Drinking wine may cause a gout flare

Originally published in Arthritis Self-Management, May 2014

Diet, including the consumption of alcohol, has long been cited as a potential trigger for gout flares. However, it had been thought that wine, drunk in moderation, did not greatly increase a person’s gout flare risk. But a study suggests wine may not only increase the risk, it may do so more than beer or hard liquor.

Gout is thought to affect more than 8 million Americans, making it the most common form of inflammatory arthritis in the United States. In people with gout, increased blood levels of a substance called uric acid lead to the formation of crystals in joints, which can cause redness, inflammation and pain so intense that an acute flare of gout is often touted as one of the most painful events in any form of arthritis.

Gout is more common in men, postmenopausal women and people with diabetes, obesity and certain cardiovascular problems. Eating certain foods—such as organ meats, red meats and lobster—is thought to increase a person’s risk of a gout flare, as is drinking alcoholic beverages, especially beer. But the results of a 2004 study of nearly 50,000 people suggested moderate wine consumption may not greatly increase a person’s risk.

However, the findings of a study published in 2014 in The American Journal of Medicine may prompt people with gout to steer clear of wine as well. The study authors said much of the research looking at the link between gout and alcohol—including the study from 2004—focused on a person’s first gout attack, rather than looking at the risk of subsequent, recurrent attacks in people with established gout. To see what effect the moderate consumption of different kinds of alcohol might have on people who already have gout, the researchers looked at a year’s worth of gout attacks in more than 700 people who had at least one gout attack the year before.

Over the course of a year, the researchers asked the study participants to fill out a questionnaire when they had an attack of gout. The questionnaire asked about possible risk factors for gout, such as what the participants ate and drank, in the 24 hours before the attack. For comparison, the researchers also asked participants to fill out questionnaires about 24-hour periods when they had not had attacks.

The researchers found that regardless of the type of alcohol drunk, drinking one alcoholic drink in a 24-hour period didn’t seem to increase a person’s risk of a flare that much. But drinking any more than that resulted in a one-third increase in the risk of a gout attack compared to not drinking at all. And the more a person drank, the more his risk of a flare increased. Compared to not drinking at all, having more than 2-4 drinks over 24 hours raised a person’s risk of a flare 50%, having more than 4-6 drinks doubled the risk of a flare and having more than 8 drinks more than tripled it.

When the researchers looked at the risks associated with specific kinds of alcoholic drinks, they found more than 1-2 glasses of wine more than doubled a person’s risk of a flare. Drinking the equivalent of about twice as many cans of beer or shots of hard liquor only increased a person’s risk about half as much.

The researchers said previous studies may have found less of a risk with wine because people who drink wine tend to eat healthier diets than people who drink beer. Since this study compared each participant’s gout risk at different times, it may have better isolated the effects of each beverage from those of a person’s diet and overall lifestyle.

They also said the risk factors for a first gout attack and a recurrent gout attack may be different.

The researchers also found allopurinol (brand name Aloprim) and colchicine (Colcrys), drugs commonly used to treat gout, helped to lessen the negative effects of alcohol on gout. Nonsteroidal anti-inflammatory drugs (NSAIDs) did not seem to have much of an effect.

The study had limitations. For example, the participants may have misremembered how much they drank, especially given the common belief that alcohol can trigger a flare.

Although diet is an important tool in preventing acute attacks of gout, it is just one part of successful gout management. If you have gout or are at risk for gout, talk to your doctor about finding the right combination of lifestyle changes and medicines to help you avoid flares.

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