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This general population-based cohort study suggests that statin initiation is associated with a substantially lower risk of mortality among patients with AS. The magnitude of the inverse association appears to be larger than that observed in randomised trials of the general population and in population-based cohort studies of patients with rheumatoid arthritis.

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BackgroundGout and rheumatoid arthritis (RA) are the two most common inflammatory arthritides. As hospitalizations for these conditions are known to incur substantial resource use, hospitalization trends and associated costs provide key benchmarks of disease burden. Varying levels of perceived success in their care and changing epidemiology (mainly for gout) may have made a substantial impact over recent years; however, relevant data are scarce.ObjectivesTo examine hospitalization trends of gout and rheumatoid arthritis in the US.MethodsWe examined trends in the annual hospitalization rate of gout and RA using the US Nationwide Inpatient Sample (1993–2011).ResultsFrom 1993 to 2011, the annual hospitalization rate for patients with a principal diagnosis of RA declined by 67% from 13.9 to 4.6 per 100,000 US adults (p<0.001), whereas that for gout doubled from 4.4 to 8.8 per 100,000 US adults (p<0.001), reversing the hospitalization rates between the two conditions over the past two decades. These trends persisted among subgroups by age, sex, race, and geographic region (all p-values<0.001). Approximately 60% of RA admissions and 2% of gout admissions were associated with total joint replacement or other major joint surgeries; the frequency trend of these surgeries paralleled the declining trend in RA hospitalizations (all p-values <0.001). The hospital costs also reflected the hospitalization trends, resulting in $58,003 (2011 USD) per 100,000 US adults for gout and $55,988 per 100,000 US adults for RA in 2011.ConclusionsThese nationally representative inpatient data indicate that both primary hospitalization rates and the inpatient economic burden for gout have increased substantially over the past two decades, whereas those for RA have declined considerably. These trends reflect both suboptimal gout care in addition to its increasing prevalence; these data also provide a key reassuring benchmark for the perceived improvement in RA care, thereby preventing joint replacements. These data support the critical need to improve gout prevention and care.AcknowledgementThis work was supported in part from a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR065944)Disclosure of InterestNone declared

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