A study suggests that drinking plenty of water can help reduce the chances of having a gout attack.

Gout is an agonizing condition caused by an excess of a metabolic by-product called uric acid. When uric acid builds, it can form needle-like crystals that deposit in the joints and other organs, causing severe pain, inflammation, and hard lumps called tophi.

People who have gout may also experience flares – intense episodes of pain and swelling in individual joints – most often in the feet.

While medication can help lower uric acid levels, recurrences are common, and managing the disease can be difficult because of related diet and lifestyle factors.

It has been thought that dehydration is a possible trigger for gout attacks, so researchers at the Boston University School of Medicine wanted to determine if drinking water could reduce their likelihood.

“Dehydration can increase the concentration of serum uric acid in the blood. It can also affect the kidney’s ability to clear uric acid and can make uric acid more likely to form crystals. In combination, these factors can lead to an increased risk for a gout attack. Water can reverse the effects of dehydration,” says lead author Tuhina Neogi, MD, PhD.

For this Internet-based study, researchers recruited 535 people with gout who had experienced a gout attack within one year of the study. Seventy-eight percent were men, their average age was 53 and their gout diagnosis was confirmed through medical records. Participants were asked to provide information about how much water they consumed in the 24 hours before each gout attack and during times when they did not have a gout attack. Participants could respond with zero to one glasses per 24 hour period, two to four, five to eight or more than eight.

The results showed that with each glass of water consumed in the 24 hours before an attack, the risk for recurrent gout attacks decreased, even when accounting for other fluid intake.

“For example, those drinking five to eight glasses of water had a 40 percent reduced risk of gout attack compared with those who drank only one glass of water or less in the prior 24 hours,” Dr. Neogi explains.

Dr. Neogi says he can’t make specific recommendations about the amount of water people should drink because it depends on their underlying medical conditions and physical activity levels. He says patients should talk to their doctor if they have any questions on that front.

The study was presented at the 2009 annual meeting of the American College of Rheumatology in Philadelphia.

John Sundy, MD, PhD, a rheumatologist and associate professor of medicine at Duke University Medical Center in Durham, N.C., questions the reliability of the information in this study because it is based solely on patient’s recall. “If you are asking people to recall dietary intake any more than 12 hours after the fact, it is notoriously inaccurate,” he explains.

But he says the results are still intriguing because they provide scientific proof to existing anecdotal evidence. “I think it’s probably one of the first efforts to try to actually gather data to test this hypothesis or this notion that dehydration is important. The dehydration issue had been driven a lot by doctor-patient experience but there are limited examples,” Dr. Sundy says. “I think what it is, is an effort to provide new confirmation to an old idea.”

Dr. Sundy says there are plenty of other benefits to staying hydrated, so he doesn’t think it would hurt most patients to drink water regularly. “It’s one more tool in the tool chest that might be helpful,” he says. “This might be a reasonable thing to try.”

But he cautions there are some people who have to be careful with their fluid intake. That includes people with poor heart function or poor fluid handling by kidneys not able to eliminate a water burden.

Dr. Neogi says he and his research team are continuing to study potential triggers for gout attacks, including other liquids. They don’t think all liquids will have a beneficial effect on reducing the risk for recurrent gout attacks because some, including caffeinated and alcoholic beverages, may have potentially detrimental effects on serum uric acid and volume status.