What will it take to see gout as a serious disease? Already an estimated 9.2 million people in the U.S. suffer from this painful form of arthritis[i] caused by too much uric acid in the body.[ii] We know that in just over two decades, all-cause hospitalizations for people with gout have increased over 400%, which is nearly one-hundred times more than the increase seen in the general population.[iii] Coupled with these numbers are new studies shining a light on the staggering consequences of the under-management of the condition.

When a patient has high levels of uric acid, it can build up and form crystals in their joints and throughout their body.[ii] As these uric acid crystal deposits accumulate, they can form lumps, called tophi. It’s important to recognize that even if tophi are not acutely inflamed and causing severe pain, there are still serious consequences for patients. In fact, joint damage can occur in clinically asymptomatic patients.[iv] Expanding research also shows a clear correlation between these urate deposits and bone erosions.[v]

It is also well documented that people with gout are more likely to have other serious health conditions, including obesity, hypertension, type 2 diabetes, chronic kidney disease and cardiovascular disease.[vi] According to one study, 69.4 percent of gout patients had hypertension, while 22.5 percent had chronic kidney disease – numbers that are substantially higher than for those without gout.[vii] Research also shows that a person who has had gout for less than 10 years has a 2-fold increased risk of death compared with the general population.[viii] Additionally, the presence of detectable tophi on physical exams has been associated with an almost 3-fold increased risk of death.8

Simply put, patients with gout are dying.

But we can do better, in fact we need to.
Only 32.8% of U.S. patients with gout are receiving urate lowering therapies,[ix] and because of the unique mechanism that resolves acute pain in gout, patients often delay discussions with the physician. Emerging research compels us to move beyond under-management of gout and to change the way we intervene and care for people living it. With this clearer understanding of the clinical impact of gout and how comorbid conditions can put patients at an even greater risk of hospitalization and death, we have a responsibility to urgently identify patients with gout and provide necessary treatment.

Specifically, gout should be treated according to guidelines from the American College of Rheumatology. New guidelines surrounding gout are currently in development and are expected in early 2020. These should strengthen clinician resources for navigating this misunderstood and frequently mismanaged disease.

Many people still believe that gout can be managed with lifestyle changes alone – primarily dietary changes. But only one-third of the body’s uric acid is related to dietary intake[x] and adhering to a strict diet will only reduce uric acid levels by a small amount. In fact, one study found that overall diet may account for less than one percent of the total variability in uric acid levels.[xi] Still, nearly 1 in 4 patients believe natural remedies can effectively treat the disease.[xii]

We as clinicians must acknowledge the magnitude of gout and take action to further the understanding of the true extent of urate burden. Together, we will change how gout is perceived, treated and ultimately managed. Our patients are counting on us.

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Chen-Xu M, Yokose C, Pillinger M, Choi HK. Contemporary Prevalence of Gout and Hyperuricemia in the United States (National Health and Nutrition Examination Survey [NHANES] 2015-2016) and Decadal Trends (NHANES 2007-2016) [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/contemporary-prevalence-of-gout-and-hyperuricemia-in-the-united-states-national-health-and-nutrition-examination-survey-nhanes-2015-2016-and-decadal-trends-nhanes-2007-2016/

What is Gout? The Arthritis Foundation. Accessed June 1, 2017.

Singh G, Mithal A. Not Just a Swollen Big Toe: Increasing All-Cause Hospitalizations in Patients with Gout in the United States: 1993–2014 [abstract]. Arthritis Rheumatol.2018; 70 (suppl 10). https://acrabstracts.org/abstract/not-just-a-swollen-big-toe-increasing-all-cause-hospitalizations-in-patients-with-gout-in-the-united-states-1993-2014/

Puig JG, et al. Nucleosides Nucleotides Nucleic Acids. 2008;27(6):592-595.

Dalbeth N, et al. Ann Rheum Dis. 2009;68(8):1290-1295

Lisa K. Stamp, Peter T. Chapman; Gout and its comorbidities: implications for therapy. Rheumatology (Oxford) 2013; 52 (1): 34-44. doi: 10.1093/rheumatology/kes211

Chen-Xu M, Yokose C, Pillinger M, Choi HK. Contemporary Comorbidity Burden of Gout and Hyperuricemia in the US during the Past Decade (National Health And Nutrition Examination Survey [NHANES] 2007-2016) [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/contemporary-comorbidity-burden-of-gout-and-hyperuricemia-in-the-us-during-the-past-decade-national-health-and-nutrition-examination-survey-nhanes-2007-2016/. Accessed April 30, 2019.

Vincent ZL, Gamble G, House M, et al. Predictors of mortality in people with recent-onset gout: a prospective observational study. J Rheumatol. 2017;44(3):368-373. doi: 10.3899/jrheum.160596

Chen-Xu M, Yokose C, Pillinger M, Choi HK. Contemporary Prevalence of Gout and Hyperuricemia in the United States (National Health and Nutrition Examination Survey [NHANES] 2015-2016) and Decadal Trends (NHANES 2007-2016) [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/contemporary-prevalence-of-gout-and-hyperuricemia-in-the-united-states-national-health-and-nutrition-examination-survey-nhanes-2015-2016-and-decadal-trends-nhanes-2007-2016

Arthritis.org. (2019). How Diet Affects Gout | Purine Rich Foods. [online] Available at: https://www.arthritis.org/about-arthritis/types/gout/articles/purine-foods-gout-attack.php

Major Tanya J, Topless Ruth K, Dalbeth Nicola, Merriman Tony R. Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts BMJ 2018; 363 :k3951

National Survey of Patients’ Attitudes Toward Gout. Alliance for Gout Awareness. Accessed April 17, 2019.