VANCOUVER, British Columbia—Drinking four or five cups of coffee a day reduces the  risk of gout by 40% in men, according to a prospective study in the June 2007 issue of Arthritis & Rheumatism,¹ and the risk reduction was even more dramatic among men who drank six or more cups of coffee daily.

"Our results suggest that coffee consumption is associated with a lower level of uric acid and frequency of hyperuricemia, but tea consumption is not," concludes lead author Hyon K.Choi, MD, DrPH, a rheumatologist with the Arthritis Research Centre of Canada, in Vancouver, British Columbia, and colleagues.

Effect not due to caffeine

Since tea had no impact on gout risk, "the inverse association with coffee appears to be via components of coffee other than caffeine," they write. For example, coffee is a major source of the antioxidant phenol chlorogenic acid. Another theory is that the noncaffeine xanthines in coffee may block xanthine oxidase, which would contribute to lower uric acid levels.

The new findings are generalizable only to men age 40 years and older. "Given the potential influence of female hormones on the risk of gout in women and an increased role of dietary impact on uric acid levels among patients with existing gout, prospective studies of these populations would be valuable," the study authors write.

The researchers studied 45,869 men older than 40 with no history of gout at baseline for more than 12 years. During follow-up, participants answered a food-frequency questionnaire that researchers updated every 4 years in which participants chose from nine frequency responses—ranging from never to two-to-four cups per week to six or more cups per day—to record their average consumption of coffee, decaffeinated coffee, tea, and other caffeine-containing beverages including soda and chocolate.

In another follow-up questionnaire, researchers documented 757 newly diagnosed cases of gout that met the American College of Rheumatology criteria.

The data revealed that the risk of gout was 40% lower for men who drank four-to-five cups a day and 59% lower for men who drank six or more cups a day than for men who never drank coffee. There was also a modest inverse association with decaffeinated coffee consumption. Tea drinking and total caffeine intake had no effect on the incidence of gout, the study showed.

Vets receiving suboptimal gout care

A related study²  conducted by Jasvinder A. Singh, MD, MPH, with the Minneapolis VA Medical Center, in Minnesota, and colleagues found that US veterans with gout are not receiving care that adheres to three evidence-based quality indicators (QIs). These QIs were  prescribing an allopurinol dose <300 mg in gout patients with renal insufficiency (QI 1), ordering a uric acid check within 6 months of starting a new allopurinol prescription (QI2), and conducting a complete blood count and creatine kinase check every 6 months for gout patients receiving prolonged colchicine therapy (Q1 3).

"Frequent lack of physician adherence to these QIs is problematic and identifies gout treatment and management as an area requiring intervention," the study authors conclude.

The researchers identified a cohort of 3,658 veterans receiving medication to treat gout between January 1, 1999, and December 31, 2003, using the Minneapolis Veterans Affairs (VA) electronic medical record system. They calculated the proportion of patients whose therapy adhered to each QI and determined overall physician adherence to all applicable indicators.

A total of 663 patients qualified for examination of >e; 1 QI. Of these patients, therapy in only 22% (144) adhered to all applicable QIs. Specifically, 78% of 76 adhered to QI 1, 24% of 643 adhered to QI  2, and 35% of 52 adhered to QI  3. The study found that overall physician adherence to QIs was significantly lower in older veterans and in those with more inpatient visits per year but was higher among those veterans with more primary care visits or more healthcare providers.

The fact that 22% of patients with renal insufficiency received higher than recommended doses of allopurinol is "not acceptable," they write.

The findings cannot be generalized outside of the VA system, but the researchers point out that it is not likely that the quality of gout care is much worse in VA than non-VA health systems. "Nonetheless, studies of physician adherence to gout QIs in the general US population are needed," the authors conclude.

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References

1. Choi HK, Willet W, Curhan G. Coffee consumption and risk of incident gout in men: a prospective study. Arthritis Rheum. 2007;57:2049-2055.
2. Singh JA, Hodges JS, Toscano JP, et al. Quality of care for gout in the US needs improvement. Arthritis Rheum. 2007;57:822-829.