Update on Gout and Hyperuricemia

J. F. Baker; H. Ralph Schumacher

Disclosures

Int J Clin Pract. 2010;64(3):371-377. 

In This Article

Epidemiology

Gout is the most common form of inflammatory arthritis in men > 40 years of age, often presenting initially in the form of podagra (acute onset of pain, erythema and swelling of the first metatarsophalangeal joint). Women may develop gout later in life, and in women it is more likely to involve the upper extremities. The lifetime prevalence of gout in the United States has been estimated at 6.1 million, and studies in the UK have reported a prevalence approaching 7%.[1,2] Hyperuricemia is significantly more prevalent. For example, it is now present in as many as 25% of people in China (defined for that study as serum urate > 420/> 360 μmol/l in men and women, respectively).[3] The prevalence of gout and hyperuricemia has been increasing over the past few decades in response to a number of factors.

An elevated serum uric acid level (SUA) is perhaps the most highly correlated laboratory value with the metabolic syndrome,[4] which is a concern with global westernisation of diet, increasing access to high caloric foods and greater prevalence of obesity.[5] Increasing life expectancy and use of predisposing medications, such as diuretics, may also contribute to this trend. Recent evidence suggests that the intake of fructose in beverages and foods, which has also increased worldwide, may increase the risk of both metabolic syndrome and gout.[6,7]

As a result of this global trend, it will be important to establish the wide use of safe, inexpensive and effective approaches to prevent and treat gout worldwide. Close attention to risk factors for gout such as high-purine diet, alcohol use, obesity, diabetes and kidney disease will be important in preventing and controlling an epidemic of hyperuricemia and gout, but it is unlikely to be sufficient.

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