Trends in Gout and Rheumatoid Arthritis Hospitalizations in the United States, 1993-2011

Lim, Sian Yik; Lu, Na; Oza, A.; Fisher, Mark; Sharan, K.; Menendez, Mariano E.; Choi, Hyon K.

doi:10.1001/jama.2016.3517

Cited by 94 publications

(88 citation statements)

References 6 publications

(7 reference statements)

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“…As a consequence, only a minority become free of gout, with the majority continuing to experience acute attacks, thereby contributing to an increased inpatient burden 28 34. which also contributes to many avoidable hospitalisations 13 35 36. A recent study based on the US national inpatient data found that primary hospitalisation rates for gout have increased substantially over the past two decades, whereas those for RA have declined considerably 13.…”

Section: Discussionmentioning

confidence: 99%

“…which also contributes to many avoidable hospitalisations 13 35 36. A recent study based on the US national inpatient data found that primary hospitalisation rates for gout have increased substantially over the past two decades, whereas those for RA have declined considerably 13. Moreover, a recent abstract highlighted that up to 89% of hospitalisations with a primary diagnosis of gout were preventable, owing to inefficient or inadequate care 36…”

Section: Discussionmentioning

confidence: 99%

“…However, no equivalent secular trend data are available for gout. Given the well-documented suboptimal gout care, opposing mortality trends may exist between RA and gout, as was recently shown in their hospitalisation trends 13. We evaluated this hypothesis by examining mortality trends among patients with gout over the same period as in our recent study of RA (ie, 1999–2014) based on the same general population database 12.…”

Section: Introductionmentioning

confidence: 99%

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The unclosing premature mortality gap in gout: a general population-based study

Fisher

Sharan

et al. 2017

Ann Rheum Dis

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The unclosing premature mortality gap in gout: a general population-based study

Fisher

Sharan

et al. 2017

Ann Rheum Dis

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“…By contrast, rheumatologists generally see gout as a chronic, very often progressive, condition that has acute flares but a tendency to progress. With gout increasing in prevalence, and with so many patients being older and affected by multiple comorbidities, gout is becoming more challenging to manage, as indicated (in part) by a marked increase in severe acute gout flares requiring hospitalization 52,53 . The G-CAN position is that the ACP's stance on ULT, essentially that ULT can be prescribed without urate monitoring or optimization of ULT dose to achieve urate concentrations below the saturation threshold of soluble urate 1 , is particularly troubling as it could help perpetuate the common practice pattern of underdosing of ULT 54 .…”

Section: Consequences Of Guideline Discordancementioning

confidence: 99%

Discordant American College of Physicians and international rheumatology guidelines for gout management: consensus statement of the Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN)

et al. 2017

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Gout is a common form of inflammatory arthritis for which highly effective treatments are available, yet the management of this disease is frequently suboptimal. Gout often presents as an acute 'flare' of painful inflammation that typically resolves within a week or two, but can be difficult to control in some instances, can negatively affect quality of life, can be costly to experience and treat, and can warrant hospital admission. If gout-associated hyperuricaemia is inadequately treated, gout flares often progress in frequency and severity, and a state of chronic, inflammatory arthritis can supervene, leading to continuous pain, decreased joint function, and permanent joint damage.Guidelines for the management of gout are intended to help physicians select the most effective course of treatment and to educate patients in order to ensure adherence. In November 2016, the American College of Physicians (ACP) published a clinical practice guideline for the management of acute and recurrent gout 1 . Despite evaluating similar evidence, the ACP clinical practice guideline differs substantially from all other gout management guidelines issued by major international rheumatology groups in the past 5 years, including the 2012 Abstract | In November 2016, the American College of Physicians (ACP) published a clinical practice guideline on the management of acute and recurrent gout. This guideline differs substantially from the latest guidelines generated by the American College of Rheumatology (ACR), European League Against Rheumatism (EULAR) and 3e (Evidence, Expertise, Exchange) Initiative, despite reviewing largely the same body of evidence. The Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN) convened an expert panel to review the methodology and conclusions of these four sets of guidelines and examine possible reasons for discordance between them. The G-CAN position, presented here, is that the fundamental pathophysiological knowledge underlying gout care, and evidence from clinical experience and clinical trials, supports a treat-to-target approach for gout aimed at lowering serum urate levels to below the saturation threshold at which monosodium urate crystals form. This practice, which is truly evidence-based and promotes the steady reduction in tissue urate crystal deposits, is promoted by the ACR, EULAR and 3e Initiative recommendations. By contrast, the ACP does not provide a clear recommendation for urate-lowering therapy (ULT) for patients with frequent, recurrent flares or those with tophi, nor does it recommend monitoring serum urate levels of patients prescribed ULT. Results from emerging clinical trials that have gout symptoms as the primary end point are expected to resolve this debate for all clinicians in the near term future. NATURE REVIEWS | RHEUMATOLOGY VOLUME 13 | SEPTEMBER 2017 | 561 CONSENSUS STATEMENT © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d . UricaseAn enzyme that degrades ur...

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“…An increase in hospitalization for gout has been shown for the last 2 decades in North America 1,2 . We evaluated the trend for hospitalization of gout in western Sweden from 2002 to 2012 and compared it to the total hospitalization rate.…”

Section: Trends In Gout Hospitalization In Swedenmentioning

confidence: 99%