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Sugary soft drinks linked to increased risk of gout in men

Soft drinks, fructose consumption, and the risk of gout in men: Prospective cohort study

January 31, 2008 -- Consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men, finds a study published on bmj.com today.

Gout is a joint disease which causes extreme pain and swelling. It is most common in men aged 40 and older. It is caused by excess uric acid in the blood (hyperuricaemia) which leads to uric acid crystals collecting around the joints.

In the United States, levels of gout have doubled over the last few decades, which coincided with a substantial increase in the consumption of soft drinks and fructose (a simple sugar and the only carbohydrate known to increase uric acid levels).

Conventional dietary recommendations for gout have focused on the restriction of purines (found in high levels in meat and meat products, especially liver and kidney) and alcohol but with no restriction of sugar sweetened soft drinks.

So researchers in the US and Canada examined the relation between intake of sugar sweetened soft drinks and fructose and the risk of gout.

They followed over 46,000 men aged 40 years and over with no history of gout. The men completed regular questionnaires on their intake of more than 130 foods and beverages, including sugar sweetened soft drinks and diet soft drinks, over a period of 12 years. Different types of fruits and fruit juices (high in natural fructose) were also assessed.

At the start of the study, and every two years thereafter, information on weight, regular use of medications and medical conditions were also recorded. Gout was diagnosed according to American College of Rheumatology criteria.

During 12 years of follow-up, the researchers documented 755 newly diagnosed cases of gout.

The risk of gout increased with increasing intake of sugar sweetened soft drinks. The risk was significantly increased with an intake level of 5-6 servings per week and the risk was 85% higher among men who consumed two or more servings of sugar-sweetened soft drinks per day compared to those who consumed less than one serving per month.

These associations were independent of other risk factors for gout such as body mass index, age, diuretic use, high blood pressure, alcohol intake, and dietary factors.

Diet soft drinks were not associated with the risk of gout.

Fruit juice and fructose rich fruits (apples and oranges) were associated with a higher risk of gout. However, the authors stress that this finding needs to be balanced against the benefit of fruit and vegetable intake to prevent other chronic disorders like high blood pressure, coronary heart disease, stroke and certain types of cancer.

In conclusion, our findings provide prospective evidence that consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout, say the authors. Furthermore, fructose rich fruits and fruit juices may also increase the risk. In contrast, diet soft drinks were not associated with the risk of gout.

Phase III Study Reveals Potential New Therapy for Gout

November 7, 2007 — Rilonacept (IL-1 Trap) may substantially decrease both disease activity and pain in patients with chronic active gout, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Boston, Mass.

Gout is a painful and potentially disabling form of arthritis that has been recognized since ancient times. Initial symptoms usually consist of intense episodes of painful swelling in single joints, most often in the feet, especially the big toe.

Rilonacept, a potential new therapy currently being tested in the treatment of inflammatory conditions, prevents interleukin-1 from attaching to cell-surface receptors – creating a flare in disease. Interleukin-1 is a protein secreted by many cells in the body; secreted in excess, IL-1 can trigger disease activity in gout.

To assess the safety and change in disease activity in patients with chronic, active, gouty arthritis after treatment with rilonacept, researchers followed 10 patients who participated in a multi-center, non-randomized, single-blind, placebo-controlled study.

The participants were on average 62 years old, had gout for an average of 13 years, and had suffered from chronic gout. Participants received twice-weekly subcutaneous injections of placebo followed by six weekly injections of rilonacept. Gout activity was assessed by the degree of pain reported by the patient, overall disease assessment, the number of joints experiencing joint pain, and a C-reactive protein blood test used to measure inflammation in the body.

There were no reported deaths or serious adverse events. Drug-related adverse events were most often associated with mild-to-moderate reactions at the injection site.

In the second through eighth week of treatment, 70 percent of participants had at least a 50 percent improvement in pain, and 60 percent of participants had at least a 75 percent improvement in pain. No participants on placebo showed improvement.

Inflammation levels detected in the blood decreased by 59 percent by the eight week of rilonacept therapy, and at week 14, a trend toward baseline levels was observed.

“The last two decades have seen a remarkable resurgence of gout in the USA, and practitioners are facing increasingly complex, refractory cases in which advanced age, co-morbidities including chronic kidney disease, and concomitant medications impose difficult management decisions,” said Robert Terkeltaub, MD, section chief, rheumatology-allergy, VA Medical Center, San Diego; professor of medicine, University of California, San Diego; and an investigator in the study. “Practitioners are further limited by the lack of new FDA-approved therapeutic options for gouty inflammation and hyperuricemia management for patients who present with ‘difficult gout’ – particularly those who have extensive gouty skin and joint deposits of tophi and frequent or persistent inflammation of multiple joints. Experimental gouty inflammation is clearly IL-1beta-driven, and preliminary studies of gout patients suggest therapeutic benefit of IL-1 receptor antagonism, reinforced by this small pilot study of rilonacept in a group of refactory patients.”

New Treatment Shows Promise for Gout

November 8, 2005 -- A new treatment called febuxostat, the first new gout treatment in 40 years, may be superior at lowering levels of serum uric acid in patients with gout compared to allopurinol and placebo, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Diego.

Gout is a chronic, potentially disabling form of arthritis that includes symptoms such as intense attacks of painful swelling in single joints, often in the feet and most commonly in the big toe. The underlying cause of gout is hyperuricemia, or levels of uric acid in the blood greater than 6.8 mg/dL. Gout affects more than five million Americans. It is the most common form of arthritis in men over the age of 40, and though women are less commonly affected, the prevalence of gout may be rising among postmenopausal women with other conditions like high blood pressure.

The study compared the impact of multiple dosage levels of febuxostat to allopurinol, a current standard gout treatment, and to placebo. Researchers examined uric acid levels in blood samples among patients receiving daily doses of 80, 120 or a safety dose of 240 mg of febuxostat over 28 weeks. These results were compared to results for patients receiving 100 or 300 mg of allopurinol (the dose amount depended upon kidney function) and for patients receiving placebo.

The primary endpoint of the study was the number of patients whose uric acid blood levels were less than 6 mg/dL at the last three monthly visits. The target reduction was achieved by 48 percent of patients taking febuxostat 80 mg/day, 65 percent of patients taking 120 mg/day, and 69 percent of patients taking 240 mg/day. Only 22 percent of patients taking allopurinol and zero percent of patients taking daily placebo achieved the same target.

When a single visit at week 28 was evaluated, those patients whose uric acid level was reduced to <6 mg/dL was 76 percent taking febuxostat 80 mg/day, 87 percent taking 120 mg/day, and 94 percent taking 240 mg/day, compared to 41 percent taking allopurinol and one percent of patients taking placebo. Results showed that when compared to allopurinol, febuxostat is at least twice as effective in reducing serum uric acid levels.
The trial was meant to determine the effectiveness and safety of febuxostat. Patients in the study included those with risk factors such as hypertension, elevated cholesterol, cardiovascular disease, obesity and alcohol use. Most were men with a mean age of 52. Adverse events, which included digestive disturbances, headache and liver abnormalities, were similar across all treatment groups, and of the 34 serious adverse events across all treatment groups, most were cardiac disorders in patients with pre-existing cardiovascular disease.

“This study is very encouraging because it shows that febuxostat was superior at lowering serum uric acid levels compared to allopurinol, the current standard of treatment,” said Robert Wortmann, MD, lead researcher for the study and professor of medicine at the University of Oklahoma.

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