Gout is worldwide the most common non-degenerative inflammatory joint disease, exemplified by a prevalence of 3.9% in the US and 1.7–2.5% in Europe.
The incidence increase with increasing age and BMI, is influenced by genetic, dietary factors and other life style factors as well the occurrence of comorbidity. Of the latter decreasing kidney function is by far the most important.
Several studies have pointed out that the age-adjusted incidence is rising worldwide, partly due to an increase in age and BMI, and we therefore face an upcoming epidemic.
Comorbidity outcomes: Gout identified in registers, thus reflecting the whole spectrum of the disease, has repeatedly been shown to be strongly associated with an increased morbidity in cardiovascular outcomes, deteriorating kidney function and overall mortality. To what extent this is related to hyperurecemia or systemic inflammation as reflected by clinical gout has not been completely disentangled. Very low serum-urate levels have on the other hand been suggested to increase the risk for dementia and Parkinsons disease, although this would need be confirmed.
Health related Quality of Life (HQoL): Whereas it is clinically obvious that very severe gout can have severe impact on HQoL, there is limited data to what extent early disease or more limited gout manifestations reduces HQoL
Societal costs: Once considered a disease of the wealthy, gout has recently been shown to be associated with lower income and socioeconomic class as is the case for most chronic diseases. It is difficult to disentangle the effects of joint manifestations and associated comorbidities on the incremental costs that some studies have demonstrated in groups of gout and this would need to be furthers studied.
What can we do to stop this epidemic? Apparently there are still large opportunities for improvements with regard to early detection and initiation of urate lowering therapy. In addition, improvements in life style are likely to be highly protective. Since gout is an increasing problem, there is also a high need for studies describing the effects on HQoL and costs over the whole range of the disease.
Disclosure of Interest None declared