Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study

Abstract

ObjectivesTo describe trends in the epidemiology of gout and patterns of urate-lowering treatment (ULT) in the UK general population from 1997 to 2012.MethodsWe used the Clinical Practice Research Datalink to estimate the prevalence and incidence of gout for each calendar year from 1997 to 2012. We also investigated the pattern of gout management for both prevalent and incident gout patients.ResultsIn 2012, the prevalence of gout was 2.49% (95% CI 2.48% to 2.51%) and the incidence was 1.77 (95% CI 1.73 to 1.81) per 1000 person-years. Prevalence and incidence both were significantly higher in 2012 than in 1997, with a 63.9% increase in prevalence and 29.6% increase in incidence over this period. Regions with highest prevalence and incidence were the North East and Wales. Among prevalent gout patients in 2012, only 48.48% (95% CI 48.08% to 48.89%) were being consulted specifically for gout or treated with ULT and of these 37.63% (95% CI 37.28% to 38.99%) received ULT. In addition, only 18.6% (95% CI 17.6% to 19.6%) of incident gout patients received ULT within 6 months and 27.3% (95% CI 26.1% to 28.5%) within 12 months of diagnosis. The management of prevalent and incident gout patients remained essentially the same during the study period, although the percentage of adherent patients improved from 28.28% (95% CI 27.33% to 29.26%) in 1997 to 39.66% (95% CI 39.11% to 40.22%) in 2012.ConclusionsIn recent years, both the prevalence and incidence of gout have increased significantly in the UK. Suboptimal use of ULT has not changed between 1997 and 2012. Patient adherence has improved during the study period, but it remains poor.

Update on hyperuricaemia and gout with evidence based management guidelines

“…11 The prevalence of gout in the UK General Practice Research Database (GPRD) of 4 634 974 persons was 2.49% (3.7% in men and 1.5% in women). 12 The prevalence increased to nearly 10% in men over 70 years. An analysis of the National Health Insurance Research Database of over 23 million people in Taiwan showed a prevalence of gout of 6.24%.…”

“…21,22 More recent analyses of large databases showed a rise in the peak age incidence to 65-84 years in the UK and 70-85 years in Taiwan. 1,2,12 Increased mortality and co-morbidities in patients with hyperuricaemia and gout…”

“…12,48,49 It is administered subcutaneously in a weekly dose of 80 mg or 160 mg weekly for 16 weeks. Rilonacept was well tolerated and was associated with 70.3% fewer gout flares in a multinational phase III study of 1 315 patients.…”

Gout – a guide for the general and acute physicians

“…1,8 Other risk factors for gout include ethnicity (eg AfroCaribbean, South Pacific islanders); obesity; excess consumption of beer or spirits, red meat, seafood, fructose-sweetened beverages and fruit juices; medications (particularly diuretics); and hypertension, renal impairment and insulin resistance. 8 There is evidence that moderate consumption of purine-rich vegetables, fresh fruits, soya and wine do not increase the risk of gout.…”

“…1 Although it has the potential to be cured, its treatment remains suboptimal, with 30-40% of eligible patients receiving urate-lowering treatment (ULT) generally at suboptimal doses and with adherence <40% at 12 months. 1 This review summarises the current understanding of aetiopathogenesis, clinical features and management of gout.…”