Update on Gout Management: What Is Old and What Is New

Yuliya Afinogenova; Abhijeet Danve; Tuhina Neogi


Curr Opin Rheumatol. 2022;34(2):118-124. 

In This Article

Rising Prevalence and Burden of Disease

Over the last 30 years, there was a 100% increase in prevalence of gout, which is out of proportion to the 42% increase in the world population or the rise in life expectancy.[1] The Global Burden of Disease Study in 2017 estimated that approximately 41.2 million adults are living with gout worldwide, more than double the number of people living with rheumatoid arthritis.[1,2] The prevalence of gout in the USA alone is 9.2 million (3.9% of USA adults).[3] The incidence and prevalence of gout are higher in racial/ethnic minorities and in older adults.[4]

Gout is associated with a 17% higher all-cause mortality risk than those without gout, with cardiovascular disease (CVD) being the most common cause of death.[5] In addition, renal disease was associated with 1.78 times higher risk of cause-specific mortality in those with gout compared with those without.[5] Although a decrease in excess risk of premature mortality compared with the general population has been observed in rheumatoid arthritis over time,[6] this trend has not been observed in gout, with similar excess risk of mortality for patients diagnosed with gout in 1999–2006 as compared to 2007–2014.[7]

Gout contributes to tremendous healthcare costs. A 2015 meta-analysis estimated all-cause annual direct costs among employed patients ranging from $4733 to $9353 per capita.[8] Costs are higher for older adults ($16 925) and patients with treatment refractory gout ($18 362).[8] Emergency department visits for gout increased from 2006 to 2012 by 14%, and healthcare charges increased by 80% in the USA.[9] Whereas hospitalization rates for rheumatoid arthritis patients declined by 67% from 1993 to 2011, hospitalization rates doubled for patients with gout.[10] Furthermore, patients with gout incur high indirect costs related to the work impairment and productivity loss.[8]