Wednesday, 11 Dec 2019

You are here

Hospitalizations Decline for Rheumatoid Arthritis, But Increase in Gout

JAMA has reported the results of an 18-year National Inpatient Sample, a database of US non-federal hospitalizations. They examined the rate of hospitalizations for gout and rheumatoid arthritis (RA) and demonstrated a steady decline in RA, but a growing number of gout hospitalizations.

There were 254,982 hospitalizations for gout and 323,649 hospitalizations for RA between 1993 and 2011.

During this period, the hospitalization rate for RA went down from 13.9 to 4.6 per 100 000 adults (P < .001). At the same time, gout hospitalizatins increased from 4.4 to 8.8  per 100,000 adults. During this same era, the prevalence of RA dropped from 2.5 to 1.3 million affected Americans and the growth of gout (to current 8.3 million) has been fueled by the obesity epidemic. 

The authors believe these findings may reflect suboptimal care received by gout patients and its increasing prevalence, while at the same time pointing to the success of earlier diagnosis and more aggressive therapies in RA.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Rheumatologists' Comments

Looks like the same is shown for Canada. Arthritis Care Res 2016 Aug 26. Trends in Gout and Rheumatoid Arthritis Hospitalizations in Canada from 2000-2011...indings indicate that hospitalization rates for gout have doubled over the past decade, while those for RA have decreased considerably. While these data provide an encouraging benchmark for RA care, they also highlight the critical need to improve gout management and prevention to mitigate its rising disease burden in Canada and beyond.

More Like This

Pegradicase+ImmTOR SEL-212 Shows Promising Results In Active Gout

Therapies targeting sUA accumulation or improving its excretion are widely used for treatment of symptoms and prevention of progression of gout for decades. Despite our best effort, there is still a significant amount of patients who remain symptomatic and/or experiences progressive joint damage and disability. Regardless of the cause, either its lack of compliance or poor tolerability, more effective treatments are needed.

PANLAR Ultrasound Study Group: Recommendations On Imaging Modalities In Gout

Gout is a systemic inflammatory disease with high potential for joint damage due to erosive changes and MSU deposits resulting in disability and chronic pain. Prompt diagnosis and effective treatment are key to better long term outcomes and decreased disability.

T2T Lowers Mortality in Gout

A Spanish prospective cohort of active, uncontrolled gout patients were followed and showed that failure to reach a target serum uric acid (sUA) level of 6 mg/dl (0.36 mmol/L) or less was associated with a 2-3 fold increase in mortality.

Novel Inhibition of MSU Crystal Inflammation

Researchers from Washington State University have shown that inhibition of tumor growth factor-β (TGF-β)-activated kinase 1 (TAK1) can effectively downregulate inflammatory mediators and suppress inflammation caused by gout.

Monosodium urate (MSU) crystals directly activate the inflammasome to produce a plethora of pro-inflammatory cytokines, including interleukin-1β (IL-1β). 

Patients Prefer Nurse Led Care for their Gout

Despite the well known, well publicized treat-to-target (T2T) goal of a serum uric acid (SUA) level < 6 mg/dl, this goal is seldom achieved (< 40%) in clinical practice and patient adherence has been unacceptably low. A recent study shows that nurse-led care led to better outcomes in gout including patient acceptability, long-term adherence, and less flares.