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Extended report
Purine-rich foods intake and recurrent gout attacks
  1. Yuqing Zhang1,
  2. Clara Chen2,
  3. Hyon Choi1,3,
  4. Christine Chaisson2,
  5. David Hunter4,
  6. Jingbo Niu1,
  7. Tuhina Neogi1,3
  1. 1Clinical Epidemiology Research and Training Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  2. 2Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts, USA
  3. 3Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  4. 4Department of Rheumatology, University of Sydney, New South Wales, Australia
  1. Correspondence to Yuqing Zhang, Boston University, Boston University School of Medicine, 715 Albany Street, A203, Boston, Massachusetts MA 02118, USA; yuqing{at}


Objective To examine and quantify the relation between purine intake and the risk of recurrent gout attacks among gout patients.

Methods The authors conducted a case-crossover study to examine associations of a set of putative risk factors with recurrent gout attacks. Individuals with gout were prospectively recruited and followed online for 1 year. Participants were asked about the following information when experiencing a gout attack: the onset date of the gout attack, clinical symptoms and signs, medications (including antigout medications), and presence of potential risk factors (including daily intake of various purine-containing food items) during the 2-day period prior to the gout attack. The same exposure information was also assessed over 2-day control periods.

Results This study included 633 participants with gout. Compared with the lowest quintile of total purine intake over a 2-day period, OR of recurrent gout attacks were 1.17, 1.38, 2.21 and 4.76, respectively, with each increasing quintile (p for trend <0.001). The corresponding OR were 1.42, 1.34, 1.77 and 2.41 for increasing quintiles of purine intake from animal sources (p for trend <0.001), and 1.12, 0.99, 1.32 and 1.39 from plant sources (p=0.04), respectively. The effect of purine intake persisted across subgroups by sex, use of alcohol, diuretics, allopurinol, NSAIDs and colchicine.

Conclusions The study findings suggest that acute purine intake increases the risk of recurrent gout attacks by almost fivefold among gout patients. Avoiding or reducing amount of purine-rich foods intake, especially of animal origin, may help reduce the risk of gout attacks.

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  • Contributors YZ and TN had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding Arthritis Foundation, American College Rheumatology Research and Education Fund, and NIH.

  • Competing interests None.

  • Ethics approval Approval provided by the Institutional Review Board of Boston University Medical Campus.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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