Gender

About

Gender is important for evaluation and treatment of gout for two main reasons: 1. determining the likelihood that a patient's symptoms are due to gout (flares), and 2. estimating kidney function to determine the safest medication dosing. As such, GoutHelper often needs to know the biological sex of GoutPatients in order to give accurate results. Needing to know biological sex is unavoidable GoutHelper appreciates the sensitive nature of birth-assigned sex and gender, but needs to know the former because of the importance of genetics and hormones for providing safe and accurate gout care.

Flares

Biological sex is an important consideration when deciding whether or not a patient's symptoms are due to a gout flare or not. It is very rare for men to get gout until after puberty1. Women typically don't get gout until after menopause, as estrogen causes urinary excretion of uric acid and protects them2. There are exceptions for both sexes, such as when an individual has chronic kidney disease (CKD), is on a medication that lowers urinary uric acid excretion, or has rare inborn genetics that predispose him or her to gout.

Kidney Function

Biological sex is used to calculate kidney function3. Kidney function is very important for safely determining medication doses for several drugs used to treat gout, including the cornerstone treatment ULT. Kidney function also influences colchicine dosing, both for flares and prophylaxis.

References

  1. Singh JA, Gaffo A. Gout epidemiology and comorbidities. Semin Arthritis Rheum. 2020 Jun;50(3S):S11-S16. doi: 10.1016/j.semarthrit.2020.04.008. PMID: 32620196.
  2. Te Kampe, Ritch, et al. "Sex differences in the clinical profile among patients with gout: cross-sectional analyses of an observational study." The Journal of Rheumatology 48.2 (2021): 286-292.
  3. Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, Crews DC, Doria A, Estrella MM, Froissart M, Grams ME, Greene T, Grubb A, Gudnason V, Gutiérrez OM, Kalil R, Karger AB, Mauer M, Navis G, Nelson RG, Poggio ED, Rodby R, Rossing P, Rule AD, Selvin E, Seegmiller JC, Shlipak MG, Torres VE, Yang W, Ballew SH, Couture SJ, Powe NR, Levey AS; Chronic Kidney Disease Epidemiology Collaboration. New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. N Engl J Med. 2021 Nov 4;385(19):1737-1749. doi: 10.1056/NEJMoa2102953. Epub 2021 Sep 23. PMID: 34554658; PMCID: PMC8822996.
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