Risk was also higher in those who ate purine-rich foods (such as beef, pork and some fish) and those who used diuretics, which raise blood levels of uric acid. On the other hand, taking the gout drugs allopurinol or colchicine lessened the effects of alcohol somewhat.

When the three types of alcohol were compared, wine was actually a significant trigger. Drinking between one to two glasses of wine in the 24 hours before the attack raised the risk of recurrent attacks by 138 percent ; in other words, it more than doubled the risk of a gout attack, compared to drinking no wine. By contrast, drinking between two to four beers in the 24 hours before an attack increased the risk by 75 percent.

The researchers point out that these results apply to men; findings for women are less clear, mainly because so few women were in the study.

“We were unable to draw definitive conclusions about the effects of alcohol in women because the number included in our study were too small, limiting our ability to detect statistically significant results,” Dr. Neogi says. “But the patterns of alcohol’s effects on risk of gout attacks were generally similar to [those] seen in men.”

She adds that study participants acted as their own controls, “each compared with him- or herself over time.” This minimized between-person differences (such as healthy lifestyle factors) that could make it harder to detect the effects of alcohol.

Dr. Neogi says, “Based on this study, I would counsel gout patients that any type of alcohol may trigger an attack; it’s not just beer or liquor but also wine. In addition, I would counsel moderation and limiting the consumption of all types of alcohol, not just beer. Each patient is different, so a ‘safe’ limit can’t be uniformly set, but obviously abstaining from alcohol would avoid any risk of attack due to [its use].”

Kenneth Saag, MD, professor of medicine at the University of Alabama at Birmingham and director of its Center for Outcomes and Effectiveness Research and Education, says the study is well designed, and patients recruited through the Internet are “an important resource.”

He also notes that the study “sheds further contrasting light on a suspicion raised by work from the Health Professionals Follow-up Study and the NHANES [National Health and Nutrition Examination Survey] data that certain alcoholic beverages may be preferential for gout. At least in terms of flares, nearly all alcoholic beverages appear equal in this investigation.”