Abstract
ObjectivesTo determine the proportion of people with gout who self-report triggers of acute attacks; identify the commonly reported triggers, and examine the disease and demographic features associated with self-reporting any trigger(s) of acute attacks of gout.MethodsIndividuals with gout were asked to fill a questionnaire enquiring about triggers that precipitated their acute gout attacks. Binary logistic regression was used to compute odds ratio (OR) and 95% confidence intervals (CI) to examine the association between having ≥1 self-reported trigger of acute gout and disease and demographic risk factors and to adjust for covariates. All statistical analyses were performed using STATA.Results550 participants returned completed questionnaires. 206 (37.5%) reported at least one trigger of acute attacks, and less than 5% reported >2 triggers. Only 28.73% participants reported that their most recent gout attack was triggered by dietary or lifestyle risk factors. The most frequently self-reported triggers were alcohol intake (14.18%), red-meat or sea-food consumption (6%), dehydration (4.91%), injury or excess activity (4.91%), and excessively warm or cold weather (4.36% and 5.45%). 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 (aOR (95%CI) 1.73 (1.12–2.68) after adjusting for covariates.ConclusionMost people with gout do not identify any triggers for acute attacks, and identifiable triggers are more common in those with young onset gout. Less than 20% people self-reported acute gout attacks from conventionally accepted triggers of gout e.g. alcohol, red-meat intake, while c.5% reported novel triggers such as dehydration, injury or physical activity, and weather extremes.
Highlights
Gout is the commonest inflammatory arthritis [1] and is a direct consequence of hyperuricaemia which results in intra- and/or peri-articular monosodium urate (MSU) crystal deposition [2]
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 (aOR (95%confidence intervals (CI)) 1.73 (1.12–2.68) after adjusting for covariates
Most people with gout do not identify any triggers for acute attacks, and identifiable triggers are more common in those with young onset gout
Summary
Gout is the commonest inflammatory arthritis [1] and is a direct consequence of hyperuricaemia which results in intra- and/or peri-articular monosodium urate (MSU) crystal deposition [2]. The factors that trigger acute gout are under-researched but many drug, dietary and lifestyle factors are implicated, resulting in common advice regarding lifestyle and dietary modifications to prevent gout attacks [3]. It is a reduction in SUA that is believed to trigger acute gout via increased crystal dissolution which encourages crystal “shedding” [6, 9]. An increase in SUA could trigger acute attacks as UA is a pro-inflammatory chemical [11]. It is possible that some dietary factors e.g. bioactive lipids can trigger gout attacks by stimulating toll like receptors which activate the NALP-3 inflammasome [12], which plays a central role in MSU crystal induced inflammation [13]
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