Risking More Than a Hangover

Imagine your toe or your ankle caught in a vise-like grip — that’s how many patients describe the excruciating pain of gout, a disease that limits the body’s ability to excrete uric acid. Certain foods, such as red meat, have been known to worsen the condition, but a recent School of Medicine study has linked gout flare-ups to alcohol consumption as well.

Gout, also called metabolic arthritis, occurs when an excess of uric acid forms needle-like crystals in the cartilage of a joint and in the surrounding tissues. Alcohol consumption has long been suspected to trigger gout attacks, but the hypothesis had not formally been tested until Yuqing Zhang, a MED professor of medicine and epidemiology, and his colleagues studied 279 patients who had episodes of gout within the previous year. The study was published in the September issue of the American Journal of Medicine.

Yuqing Zhang, MED
professor of medicine.

Contrary to assumptions in the medical community, Zhang found that it doesn’t take heavy drinking to set off a gout attack. Even a light-to-moderate amount of alcohol can cause inflammation of tissues — usually in the big toe — within 24 hours of imbibing. “Those who drank five to six alcoholic beverages during a 48-hour period were twice as likely to have a recurrent attack than individuals who did not drink,” says Zhang. Patients who drank seven or more drinks over a two-day period were two and a half times more likely to experience a gout flare-up than those who abstained.

Previous research on gout has suggested that beer may aggravate the condition more than wine and spirits because brewer’s yeasts are rich in purines, which are organic compounds that elevate uric acid levels. The MED study found, however, that no specific alcoholic drinks were associated with an increased risk. “We believe that the total amount of ethanol, rather than other components in different types of alcoholic beverages, is responsible for triggering gout attacks,” says David Hunter, a MED assistant professor of medicine and one of the study’s authors.

Gout affects about 8.4 of every 1,000 people in the United States, and its incidence is increasing in industrialized nations, where foods high in purines, including red meat, sausage, kidney, liver, peanuts, and dairy products, are consumed in larger quantities.  Many physicians believe the disease, which can lead to permanent joint and kidney damage, is caused by a combination of dietary factors and an ongoing lack of physical activity, but others point to a genetic predisposition in some patients, along with a nonfunctioning enzyme that would normally help the body break down purines. Zhang believes that drinking alcohol increases uric acid levels while also causing dehydration, so that the uric acid is not flushed from the body.

Participants in the study were predominantly male (80 percent) and white (88 percent), and their average age was 52. Zhang and his colleagues examined the amount and type of alcohol consumption and weighed in such factors as the purine content in the food subjects ate before the flare-up as well as their use of diuretics, which decrease the amount of uric acid.

“There are studies that show that moderate drinking lowers your risk for coronary heart disease, but that means having four to five drinks a week, which could touch off gout symptoms,” says Zhang. “People with established gout should avoid drinking alcohol altogether.”

Although there are effective drug treatments for gout, patients often suffer from repeated attacks. Many investigations have concentrated on risk factors for the initial occurrence of the disease, “but few of the past studies have looked at what causes acute episodes among those already diagnosed with the gout,” says Christine Chaisson, associate director of operations at the BU School of Public Health Data Coordinating Center and one of the study’s authors. 

The other researchers involved in the study are Tuhina Neogi, a MED assistant professor of medicine, Jingbo Niu, a MED research associate, Ryan Woods, a statistical analyst at the SPH Data Coordinating Center, and Timothy McAlindon, an associate professor of medicine at the Tufts University School of Medicine.

Brian Fitzgerald can be reached at bfitzger@bu.edu.