Primary Care Research

Factors leading to gout and its management are different in women and men

About 5 million Americans suffer from gout, a painful inflammation of joints caused by defects in uric acid metabolism. While gout has long been thought of as a condition primarily affecting men over the age of 60, women may come down with gout as often as men. Factors leading to gout, as well as its management, are different in women and men, according to a new study. Women with gout were older (mean age of 70 vs. 58), had a greater number of coexisting medical conditions, and received diuretics more often (77 vs. 40 percent). Diuretics are often used to control hypertension, which is more common in women than in men over the age of 50. Both diuretics and hypertension predispose a person to gout. Thus, current recommendations of diuretics for hypertension may affect the rate of gout, particularly among older women, note the researchers.

The researchers examined data from 1.4 million members of 7 U.S. managed care plans from 1999 through 2003. They identified 6,133 adult members with gout (4,975 men and 1,158 women). They also identified new users of urate-lowering drugs (ULDs). About 56 percent of men and women received the ULD allopurinol, yet, after controlling for age, coexisting conditions, and use of diuretics, women were less likely to receive this medication. Women received glucocorticoids and narcotics more often than men, possibly suggesting they had more severe or chronic gout, or were less tolerant of other gout treatments. Further study is needed to determine whether the elevated use of glucocorticoids and narcotics by women in this study was in fact related to gout or was related to the presence of other conditions where these medications can be used.

Only 37 percent of new users of ULDs had appropriate surveillance of serum urate levels within 6 months after beginning treatment with ULDs. However, after controlling for age, coexisting conditions, gout treatments, number of ULD dispensings, and health plan, women were 36 percent more likely to receive the recommended serum urate level monitoring.

The study was conducted by researchers at the Centers for Education and Research at the HMO Research Network and the University of Alabama, which are supported by the Agency for Healthcare Research and Quality (HS10391 and HS10389).

See "Sex differences in gout epidemiology: Evaluation and treatment," by Leslie R. Harrold, M.D., M.P.H., Robert A. Yood, M.D., Ted R. Mikuls, M.D., and others, in the October 2006 Annals of the Rheumatic Diseases 65, pp. 1368-1372.

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