Beer and hard liquor have long been known to increase the risk of gout, the most common form of inflammatory arthritis, but according to a new study in The American Journal of Medicine, wine also can contribute to recurrent gout attacks.

Gout occurs when excess uric acid builds up around joints – often in the big toe, but also in the feet, ankles, knees, wrists and elbows – leading to episodes of intense pain, redness and swelling. It affects more than 8 million adults in the United States, and the numbers are rising sharply, due mainly to obesity and other lifestyle factors.

Beer and spirits are thought to trigger gout flares because they increase blood levels of purines, which break down into uric acid. That idea was supported by the influential 2004 Health Professionals Follow-up Study, which linked all types of alcohol except wine to first-time gout attacks.

But Tuhina Neogi, MD, a professor at Boston University School of Medicine and lead author of the new study, says many of her patients report, “they can’t even sniff wine without having a gout attack,” leading her to suspect that wine could trigger repeat bouts of the disease.

To investigate the matter, Dr. Neogi and colleagues examined the survey responses of 724 gout patients recruited via the Internet between 2003 and 2012. Most were overweight men in their 50s and all had experienced at least one gout attack in the previous year. To be considered a gout attack, an episode had to meet at least two of four criteria, including treatment with gout medication, involvement of the big toe, pain that was worst in the first 24 hours and redness around the joint.

Study participants completed questionnaires every few months as well as after gout attacks about their diet, medications, exercise and number of alcoholic drinks consumed. The researchers compared what a participant consumed on an average day to what that participant had consumed in the 24 hours before a gout attack. Researchers looked at the overall effect of alcohol on gout attacks as well as the individual effects of wine, beer and liquor, while taking diet and other factors into account. (For purposes of the study, a drink was defined as 12 ounces of beer, 5 ounces of wine or up to 1.5 ounces of liquor. Moderate alcohol consumption is considered no more than two drinks per day for men and no more than one drink for women.)

Results showed that a single serving of wine, beer or liquor (either straight or in a mixed drink) in a 24-hour period didn't significantly increase the chance of repeat gout attacks. But consuming more than one to two drinks a day did – by 36 percent. With two to four drinks, the risk rose 50 percent, and it continued to rise with the amount of alcohol consumed.