Chronic gout: epidemiology, disease progression, treatment and disease burden

Abstract Background: Gout is a painful and disabling inflammatory arthritis of increasing prevalence associated with hyperuricemia and the deposition of monosodium urate crystals in soft tissues and joints. Diagnosed gout cases have been estimated at 2.13% of the 2009 US population. The highest incidence occurs in the 65+ year age group, with males more than twice as likely to be afflicted as females. Objective: To present the epidemiology of chronic gout and to discuss its disease burden. Methods: This commentary is based on expert opinion and supplemented with published/presented information identified through PubMed and rheumatology associations. Results: The steady rise of diagnosed gout cases can generally be linked to an aging population with multiple comorbidities, the use of certain prescription medications, and changes in diet and lifestyle. Progression to chronic gout has numerous causes such as poor compliance with, ineffectiveness of, or inability to tolerate prescribed regimens. Despite the availability of urate-lowering therapies (ULT), patients may either have contraindications to them or may not adequately respond. Patients with high flare frequency, tophi, and the inability to maintain serum urate levels below 6 mg/dL with ULT can be categorized as having chronic gout that is refractory, with a substantial disease burden. Based on lack of therapeutic options for urate-lowering for patients with chronic gout refractory to conventional therapy, the economic burden of this small but substantial population contributes disproportionately to the overall economic burden of chronic gout. Recent availability of gout-specific ICD-9-CM codes capturing the cost intense and impactful aspects of the disease – flares and tophi – is likely contribute to understanding the full health economic burden in gout. Conclusion: The impact of chronic gout, especially if refractory to treatment, on functionality, productivity, quality of life and health care costs can be substantial and is deserving of future research.

[1]  H. Schumacher,et al.  Quality of Life and Disability in Patients with Treatment-Failure Gout , 2009, The Journal of Rheumatology.

[2]  K. Saag,et al.  Gout medication treatment patterns and adherence to standards of care from a managed care perspective. , 2006, Mayo Clinic proceedings.

[3]  Hyon K. Choi,et al.  Gout and Quality of Life , 2009, The Journal of Rheumatology.

[4]  P. Kimmel,et al.  New-Onset Gout after Kidney Transplantation: Incidence, Risk Factors and Implications , 2005, Transplantation.

[5]  N. Edwards,et al.  The role of hyperuricemia in vascular disorders , 2009, Current opinion in rheumatology.

[6]  G. Hermann,et al.  A radiologic reevaluation of gout: a study of 2,000 patients. , 1980, AJR. American journal of roentgenology.

[7]  E. Krishnan,et al.  Frequency, Risk, and Cost of Gout-related Episodes Among the Elderly: Does Serum Uric Acid Level Matter? , 2009, The Journal of Rheumatology.

[8]  C. Wise,et al.  Gout and hyperuricemia , 1989, Current opinion in rheumatology.

[9]  K. Saag,et al.  Pathophysiology, Clinical Presentation and Treatment of Gout , 2012, Drugs.

[10]  A. Gutiérrez-Macías,et al.  Fatal allopurinol hypersensitivity syndrome after treatment of asymptomatic hyperuricaemia , 2005, BMJ : British Medical Journal.

[11]  J. Alvarez-Nemegyei,et al.  Factors associated with musculoskeletal disability and chronic renal failure in clinically diagnosed primary gout. , 2005, The Journal of rheumatology.

[12]  J. Brailsford.  The radiology of gout. , 1959, British Journal of Radiology.

[13]  H. Schumacher,et al.  Treatment of chronic gout. Can we determine when urate stores are depleted enough to prevent attacks of gout? , 2001, The Journal of rheumatology.

[14]  Hyon K. Choi,et al.  Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. , 2005, Archives of internal medicine.

[15]  N. Schlesinger.  Management of acute and chronic gouty arthritis: present state-of-the-art. , 2004, Drugs.

[16]  F. Perez-Ruiz,et al.  Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout. , 2002, Arthritis and rheumatism.

[17]  A. Hingorani,et al.  British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout. , 2007, Rheumatology.

[18]  Elizabeth W Karlson,et al.  Purine-rich foods, dairy and protein intake, and the risk of gout in men. , 2004, The New England journal of medicine.

[19]  A. Tykarski.  Evaluation of renal handling of uric acid in essential hypertension: hyperuricemia related to decreased urate secretion. , 1991, Nephron.

