Gout Around the Globe

Gout used to be called the “disease of kings” or the “rich man’s disease” because it was believed that the disease was caused by a “rich” diet — one high in alcohol, red meat, and seafood. We now know that the facts are not that simple, but a new research paper examining the incidence of gout in different parts of the world has discovered that the illness is in fact more prominent in affluent countries.

The new report, a review of the current literature on the available statistical information about gout, concluded that the condition is most common in North America and western Europe, where it affects from 1 to 4 percent of the population. For the United States, the figure is 3.9 percent of adults 20 and over.

Gout is rare in Guatemala, Iran, Malaysia, the Philippines, Saudi Arabia, rural Turkey, Africa, and the regions of the former Soviet Union, while the highest incidence is reported among the native Taiwanese population and the Maori of New Zealand. The report also found that the prevalence of gout in affluent countries appears to be increasing. The trend parallels a recognized increase in hyperuricemia, an abnormally high level of uric acid in the blood that seems to be the main risk factor for gout.

The report also said that the incidence of gout generally increases with age, reaching a plateau at age 70. Although gout is more common in men, the risk among women rises greatly after menopause.

The report concluded that the major risk factors for gout include not only hyperuricemia, but also dietary factors, medications, exposure to lead, comorbidities (other diseases that exist alongside the gout), obesity, and certain tissue characteristics that facilitate the growth of monosodium urate (MSU) crystals, which cause the inflammation and tissue damage in gout.

The report also found that gout is more common in people with psoriasis and sickle cell anemia. A connection appears to exist between gout and the use of diuretics, or “water pills,” which are commonly used in treating high blood pressure. (Rates of high blood pressure have been increasing globally as well.) Finally, it’s becoming clear that a person’s ethnic background affects the chance of getting gout and that some people have a substantial genetic predisposition to the disease. African Americans and other ethnic minorities tend to have a higher prevalence of gout, the researchers found.

Joseph Gustaitis is a freelance writer and editor based in the Chicago area.

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