Hospitalizations associated with gout show a dramatic increase in the past two decades in the United States, while those related to rheumatoid arthritis have steadily decreased in the same period. These are the results of a study titled “Trends in Gout and Rheumatoid Arthritis Hospitalizations in the United States, 1993-2011,” recently published in the journal JAMA.
“Our findings provide a remarkably encouraging benchmark for the improvement in rheumatoid arthritis care in recent years. However, they also highlight the critical need to improve gout management in the U.S. and beyond,” study lead author Hyon K. Choi, MD, DrPH, of the Massachusetts General Hospital Division of Rheumatology, Allergy and Immunology, said in a press release.
The two diseases, gout and rheumatoid arthritis, are the most common inflammatory joint disorders worldwide. But long-term data related to hospitalizations for both diseases is lacking. This information is crucial for a deeper understanding of the disease burden and associated care costs.
Authors looked at hospitalizations trends, rates of surgery, and inflation-adjusted hospital costs associated with both diseases, analyzing data retrieved from the Nationwide Inpatient Sample compiled by the Agency for Healthcare Research and Quality, for the years 1993 to 2011.
The team detected a 67 percent decrease in the rate of hospitalizations in the U.S. for rheumatoid arthritis. But, during the same period, the rate for gout hospitalizations doubled. Moreover, surgeries for rheumatoid arthritis dropped by 75 percent and inflation-adjusted annual costs decreased by 33 percent. On the other hand, gout surgeries remained unchanged and inflation-adjusted annual hospitalization costs increased by 68 percent.
These differences, authors emphasized, are related to the widespread use of effective medications for rheumatoid arthritis, together with better management and earlier treatment. Western diet (including meat consumption, fats, sugary sodas, and alcohol) and obesity, hypertension, and chronic kidney disease are significant factors for the increase in gout, which affects more than 8 million people in the U.S.
“A recent study found that up to 89 percent of hospitalizations for gout were preventable, owing to inadequate or inefficient care,” Choi explained. “While many patients are candidates for uric-acid-lowering medications, only a small proportion receive treatment. In fact, many physicians are not even measuring uric acid levels for their patients who do receive uric-acid-lowering prescriptions.
“Most importantly, few patients receive personalized lifestyle advice to reduce risk factors and complications or clear education about the essentially curable nature of this disease. That has led to very poor treatment adherence among patients, with one study finding adherence among gout patients to be the worst among seven chronic conditions.”
Choi added, “Advanced gout can be quite debilitating, as it leads to joint destruction and deformity, and acute gout flares are one of the most painful conditions experienced by humans. The pathogenesis of gout is well understood and effective treatments are available, but the care of gout remains remarkably suboptimal due to a lack of proper patient education and treatment mismanagement.”