[20]  W. Bilker,et al.  Suboptimal physician adherence to quality indicators for the management of gout and asymptomatic hyperuricaemia: results from the UK General Practice Research Database (GPRD). , 2005, Rheumatology.

[21]  L. Stamp,et al.  Gout in solid organ transplantation: a challenging clinical problem. , 2005, Drugs.

[22]  J. Puig,et al.  Plasma oxypurinol concentration in a patient with allopurinol hypersensitivity. , 1989, The Journal of rheumatology.

[23]  N. McGill.  The epidemiology and treatment of gout , 2011, Open access rheumatology : research and reviews.

[24]  W. Taylor,et al.  Validation of a radiographic damage index in chronic gout. , 2007, Arthritis and rheumatism.

[25]  S. Novak,et al.  Metabolic syndrome-related conditions among people with and without gout: prevalence and resource use* , 2007, Current medical research and opinion.

[26]  R. Glynn,et al.  Asymptomatic hyperuricemia. Risks and consequences in the Normative Aging Study. , 1987, The American journal of medicine.

[27]  H. Schumacher,et al.  Monosodium Urate Crystal Deposition Arthropathy Part I : Review of the Stages and Diagnosis of Gout , 2005 .

[28]  W. Willett,et al.  Alcohol intake and risk of incident gout in men: a prospective study , 2004, The Lancet.

[29]  N. Kleinman,et al.  The impact of gout on work absence and productivity. , 2007, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[30]  Hyon K. Choi,et al.  Pathogenesis of Gout , 2005, Annals of Internal Medicine.

[31]  J. Sundy,et al.  Refractory gout: what is it and what to do about it? , 2008, Current opinion in rheumatology.

[32]  H. Schumacher,et al.  Clinical Efficacy and Safety of Successful Longterm Urate Lowering with Febuxostat or Allopurinol in Subjects with Gout , 2009, The Journal of Rheumatology.

[33]  S. Gabriel,et al.  Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. , 2008, Arthritis and rheumatism.

[34]  R. Wortmann,et al.  Increasing prevalence of gout and hyperuricemia over 10 years among older adults in a managed care population. , 2004, The Journal of rheumatology.

[35]  S. Andrade,et al.  Adherence with urate-lowering therapies for the treatment of gout , 2009, Arthritis research & therapy.

[36]  V. Strand,et al.  Use of “spydergrams” to present and interpret SF-36 health-related quality of life data across rheumatic diseases , 2009, Annals of the rheumatic diseases.

[37]  T. Dawber,et al.  Epidemiology of gout and hyperuricemia. A long-term population study. , 1967, The American journal of medicine.

[38]  H. Schumacher,et al.  Febuxostat in the treatment of gout: 5-yr findings of the FOCUS efficacy and safety study. , 2008, Rheumatology.

[39]  G. Curhan,et al.  The association between gout and nephrolithiasis: the National Health and Nutrition Examination Survey III, 1988-1994. , 2002, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[40]  N. Kleinman,et al.  The economic burden of gout on an employed population , 2006, Current medical research and opinion.

[41]  J. Singh.  Quality of life and quality of care for patients with gout , 2009, Current rheumatology reports.

[42]  G. Percheron,et al.  REVISION OF THE INTERNATIONAL CLASSIFICATION OF DISEASES , 1971 .

[43]  P Netter,et al.  EULAR evidence based recommendations for gout. Part II: Management. Report of a task force of the EULAR Standing Committee For International Clinical Studies Including Therapeutics (ESCISIT) , 2006, Annals of the rheumatic diseases.

[44]  H. Schumacher,et al.  Serum Urate Levels and Gout Flares: Analysis From Managed Care Data , 2006, Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases.

[45]  E. Krishnan,et al.  Disease-Related and All-Cause Health Care Costs of Elderly Patients With Gout , 2008, Journal of managed care pharmacy : JMCP.

[46]  Atlanta,et al.  Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. , 2008, Arthritis and rheumatism.

[47]  E. McDonald,et al.  Stopping progression to tophaceous gout. When and how to use urate-lowering therapy. , 1998, Postgraduate medicine.

[48]  S. Kong,et al.  A literature review of the epidemiology and treatment of acute gout. , 2003, Clinical therapeutics.

[49]  R. Terkeltaub,et al.  Recent developments in our understanding of the renal basis of hyperuricemia and the development of novel antihyperuricemic therapeutics , 2006, Arthritis research & therapy.

[50]  N. Schlesinger.  Management of Acute and Chronic Gouty Arthritis , 2012, Drugs.