Clinical research study
Alcohol Quantity and Type on Risk of Recurrent Gout Attacks: An Internet-based Case-crossover Study

https://doi.org/10.1016/j.amjmed.2013.12.019Get rights and content

Abstract

Objectives

Although beer and liquor have been associated with risk of incident gout, wine has not. Yet anecdotally, wine is thought to trigger gout attacks. Further, how much alcohol intake is needed to increase the risk of gout attack is not known. We examined the quantity and type of alcohol consumed on risk of recurrent gout attacks.

Methods

We conducted a prospective Internet-based case-crossover study in the US among participants with gout and who had at least one attack during the 1 year of follow-up. We evaluated the association of alcohol intake over the prior 24 hours as well as the type of alcoholic beverage with risk of recurrent gout attack, adjusting for potential time-varying confounders.

Results

This study included 724 participants with gout (78% men, mean age 54 years). There was a significant dose-response relationship between amount of alcohol consumption and risk of recurrent gout attacks (P <.001 for trend). The risk of recurrent gout attack was 1.36 (95% confidence interval [CI], 1.00-1.88) and 1.51 (95% CI, 1.09-2.09) times higher for >1-2 and >2-4 alcoholic beverages, respectively, compared with no alcohol consumption in the prior 24 hours. Consuming wine, beer, or liquor was each associated with an increased risk of gout attack.

Conclusions

Episodic alcohol consumption, regardless of type of alcoholic beverage, was associated with an increased risk of recurrent gout attacks, including potentially with moderate amounts. Individuals with gout should limit alcohol intake of all types to reduce the risk of recurrent gout attacks.

Section snippets

Study Design

The Boston University online gout study is an Internet-based case-crossover study conducted over the period of 2003-2012 to examine a set of putative risk factors for recurrent gout attacks. The details of the study have been described previously.10, 14, 15 In brief, we constructed a Web site (https://dcc2.bumc.bu.edu/GOUT) on an independent secure server within the Boston University Medical Center domain. Recruitment occurred primarily by means of an advertisement on Google linked to the

Results

There were 724 participants (mean age 54 years) who completed both hazard and control period questionnaires over a consecutive 12-month period between February 2003 and January 2012. As shown in Table 1, the majority of participants was male (78%), obese (mean BMI 32 kg/m2), and white (89%). Participants were recruited from 49 states and the District of Columbia. Of these participants, 614 (85%) met the ACR Preliminary Classification Criteria for Gout. Approximately 48% were on urate-lowering

Discussion

Anecdotally, while alcohol has been thought to trigger gout attacks, the results from our study confirm that alcohol intake, potentially even moderate amounts, increases the risk of recurrent gout attacks in a short time following consumption. Further, all types of alcoholic beverages, whether it was wine, beer, or liquor, were associated, to varying degrees, with an increased risk for recurrent gout attacks. These effects were stronger in the presence of high purine intake and diuretic use,

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    Funding: TN's support included National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) K23 AR055127, Arthritis Foundation Arthritis Investigator Award, American College of Rheumatology Research Education Fund Junior Career Development Award in Geriatric Medicine (T. Franklin Williams Scholars Program); YZ's support included NIAMS AR47785, American College of Rheumatology Research Education Foundation Health Professional Investigator Award.

    Conflict of Interest: None.

    Authorship: All of the work is original, all authors meet criteria for authorship, including acceptance of responsibility for scientific content of the manuscript. All authors had access to the data and a role in writing the manuscript.

    Boston University Medical Center Institutional Review Board approval protocol number: H-22804.

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