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Objective To determine the prevalence, incidence, and burden of gout in the Veterans Health Administration (VHA) from 2005 to 2014. Methods We used national VHA data from January 1999 to December 2014 to determine the annual incidence and prevalence of gout in the VHA. Gout burden to the VHA was determined by the proportion of patients with an encounter related to gout. Rates of urate‐lowering therapy (ULT) and opiate use were determined annually. Characteristics of those with and without gout were compared using 2014 data. Results From 2005 to 2014, gout prevalence in the VHA increased from 4.2% to 5.8%, while disease incidence ranged from 5.8 to 7.4 cases per 1,000 patient‐years. Gout prevalence was highest among men, older patients, and non‐Hispanic black patients. During 2014, 4.0% of all inpatient or outpatient encounters and 1.3% of hospitalizations were gout related. Administration of ULT remained stable over the 10‐year period, with 46% of gout patients receiving ULT in 2014. In contrast, 16.4% of prevalent gout patients were receiving a weak opioid in 2014, nearly doubling the prescription rate of weak opioids in 2005, while the use of stronger opioids did not change significantly over this period. Patients with gout had greater comorbidity and health care utilization than patients without gout. Conclusion The burden posed by gout in the VHA is considerable and increased between 2005 and 2014. While the use of ULT has remained stable, the use of opioid therapy has increased among patients with gout.

Objective Controversy remains as to whether low serum urate or uric acid (UA) levels contribute to adverse outcomes. We evaluated the relation between low serum UA levels and sarcopenia and assessed whether sarcopenia confounds associations between these low levels and mortality. Methods We utilized data from the National Health and Nutrition Examination Survey (1999–2006). Participants with available whole‐body dual x‐ray absorptiometry body composition measurements and serum UA concentrations were included. Body composition assessments included body mass index (BMI), waist circumference, maximum lifetime BMI, and age‐, sex‐, and race‐specific appendicular lean mass index (ALMI) and fat mass index (FMI) Z scores. We also calculated Z scores for ALMI relative to FMI (ALMIFMI). We evaluated associations between serum UA levels and body composition using logistic regression and assessed associations between serum UA levels and mortality before and after adjusting for differences in body composition using Cox proportional hazards regression. Results Among the 13,979 participants, low serum UA concentrations (<2.5 mg/dl in women, <3.5 mg/dl in men) were associated with low lean mass (ALMI and ALMIFMI Z scores), underweight BMI (<18.5 kg/m2), and higher rates of weight loss. The proportion of patients with low ALMI Z scores was 29% in the low serum UA group and 16% in the normal serum UA group (P = 0.001). Low serum UA levels were associated with increased mortality before we adjusted for body composition (hazard ratio 1.61 [95% confidence interval 1.14–2.28]; P = 0.008) but was attenuated and not significant after adjustment for body composition and weight loss (hazard ratio 1.30 [95% confidence interval 0.92–1.85], P = 0.13). Conclusion Sarcopenia and weight loss are more common among patients with low serum UA concentrations. Differences in body composition may help to explain associations between low levels of serum UA and higher mortality.