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Epidemiology of gout: An update

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Gout is the most common inflammatory joint disease in men, characterised by formation of monosodium urate (MSU) crystals in the synovial fluid of joints and in other tissues. The epidemiology of gout provides us with the understanding of the disease distribution and its determinants. In an attempt to update the knowledge on the topic, more recent research reports on the descriptive epidemiology of gout are reviewed in this article. The review describes clinical characteristics and case definitions of gout, including the Rome and New York diagnosis criteria of gout, ‘1977 American Rheumatism Association (ARA) criteria’ and the 10 key propositions of the European League Against Rheumatism (EULAR) recommendations. Gout incidence, prevalence, morbidity and mortality, geographical variation of the disease, relevant risk factors for both the occurrence and outcome of gout and trends of the disease over time are then described. Difficulties in obtaining the information and data reported are also discussed.

Section snippets

Descriptive epidemiology

Gout is a crystal-deposition rheumatic disease. It is a more common inflammatory arthritis in men, characterised by formation of monosodium urate (MSU) crystals in the synovial fluid of joints and in other tissues. The crystals’ formation is caused by persistent urate levels in extracellular fluids (ascertained as serum uric acid levels) over the saturation threshold. Serum uric acid (sUA) is the endproduct of purine metabolism, in most cases, resulting from the inefficiency of renal urate

Geographical difference in occurrence/outcome of gout

Variation of the occurrence/outcome of gout due to geographical difference is described below. In addition, within similar geography, some variation of the disease was also presented.

What are the relevant risk factors for the occurrence of gout?

There were both non-modifiable and modifiable risk factors for hyperuricaemia and gout [92]. Non-modifiable risk factors included age and sex. In a Taiwanese population, where gout prevalence was exceptionally high, it was reported that 25% of the patients had their first gouty attack before the age of 30 years [87]. However, the disease was more commonly seen in an older population [93]. Gout primarily occurs in men but, in elderly patients, the ratio between men and women was less. In a

What are the time trends?

Trends in alcohol use, diet, obesity and MS in the general population might explain the increase in gout prevalence and incidence over time. In a population where gout was previously rare, the disease was more prevalent throughout Sub-Saharan Africa [89], [119]. Hyperuricaemia and gout were common among Maoris in New Zealand. Nevertheless, the prevalence of gout was reported to be on the increase, both in Maori and in Europeans, particularly in men. Compared to previous studies, in Maori men,

Difficulties in obtaining these informations: what are the weaknesses of the data reported above?

It was apparent that the classification criteria developed for the diagnosis of gout for population surveys, and epidemiological and clinical studies still required further investigation and validation. In addition, there were some variations in the sUA levels used to define hyperuricaemia in different studies reported on gout and/or hyperuricaemia. For example, the sUA levels ranging from 4.7 mg dl−1 to 6.6 mg dl−1 for women and from 5.7 mg dl−1 to 7.7 mg dl−1 for men were reported in the

Conclusion

Gout is a crystal-deposition rheumatic disease, more commonly seen in men and the older population. An update on the fundamental descriptive epidemiology of gout has considerably added to our knowledge and understanding of the disease. It is evident that there is an improvement on the clarity of the classification criteria for the diagnosis of gout, although further validation is still needed. Gout incidence and prevalence are influenced by the changes in diet, lifestyle and environmental

Acknowledgements

This work was supported by the Australian Commonwealth Department of Health and Ageing (to LM, ES). The funder had no role in the collection, analysis and/or interpretation of data or in the writing of the article.

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