Gout in women.

WOMEN GET GOUT TOO Gout is not rare in women. Although women comprise approximately 5% of all gout patients, the incidence has risen. According to Arromdee, et al, the incidence of gout in men and women has doubled over the past 20 years. Because it is principally a disease seen in men, gout is often misdiagnosed in women, and/or the diagnosis is often delayed. In this article we will discuss some of the epidemiological, clinical and treatment aspects that distinguish female from male gout patients. Women are older than men at the time of diagnosis of gout. In several studies, the mean age at diagnosis of gout was 7-12 years greater in women than in men. In patients older than 60 years with newly diagnosed gout, approximately half will be women. The incidence of females with gout peaks at age 80 years and older. One important difference between women and men with gout is the change in urate levels that occurs in women after menopause. Serum urate concentrations in men average about 1mg/dl higher than those in adult women until after menopause, at which time the serum levels of uric acid in women approach or equal those in men. In 2008, Hak and Choi reviewed data from the Third National Health and Nutrition Examination Survey, and published their findings on menopause, postmenopausal hormone use, and serum uric acid levels in women. They concluded that menopause was associated with higher serum uric acid levels, and that postmenopausal hormone replacement was associated with lower serum uric acid levels, suggesting that estrogen plays a key role in protecting women from hyperuricemia and gout. Pui et al found further evidence of the role of estrogens in regulating serum uric acid: they found early onset hyperuricemia and gout following hormone treatment given for the purpose of female to male gender reassignment. Estrogen may enhance renal uric acid excretion. During gender reassignment, testosterone treatment likely dampens the effect of estrogen, and causes increased serum urate concentrations by reducing renal excretion of uric acid. It was also suggested that sex hormones may also influence the expression of acute gout through effects on the inflammatory response to monosodium urate crystals.