diseases looked at 9,642 people over age 65 with gout and 48,210 matched people without gout. Results showed that women with gout were about 39% more likely to have a heart attack than the control group. In comparison, men with gout were only 11% more susceptible to cardiovascular disease.
The culprit? Physicians think high levels of uric acid increase inflammation and make blood platelets “stickier,” which can lead to blood clots.
The good news is uric acid-lowering medications are highly effective. It was once thought that eating a low-purine diet might be enough to stave off attacks, but Dr. Fields explains this method alone usually fails to lower uric acid levels enough.
“There is a huge misconception that gout is a dietary disease,” he says. “Diet can make gout worse, but it is really a genetic disease.”
The bottom line for women:
- Gout can show up in unusual places, so talk to your doctor.
- Take your medication as prescribed.
- Pay special attention to your heart and kidney health.
Author: Carolyn Sayre
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