Gout: History, Research, and Recent NIH–Supported Advances

Gout—Before Modern Medicine

Before medical research discovered the causes and possible cures for gout, the disease was treated as a painful curse and blamed on a variety of dietary and physical reasons.

In this 1815 caricature, the artist Henry William Bunbury seems to blame strong drink, aided by a demon, to explain the terrible pain and swelling of the sufferer.

Research Findings

Because uric acid’s role in gout is well understood and medications are widely available, gout is one of the most controllable forms of arthritis. But researchers continue to make advances that someday may prevent this extremely painful disease. Some promising areas include:

• Refining current treatments. Recent studies have compared the effectiveness of different NSAIDs and looked at the best dosages of colchicine and allopurinol (a uric acid-lowering drug) to control and/or prevent painful attacks.
• Evaluating new therapies. A number of new therapies based on biologic agents that block a chemical called tumor necrosis factor, believed to play a role in gout inflammation, have shown promise.
• Discovering the role of foods. Certain foods may prevent gout. For example, a high intake of low-fat dairy products has been found to reduce the risk of gout in men by half. Another study suggests that vitamin C may be of use in the prevention and management of gout and other diseases associated with uric acid production.
• Searching for new approaches. Scientists are also studying how urate crystals lead to acute as well as chronic gout and cause debilitating bone problems among people with chronic gout. Better understanding of gout’s inflammatory reactions may provide clues for treatment.
• Examining genes and the environment. Researchers are studying different populations to determine how certain genes and environmental factors may affect uric acid production and result in gout.

Recent NIH-Supported Advances

Gout in Women – Analyzing data between 1950 and 2002 from the Framingham Heart Study, researchers have found that higher levels of uric acid in the blood increase the risk of gout among women, although at a lower rate than among men. Increasing age, obesity, alcohol consumption, hypertension, and diuretic use also were associated with gout among women

Obesity, Younger Age and Gout – As part of an 18-year study of heart disease and cancer, begun in 1989, of more than 15,000 residents in and around Washington County, Maryland, researchers associate obesity and younger age with gout onset. While the overall mean age for gout was 59.3 years, gout occurred 3.1 years earlier in obese participants. For participants who were 21 years old and obese at the beginning of the study, gout came on 11 years earlier.

Fructose-Rich Beverages and Risk of Gout in Women – Based on an analysis of data from the Nurses’ Health Study, which ran from 1984-2006, researchers linked consumption of fructose-rich beverages to an increased although modest risk of gout in women.