by WV Marshall

England’s King Henry VII famously had gout. It is the so-called disease of kings. However, during the last two decades cases of gout reported among women has more than doubled.

Two million women and 6 million men in the United States have been diagnosed with this inflammatory form of arthritis that causes joint swelling and telltale pain at the base of the big toe, the Arthritis Foundation reported in its blog.

Gout occurs when elevated levels of uric acid build up in the blood and form needle-shaped crystals in the joints, leading to pain, swelling and redness. Estrogen protects women because it naturally causes uric acid to be flushed out in women’s urine.

Guess what happens when women lose estrogen after menopause? The level of uric acid in their blood starts to rise.

Gout is rare among women who are premenopausal or on estrogen replacement therapy, Mandell said. When a woman is diagnosed with gout before age 60, she typically has other risk factors, including taking diuretics or a history of kidney problems, Dr. Brian F. Mandell, a rheumatologist at the Cleveland Clinic and board member of The Gout & Uric Acid Education Society, said in the Arthritis Foundation’s blog.

But, of course, more than hormones are at work, the Arthritis Foundation said. In 2017, BMC Musculoskeletal Disorders published a study that found that, in addition to being older, women diagnosed with gout were more likely than men to have other conditions, such as high blood pressure, diabetes, kidney disease and obesity.

Women tend to develop gout in their knees, toes, wrists and ends of their fingers.

“In women, gout likes to travel to those distal finger joints where they may already have some osteoarthritis-related damage,” Dr. Theodore Fields, a rheumatologist at The Hospital for Special Surgery in New York, explained in the Arthritis Foundation’s blog.

Gout in women is more likely to appear in multiple joints slowly over time as compared to men, Mandell said.

“In women, it seems there is a greater prevalence of the initial episode of gout being in multiple joints. It may not always be the typical swollen great toe. In the hands this is often misdiagnosed as inflammatory osteoarthritis when it may actually be attacks of gout,” Mandell said.

**The Arthritis Foundation makes note of three essentials for women:

• Gout can show up in unusual places, so talk to your healthcare provider.
• Take your medication as prescribed.
• Pay special attention to your heart and kidney health.**