Findings from a prospective cohort study over three decades show that obese women who were also genetically predisposed at the same time were at a higher risk of developing gout compared to the risk associated with them independently.¹

The study reported in the Annals of the Rheumatic Diseases examined the potential association of obesity and genetic predisposition with the risk of incident gout among 18,244 women (mean age 47 years) from the Nurses’ Health Study, both independent and combined. They were compared with risks for 10,888 men from the Health Professionals Follow-Up Study (HPFS). The genetic risk score for hyperuricaemia was obtained from 114 common urate-associated single nucleotide polymorphisms (SNPs). None of the study population had a history of gout at the start of the study.

Both BMI and genetic risk scores were found to be independently associated with the risk of gout among women. The relative risk for women in the highest BMI category (≥35) versus those in the lowest BMI category (<23) was 4.86, while the relative risk for women with the highest genetic risk score versus the lowest was 2.89. The relative risk for incident gout among women was 1.49 per 5 kg/m2 increase in BMI and 1.43 per standard deviation increase in the gout genetic risk score. But when the combined effects of the two risk factors were studied, the relative risk was found to be 2.18 demonstrating a significant additive effect. The contribution of their additive interaction was 22% among women, while the contribution of additive interaction to the increased risk was determined to be only 14% among men, which was still significant.

Gout is an inflammatory arthritis and though prevalent in men, recent years have seen a rise in the incidence of gout in women. Women who have gout are more likely to be obese and have more associated cardiometabolic comorbidities compared to men with gout.

This study has shown the independent and combined effects of higher BMI and genetic risk scores on gout in women compared to men. This association was significant. The authors speculate that this could be due to the enhanced inflammatory response to urate crystals due to obesity induced increase in inflammatory markers and adipokines. While excess body weight was a risk factor by itself, the risk was further aggravated in women who were also genetically susceptible to developing the disease. Hence, lifestyle intervention to manage overweight and obesity (adiposity) can reduce the incidence of gout in women, particularly those women at high genetic risk.

Reference

1. McCormick N, et al. Impact of adiposity on risk of female gout among those genetically predisposed: sex-specific prospective cohort study findings over >32 years. Ann Rheum Dis. 2021 Dec 2;annrheumdis-2021-221635. doi: 10.1136/annrheumdis-2021-221635.