Background/Purpose: Gouty arthritis (gout) is primarily managed in the community by primary care providers. Relatively little is known about the treatment patterns as well as time trends in general population settings.

Methods: We combined the data from National Ambulatory Medical Care Surveys (NAMCS) and National Hospital Ambulatory Medical Care Surveys (NHAMCS) from 1993 to 2009. Presence of a physician determined diagnosis of gout or prescription of allopurinol/colchicine was considered to signify a gout visit. We assessed the prescription of gout medications classified as allopurinol, colchicine, oral corticosteroids, any Non-Steroidal Anti-inflammatory drugs (NSAIDs) and Non-Coxib NSAIDs. We also studied the prescription pattern of aspirin as a ‘control’ group. Time trends were analyzed using weighted logistic regression models.

Results: Time trends in the use of medications are shown in the Figure. The trends for colchicine and steroids were not statistically significant. In logistic regressions that adjusted for age and sex, each advancing year was associated with a significant increase in the use of allopurinol with an odds ratio of 1.02 ((1.00,1.05), p=0.048) and the use of aspirin with an odds ratio of 1.09 (1.05,1.12). The use of Non-Coxib NSAIDs decreased with a yearly odds ratio of 0.96 (0.94, 0.99). There were no significant trends in other medications. The estimate of visits with concurrent prescriptions of allopurinol and probenecid was negligible. Overall, the combination of colchicine and any one of the NSAIDs were prescribed in 3.5 million (2.4 to 4.6 million) gout patients, representing 3.6% (2.6%, 4.8%) of all gout visits. The proportion of such combinations increased from 2.0% (1.2%, 3.3%) in the 1993-2000 period to 4.3% (3.1%, 6.1%) in the 2001-2009 period. In unadjusted logistic regression this change represented an odds ratio of 2.4 (1.3, 4.5) and in age-sex adjusted logistic regression the odds ratio was unchanged. Combination of NSAIDs and steroids was rare, and was prescribed in 1.7% gout visits (1.1%, 2.8%). These proportions were similar in the 1993-2000 and 2001-2009 periods: 1.3% (0.6%, 2.8%) and 1.9% (1.1%, 3.5%) respectively.

Conclusion: Distinct trends of gout medication use were observed signifying decrease in NSAIDs and increase in allopurinol. The utilization of colchicine and steroids has remained steady over time. Combination of different classes of anti-inflammatory therapies was infrequent.

Figure