Gout Incidence Increasing, but Most Patients Go Untreated

Janis C. Kelly

January 17, 2014

Previous hopes that gout incidence and prevalence had plateaued in the United Kingdom were dashed by a new report published online January 15 in the Annals of the Rheumatic Diseases.

The data showed continued increases in gout incidence from 1997 to 2012. In addition, researchers found most patients were not being treated with urate-lowering therapy (ULT), and only 18.6% of patients began treatment within 6 months of diagnosis.

"[B]oth the prevalence and incidence of gout have risen in the past 16 years and are the highest reported within Europe. However, despite being the commonest inflammatory arthritis the suboptimal management of gout continues unchanged, with only a minority of patients receiving ULT and new patients not being treated in a timely fashion," the authors write. "Although somewhat improved, patient adherence to ULT remains poor[, it] is apparent that educational initiatives to improve practitioner knowledge, interest and standard of care of the only 'curable' form of inflammatory arthritis are urgently required."

Chang-Fu Kuo, MD, from the Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, United Kingdom, and colleagues found that gout prevalence had increased from 1.52% in 1997 to 2.49% in 2012, a relative increase of 63.9%. The incidence of gout has also risen, going from 1.36 to 1.77 per 1000 person-years. The researchers used data from the UK Clinical Practice Research Datalink, which includes the medical records of about 12 million people.

A similar increase had been reported for the United States, where gout prevalence rose from 2.7% in 1988-1994 to 3.9% in 2007-2008.

Dr. Kuo and colleagues also found that of those individuals with gout in 2012, just 48.48% (95% confidence interval [CI], 48.08% - 48.89%) had consultations specifically for gout, and 37.63% (95% CI, 37.28% - 38.99%) received ULT.

"Although we were aware that there are some issues related to the poor management of gout, we did not expect this could lead to the rapid increase (4% annually) of current gout cases," senior author Weiya Zhang, PhD, told Medscape Medical News. "Since this is a disease with well-established treatments, it is a shame that we haven't controlled it properly in the past 15 years. This does raise a question on how to improve the current management of gout.

"Fortunately, we have developed a number of evidence-based guidelines in the past 10 years, which may form a basis to start. The study does raise 2 questions: Why we have done poorly? And how [do we] improve?" Dr. Zhang is associate professor and reader in academic rheumatology, University of Nottingham.

Gout prevalence and incidence varied across the United Kingdom, with the highest numbers of cases seen in Wales and the Northeast of England. Dr. Zhang said the reasons for these regional differences are unknown but are more likely to involve variations in management than lifestyle differences.

"This is a very interesting and informative study," said Robert Terkeltaub, MD, professor of medicine at the University of California, San Diego, and rheumatology section chief at the San Diego Veterans Affairs Medical Center in California. "Gout is an extremely well-understood disease, where essentially 'curative' urate-lowering therapy is available, and 2 sets of sound international medical guidelines for management have been published in the last 15 months. Yet quality of care, and patient adherence to treatment, remain substandard, a disappointing and unacceptable circumstance for a disease clearly increasing in prevalence in a similar way in the [United Kingdom] and [United States] and other Western countries."

"This situation is indicative of a systematic failure in both medical and patient education. There is lots of work to do to rectify these problems," added Dr. Terkeltaub, who was not involved in the study.

The authors and Dr. Terkeltaub have disclosed no relevant financial relationships.

Ann Rheum Dis. Published online January 15, 2014. Full text

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