Background/Purpose: Several studies have suggested that the prevalence of gout has increased over recent years. The majority of this data has been derived from insurance claims databases. However, there are few data available regarding a possible change in the incidence of gout in the United States. We therefore aimed to determine whether there has been a change in the incidence of gout over the last 20 years, and evaluate possible changes in the clinical presentation of gout.

Methods: The individual medical records of all patients with a potential diagnosis of gout in a defined geographic cohort were reviewed using a resource insuring complete medical record capture. All individuals with a possible diagnosis of incident gout during the time periods January 1^st 1989 – December 31^st 1992 and January 1^st 2009 – December 31^st 2010 were identified.  Incident cases had to fulfill at least 1 of 3 criteria: the 1977 American College of Rheumatology proposed criteria for gout, the Rome or New York criteria.  Demographic and clinical data were abstracted for every incident case. Clinical characteristics were compared between time-periods using chi-square tests. Incidence rates with 95% confidence intervals (CI) were age- and sex-adjusted to the 2010 U.S. white population.

Results: A total of  158 patients with new-onset  gout were identified during the 4 year time period between 1989-1992 and 271 patients between the 2 year time period between 2009-2010, translating into age- and sex adjusted  incidence rates of 52.1/100 000 (95%CI 43.7-60.5) and 106.9/100 000 (95%CI 94.1-119.8), respectively. The incidence rate ratio for gout of 2.57 (95%CI; 2.11, 3.13) increased significantly over the last 20 years.

Patients diagnosed with gout between 2009-2010 were less likely to present with isolated podagra compared to patients diagnosed 20 years ago (67% versus 80%). Patients with gout incident in the recent period  2009-2010 had higher likelihood of having comorbid conditions compared with 1989-1992,  such as hypertension (73% vs. 54%), diabetes (27% vs. 6%), kidney disease (32% vs. 11%), hyperlipidemia (65% vs. 21%), and heart failure (15% vs. 6%), respectively, at the time of their first gout flare. The likelihood of obesity among patient with incident gout increased from 37% to 56% over the last 20 years – with an increase of morbid class III obesity from 3% to 13%.

Conclusion: The incidence of gout has more than doubled in our population-based cohort over the last 20 years. This observation appears to be consistent with the increase in prevalence reported in several studies to date. Patients have become more likely to present with atypical presentations in joint areas other than the 1^st MTP joint, which may make the diagnosis more challenging.

The marked increase in various cardiovascular comorbidities and risk factors among patients with incident gout is concerning and emphasizes that gouty arthritis rarely occurs as a stand-alone problem, but rather must be seen as a manifestation of serious systemic metabolic disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-epidemiology-of-gout-marked-increase-in-incidence-and-comorbidities-over-20-years/