From the Guidelines
Gout is primarily triggered by high levels of uric acid in the blood, and common triggers include consuming purine-rich foods, alcoholic beverages, and certain medications, as well as dehydration and underlying medical conditions. The most recent and highest quality study on gout management is from the American College of Physicians in 2017 1, but for triggers of gout, the most relevant study is from the Autoimmunity Reviews in 2018 1. According to this study, the main causal factors for primary gout seem to be diet and genetic polymorphisms of renal transporters of urate. Some key points to consider when managing gout triggers include:
- Consuming purine-rich foods such as red meat, organ meats, seafood (especially shellfish, anchovies, and sardines) can increase uric acid levels
- Alcoholic beverages, particularly beer, can also increase uric acid levels
- Sugary drinks and foods with high-fructose corn syrup can contribute to gout flares
- Certain medications like diuretics, low-dose aspirin, and some blood pressure medications may precipitate gout attacks
- Dehydration can concentrate uric acid in the blood and trigger an attack
- Medical conditions including obesity, metabolic syndrome, diabetes, kidney disease, and rapid weight loss can contribute to gout flares
- Trauma or surgery to a joint may also trigger an attack in susceptible individuals
- Genetics plays a role too, as some people have inherited enzyme defects that affect uric acid metabolism To prevent gout attacks, patients should maintain adequate hydration, limit alcohol consumption (especially beer), reduce intake of purine-rich foods, achieve and maintain a healthy weight, and take prescribed medications like allopurinol or febuxostat consistently to lower uric acid levels, as recommended by the 2012 American College of Rheumatology guidelines for management of gout 1.
From the FDA Drug Label
Hyperuricemia may be primary, as in gout, or secondary to diseases such as acute and chronic leukemia, polycythemia vera, multiple myeloma, and psoriasis It may occur with the use of diuretic agents, during renal dialysis, in the presence of renal damage, during starvation or reducing diets, and in the treatment of neoplastic disease where rapid resolution of tissue masses may occur. Gout is a metabolic disorder which is characterized by hyperuricemia and resultant deposition of monosodium urate in the tissues, particularly the joints and kidneys. The etiology of this hyperuricemia is the overproduction of uric acid in relation to the patient's ability to excrete it An increase in acute attacks of gout has been reported during the early stages of administration of allopurinol tablets, even when normal or subnormal serum uric acid levels have been attained.
The triggers of gout include:
- Primary hyperuricemia, as in gout
- Secondary hyperuricemia due to diseases such as:
- Acute and chronic leukemia
- Polycythemia vera
- Multiple myeloma
- Psoriasis
- Use of diuretic agents
- Renal dialysis
- Renal damage
- Starvation or reducing diets
- Treatment of neoplastic disease with rapid resolution of tissue masses
- Early stages of administration of allopurinol tablets, even with normal or subnormal serum uric acid levels 2, 2, 2
From the Research
Triggers of Gout
- Triggers of gout include dietary factors, lifestyle factors, and other health conditions 3
- Commonly reported triggers of acute gout attacks include:
- The risk of recurrent gout attacks is associated with the quantity and type of alcohol consumed, with a significant dose-response relationship between amount of alcohol consumption and risk of recurrent gout attacks 4
- Consuming wine, beer, or liquor is each associated with an increased risk of gout attack, and individuals with gout should limit alcohol intake of all types to reduce the risk of recurrent gout attacks 4
Demographic Factors
- Patients who had onset of gout before the age of 50 years were significantly more likely to identify a trigger for precipitating their acute gout attacks 3
- Most people with gout do not identify any triggers for acute attacks, and identifiable triggers are more common in those with young onset gout 3
Prevention and Management
- To reduce the likelihood of recurrent flares, patients should limit their consumption of certain purine-rich foods (e.g., organ meats, shellfish) and avoid alcoholic drinks (especially beer) and beverages sweetened with high-fructose corn syrup 5
- Consumption of vegetables and low-fat or nonfat dairy products should be encouraged 5
- The use of loop and thiazide diuretics can increase uric acid levels, whereas the use of the angiotensin receptor blocker losartan increases urinary excretion of uric acid 5
- Reduction of uric acid levels is key to avoiding gout flares, and medications such as allopurinol and febuxostat can be used to prevent recurrent gout 5, 6