Gout in Women — SCE Rheumatology MCQ

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ModerateCrystal ArthropathyGout in WomenSCE Rheumatology

A 60-year-old woman has her first crystal-proven gout flare 8 years after natural menopause. Premenopausal women generally have lower serum urate concentrations and a lower incidence of gout than men. Which physiological effect best accounts for this relative protection?

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Correct answer: A — Oestrogen increases renal clearance of urate

Oestrogen is associated with lower serum urate, partly through a uricosuric effect that increases renal urate clearance. Loss of the premenopausal sex-hormone milieu therefore contributes to the rise in serum urate and gout incidence after menopause. This is not explained by reduced glomerular filtration, which would tend to impair urate elimination. There is no established protective effect from reduced intestinal absorption of dietary purines, and progesterone does not prevent monosodium urate crystallisation. Humans also lack functional uricase, so oestrogen cannot protect by increasing hepatic conversion of urate to allantoin. Other postmenopausal factors, including renal impairment, diuretic exposure and metabolic comorbidity, may further increase gout risk but do not replace the principal physiological explanation tested here.

Reference: Bolognesi A, Bortolotti M, Battelli MG, Polito L. Gender Influence on XOR Activities and Related Pathologies: A Narrative Review. Antioxidants. 2024;13:211. https://pubmed.ncbi.nlm.nih.gov/38397809/