Both metabolic syndrome and alcohol intake were associated strongly with gout. 

I suspect that primary care clinicians who treat patients with gout usually concentrate on drug therapy, but two reports remind us also to address behaviours and lifestyle-related factors.

Korean researchers used a national health service database to examine associations between metabolic syndrome and gout; they identified 1.3 million men (age range, 20 to 39 years) with no history of gout who had three general health check-ups during a five-year period. At each check-up, the researchers recorded the presence or absence of metabolic syndrome (i.e. having at least three of five traditional components: abdominal obesity, low HDL cholesterol level and elevated blood pressure, fasting glucose and triglycerides). During four-year follow up, people who met metabolic syndrome criteria at all three check-ups were four times more likely to receive diagnoses of gout than were people who did not meet those criteria. People who met criteria at one or two (but not all three) check-ups had intermediate risks for gout.

In another study, researchers in China recorded the presence or absence of tophi – using both physical examination and ultrasound – in 554 patients with gout. Alcohol intake was defined as ‘excessive’ (more than 70 g weekly) or moderate (70 g or less weekly). Patients in either category were roughly twice as likely as nondrinkers to have tophi.

Comment: These studies remind us to address alcohol intake and contributors to metabolic syndrome when we manage patients with gout. The associations likely are causal, at least in part: findings in both studies were adjusted for potentially confounding factors, and both sets of authors briefly discuss plausible physiological mechanisms.

Allan S. Brett, MD, Clinical Professor of Medicine, University of Colorado School of Medicine, Aurora, USA.

Eun Y, et al. Altered risk of incident gout according to changes in metabolic syndrome status: a nationwide, population-based cohort study of 1.29 million young men. Arthritis Rheumatol 2023; 75: 806-815. Han L, et al. Association of the quantity, duration, and type of alcohol consumption on the development of gouty tophi. Arthritis Care Res (Hoboken) 2023; 75: 1079 -1087.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine.