Table of Contents
Causes and Risk Factors
Gout is classified as either primary or secondary, depending on what causes the high levels of uric acid in the blood (hyperuricemia).
More than 99% of primary gout cases are referred to as idiopathic, meaning that the cause of the hyperuricemia cannot be determined. Primary gout is most likely the result of a combination of genetic, hormonal, and dietary factors. Secondary gout is caused by drug therapy or by medical conditions other than a metabolic disorder.
The following factors increase your risk for gout:
- Advancing age
- Male gender
- Family history of the condition; genetic predisposition
- Obesity
- Use of certain drugs, including diuretics ("water pills"), low-dose aspirin, cyclosporine, or levodopa
- Binge drinking
- Lead toxicity
- Organ transplants
- Thyroid problems
- Other serious illness
Each risk factor is discussed in more detail below.
Age
Middle-Aged Adults. Gout usually occurs in middle-aged men, peaking in the mid-40s. It is most often associated in this age group with obesity, high blood pressure, unhealthy cholesterol levels, and heavy alcohol use.
Elderly. Gout can also develop in older people, when it occurs equally in men and women. In this group, gout is most often associated with kidney problems and the use of diuretics. It is less often associated with alcohol use.
Children. Except for rare inherited genetic disorders that cause hyperuricemia, gout in children is rare.
Gender
Men. Men are significantly at higher risk for gout. In males, uric acid levels rise substantially at puberty. In about 5 - 8% of American men, levels exceed 7 mg/dL (indicating hyperuricemia). However, gout typically strikes after 20 - 40 years of persistent hyperuricemia, so men who develop it usually experience their first attack between the ages of 30 and 50.
Women. Before menopause, women have a significantly lower risk for gout than men, possibly because of the actions of estrogen. This female hormone appears to facilitate uric acid excretion by the kidneys. (Only about 15% of female gout cases occur before menopause.) After menopause the risk increases in women. At age 60 the incidence is equal in men and women, and after 80, gout occurs more often in women.
Family History/Genetics
A family history of gout is present in close to 20% of patients with this condition. Three genetic locations have been associated with the body's uric acid handling and gout. Some people with a family history of gout have a defective protein (enzyme) that interferes with the way the body breaks down purines.
Obesity
Researchers report a clear link between body weight and uric acid levels. In one Japanese study, overweight people had two to more than three times the rate of hyperuricemia as those who maintained a healthy weight. Children who are obese may have a higher risk for gout in adulthood.
Medications
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Review Date: 01/04/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
