Gout Hospitalizations Outpace Those for Rheumatoid Arthritis

Diana Phillips

June 09, 2016

Hospitalization trends in the United States for rheumatoid arthritis (RA) and gout have flip-flopped during the last 2 decades, according to data from a nationally representative database. Whereas more patients were hospitalized with RA than with gout in 1993, by 2011, the trend was reversed, investigators report in a research letter published in the June 7 issue of JAMA.

"The findings may reflect suboptimal care received by gout patients and its increasing prevalence," write Sian Yik Lim, MD, from the Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, and colleagues. "Furthermore, the findings provide a benchmark for rheumatoid arthritis care over the past 2 decades, including the reduced frequency of joint replacements and other major joint operations related to rheumatoid arthritis."

Although gout and RA are the two most common types of inflammatory arthritis, and hospitalizations for both are associated with substantial hospital resource use, relevant long-term data on hospitalization trends and costs have been lacking, the authors note.

Therefore, Dr Lim and colleagues evaluated these trends using data from the Nationwide Inpatient Sample for 1993 through 2011, focusing on principal discharge diagnoses to capture hospitalizations for RA or gout. They then calculated annual population rates of hospitalizations and relevant surgeries including joint replacements and other major joint surgeries.

During the study period, there were 254,982 hospitalizations for gout and 323,649 hospitalizations for RA.

For RA, the annual hospitalization rate per 100,000 adults declined from 13.9 (95% confidence interval [CI], 13.7 - 14.1) to 4.6 (95% CI, 4.5 - 4.7) and rose from 4.4 (95% CI, 4.3 - 4.5) to 8.8 (95% CI, 8.7 - 8.9) for gout. No significant differences in the trends were observed in age or sex subgroups, the authors note.

The annual hospitalization rate per 100,000 adults for joint operations among patients with RA similarly declined significantly, going from 8.4 (95% CI, 8.3 - 8.5) to 2.1 (95% CI, 2.0 - 2.2), whereas the corresponding surgery rates for patients with gout increased from 0.09 (95% CI, 0.08 - 0.11) and 0.17 (95% CI, 0.15 - 0.19), reflecting 2% of gout hospitalizations.

The cost of hospital care for both conditions, adjusted for inflation, paralleled the hospitalization trends, decreasing from $83,101 (95% CI, $81,852 - $84,350) to $55,988 (95% CI, $54,942 - $57,034) per 100,000 patients in the RA group and increasing from $34,557 (95% CI, $33,855 - $35,059) to $58,003 (95% CI, $57,218 - $58,788) per 100,000 patients with gout.

Although the RA data are encouraging, the authors conclude, "the gout findings suggest the need to improve care and prevention."

As reported previously by Medscape Medical News, earlier studies have shown that although the prevalence and incidence of gout has risen during the last 2 decades, new patients are not being optimally managed.

One coauthor disclosed receiving a research grant from AstraZeneca and serving as a research consultant for Takeda. The other authors have disclosed no relevant financial relationships.

JAMA. 2016;315:2345-2347. Extract

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