Big Project? Counting on Caffeine to Stay Awake? It Can Also Wake Up Your Gout

Newswise — Drinking caffeinated beverages may raise the risk for recurrent gout attacks, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in Atlanta.

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). Although treatments are available to manage gout, they are not always successful in preventing recurrent gout attacks.

Long-term caffeine intake has been associated with a decreased risk for gout attacks. However, in the short-term, caffeine has been found to increase uric acid, which can potentially trigger an attack. Based on this conflicting information, researchers recently evaluated whether drinking caffeinated beverages is associated with the risk of repeated gout attacks.

In a study, funded in part by the ACR Research and Education Foundation, researchers turned to the Internet to recruit 633 participants (obtaining 486 medical records to date confirming a gout diagnosis) who had experienced a gout attack within one year of the study to compare the amount of caffeinated beverage consumption during periods of gout attacks to periods without attacks. They noted the amount of caffeine (e.g., coffee, tea, other caffeinated beverages) and non-caffeinated beverages (e.g., non-caffeinated coffee, tea, sodas, juices) each participant consumed during a 24-hour period before a gout attack as well as during a 24-hour period without a gout attack.

With this information—and after adjusting the results to consider a participant’s diuretic use, alcohol consumption, purine consumption, and the consumption of other fluids—researchers looked at the connection between the amount of caffeinated beverages consumed (zero, one, two, three, four, five to six, or greater than six servings per 24 hours) and the risk of recurrent gout attacks. Then, to round out the study, they repeated the same analyses for non-caffeinated beverage consumption.

Among these participants with gout—who were predominantly Caucasian (89 percent), male (78 percent), and college educated (58 percent)—both with irregular daily caffeinated beverage consumption and increased intake of caffeinated beverages in the prior 24 hours were at a higher risk for recurrent gout attacks. The increased risk was present even after accounting for other fluid intake.

For example, consuming three or four more servings of caffeinated beverages in the prior 24 hours was associated with 40 to 80 percent increased risk of recurrent gout attack. This led researchers to believe that episodic increased caffeinated beverage consumption can cause a short-term increased risk for gout attacks.

“In this study, we found that intermittent increased caffeinated beverage intake—such as caffeinated coffee, tea, or soda—was associated with an increased risk of gout attacks even after taking into account all other fluid intake,” says Tuhina Neogi, MD, PhD, FRCPC; associate professor of medicine at Boston University School of Medicine and lead investigator in the study. “In contrast, non-caffeinated coffee, tea, soda or juices were not associated with an increased risk of gout attacks. These findings suggest that episodic increases in consumption of caffeinated beverages can trigger gout attacks in the short-term. Persons with gout should discuss disease management with their rheumatologists, and should keep in mind that there are lifestyle factors that can be modified to potentially help reduce their risk for recurrent gout attacks,” says Dr. Neogi.

The American College of Rheumatology is an international professional medical society that represents more than 8,000 rheumatologists and rheumatology health professionals around the world. Its mission is to advance rheumatology. The ACR/ARHP Annual Scientific Meeting is the premier meeting in rheumatology. For more information about the meeting, visit www.rheumatology.org/education. Follow the meeting on twitter by using the official hashtag: #ACR2010.

Editor’s Notes: Tuhina Neogi, MD, PhD, FRCPC will present this research during the ACR Annual Scientific Meeting at the Georgia World Congress Center at 2:30 PM on Tuesday, November 9 in Room A410.

Learn more about living well with rheumatic disease as well as rheumatologists and the role they play in health care.

Presentation Number: 1362

Short-term Effects of Caffeinated Beverage Intake on Risk of Recurrent Gout Attacks

Tuhina Neogi, MD, PhD, (Boston University School of Medicine, Boston, Mass.) Clara Chen, MHS (Boston University School of Public Health, Boston, Mass.) Christine Chaisson, MPH, (Boston University School of Public Health, Boston, Mass.) David J Hunter, MBBS, PhD, (University of Sydney, Australia)Yuqing Zhang, DSc (Boston University School of Medicine, Boston, Mass.)

Body: Purpose: Long-term caffeine intake has been associated with decreased risk for incident gout attacks and lower serum uric acid levels. Acute effects of caffeine, however, can potentially increase uric acid, for example, through a diuretic effect with volume depletion, and impaired glucose tolerance. Further, caffeine, which is a methyl xanthine, can competitively inhibit xanthine oxidase, and therefore may have effects similar to allopurinol in terms of precipitating a flare in the short-term. Given these potential conflicting effects on gout attack risk, we evaluated whether caffeinated beverage intake was associated with risk for recurrent gout attacks.

Methods: We conducted an internet-based case-crossover study to assess a set of putative risk factors thought to trigger recurrent gout attacks. This methodology uses each participant as his/her own control by comparing the frequency of a particular risk factor during periods of gout attacks with that during periods when they are not having an attack, thereby eliminating between-person confounding. Subjects with gout who had an attack within the past year were recruited online and asked to provide access to medical records pertaining to their gout diagnosis. Data were obtained on the amount of caffeine (coffee, tea, other caffeinated beverages) consumed over the 24-hour period before a gout attack and over a 24-hour period during an intercritical period, as well as non-caffeinated beverages (non-caffeinated coffee, tea, sodas, juices). We did not ask about use of sugar in the beverage. We examined the relation of amount of caffeinated beverage intake (0, 1, 2, 3, 4, 5-6, >6 servings per 24-hours) with the risk of recurrent gout attacks using conditional logistic regression adjusting for diuretic use, alcohol consumption, and purine intake, and additionally for all other fluid intake. We repeated the same analyses for non-caffeinated beverage intake. Results: Of the 633 participants who experienced recurrent gout attacks during the study period, 78% were male, 89% were White, and 58% had a college education. Of the 486 medical records reviewed to date, 82% met the ACR classification criteria for gout. Higher levels of caffeinated beverage intake in the prior 24 hours were associated with increased risk for recurrent gout attacks, even after accounting for other fluid intake, while non-caffeinated beverages were not associated with risk for recurrent gout attacks. Conclusions: Increases in or episodic caffeinated beverage intake in the short-term appears to increase risk for recurrent gout attacks. In contrast, we did not find such associations with non-caffeinated beverages. Since these beverages may have had varying amount of fructose that we did not measure, further study is warranted to evaluate the effects of caffeine independent of fructose.

Disclosure: Tuhina Neogi, nothing to disclose; Clara Chen: nothing to disclose; Christine Chaisson, nothing to disclose, David Hunter, nothing to disclose, Yuqing Zhang, nothing to disclose.

View press release with full abstract at www.rheumatology.org