Krishnan E andLinjun Chen L. Trends in physician diagnosed gout and gout therapies in the US: results from the national ambulatory health care surveys 1993 to 2009 Arthritis Research & Therapy (2013) doi:10.1186/ar4370. First published online November 6, 2013.
Ambulatory visits for gouty arthritis – especially among the elderly -- show an almost three-fold rise since 1993, reflecting increases in physician and patient awareness, report researchers from Stanford University.
An analysis of national sample surveys of US physician practices and hospital outpatient clinics estimates the number of visits rising significantly from 4.1 million in 1993 to 12.1 million in 2009. Most of the increases were seen from 2003 onwards, the authors state.
When analyzed for age, increases were statistically significant for men over age 60 and for women ages 60-79.
At the same time, there was an increase in the use of gout medications allopurinol and colchicine, while glucocorticoid use remains unchanged.
Other medication trends:
• The decline in traditional non-steroidals is possibly due to safety concerns.
• Aspirin use -- a supposed risk factor for gout and gout flares -- increased substantially.
• Prescriptions for anti-inflammatories decreased.
• Probenecid use is negligible.
• Frequency of systemic steroids is unchanged.
Why are visits increasing? "The large magnitude of this increase also cannot be explained by the modest changes in population incidence and prevalence of gout," the authors say. They speculate that the change "may be causally linked to the extensive patient and physician gout awareness programs led by manufacturers of urate-lowering therapies and entities such as the Gout and Uric acid Society since 2005."