The Rising Incidence of Gout and the Increasing Burden of Comorbidities: A Population-based Study over 20 Years

Abstract

The incidence of gout has more than doubled over the recent 20 years. This increase together with the more frequent occurrence of comorbid conditions and cardiovascular risk factors represents a significant public health challenge.

A Changing Landscape of Gout: Comorbidity Matters

“…Currently, the European League Against Rheumatism recommendations 8 , the British Society for Rheumatology 9 , and the American College of Rheumatology guidelines 10 all recommend comorbidities that may contribute to or associate with hyperuricemia as part of an initial assessment of patients with gout. The comorbidity checklist, including obesity, metabolic syn drome, diabetes mellitus, hyperlipidemia, urolithiasis, and chronic kidney diseases, is roughly consistent with the comorbidities that occurred more commonly in newly diagnosed patients with gout, as reported by Elfishawi, et al 6 . Despite recent evidence indicating that gout is associated with a greater array of comorbidities 11 , it seems reasonable to consider the most common comorbidities that are also risk factors for major adverse cardiac events such as coronary heart diseases.…”

“…The Global Burden of Disease 2010 study found no increase in global gout prevalence between 1990 and 2010 16 , which seems to contradict the results of Elfishawi, et al 6 . More studies are needed to harmonize these differences.…”

“…Data from the Rochester Epidemiology project estimated an age-and sex-adjusted incidence of gout of 45 per 100,000 people in the period 1977-1978 and 62 per 100,000 people in 1995-1996 5 . In this issue of The Journal, Elfishawi, et al also used data from the Rochester Epidemiology project to compare the incidence of gout between periods 1989-1992 and 2009-2010 6 . The incidence more than doubled, from 66.6 to 136.7 per 100,000 people.…”

“…In general, a significant change in disease incidence implies a change of risk factors or population composition. Elfishawi, et al provide their interesting observations: a multifold increase in many associated comorbidities of gout and hyperuricemia 6 . For example, there was a 4-fold increase for diabetes, 3-fold for renal diseases and hyperlipidemia, 50% for obesity, and 30% for hypertension.…”

Construction and expression of recombinant uricase‑expressing genetically engineered bacteria and its application in rat model of hyperuricemia

“…The clinical diagnostic criteria for hyperuricemia are SUA >420 µmol/l in males and SUA >360 µmol/l in females (5). Recent studies have shown that following changes to the structure of the human diet, the incidence of hyperuricemia in the world is increasing (6)(7)(8), and the age of onset of hyperuricemia is decreasing (9,10).…”