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Purine rich foods quintuple risk of gout flare-ups

01 June, 2012

Foods rich in purines, particularly those found in meat and seafood, quintuple the immediate risk of a gout flare-up, according to a research published online in the Annals of the Rheumatic Diseases.

While the anecdotal evidence has suggested that purine rich foods can trigger gout attacks, it hasn’t been clear whether they prompt flare-ups in the short term, say the authors.
 
They base their findings on 633 people with confirmed gout, whose health was tracked over a year, online. The average age of the participants was 54, and most of them (78 per cent) were men.
 
They were asked to provide details of history of gout attacks, including the timing and symptoms of the attack; what drugs they were taking to manage their condition; and to list any potential triggers in the two days running up to an attack.
 
This included dietary sources of purines. Foods rich in purines include meat, offal, seafood, beans, peas, lentils, oatmeal, spinach, asparagus, mushrooms, yeast, and alcohol.
 
They were also asked to provide the same information over two-day periods every quarter when they were not experiencing a flare-up, by way of a comparison.
 
Over half drank alcohol (61 per cent), a known risk factor for the condition, while 29 per cent used water pills (diuretics) and almost half took allopurinol—a drug used to prevent gout attacks.
 
Over half used non-steroidal anti-inflammatory drugs, while one in four (25 per cent) took colchicines, another class of anti-gout drug.
 
During the 12 month monitoring period, 1,247 gout attacks were recorded, most of which occurred in the toe joints, causing intense pain and redness.

The average amount of dietary purine during a two-day period without gout attacks was 1.66 g, while that consumed in the two days before an attack was 2.03 g.
 
Compared with those in the bottom 20 per cent of purine consumption, those in the top 20 per cent were almost five times as likely to have a gout flare-up.

Animal sources of purines carried a significantly higher risk than plant sources of triggering an attack.

These findings held true, irrespective of age, gender, alcohol intake and use of medications to control symptoms/pain.

The fact that plant sources of purines had significantly less impact than animal sources can be explained by lower purine content in those foods, say the authors, who emphasise that plant sources contain other important nutrients and contribute to lowering insulin resistance—long advocated as a measure to control gout.
 
"Avoiding or reducing purine-rich food intake, especially of animal origin, may help reduce the risk of recurrent gout attacks," they conclude.

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