Episode II - Attack of the Gout

My family history is strong with the Gout. My Grandfather had gout. As a young boy we always had to be careful of his foot when it was "flared up." My father has gout. He was 52 when he had his first attack of gout and 57 when he had his first MI. Perhaps I will get gout - I haven't measured my uric acid levels. My sister does not have gout.

I had the pleasure of speaking with Dr. Elfishawi this morning to discuss his research on the epidemiology of gout and how it has changed over the past 20 years. Dr. Eflishawi and the group at the Mayo Clinic performed a comprehensive review of charts of patients diagnosed with incident gout between 1989-1992 compared with 2009-2010. All patients met pre-defined criteria for gout.

First result - The incidence of gout is increasing. In the early 90's the age- and sex-adjusted incidence rate for gout was about 50 per 100,000 patient-years. At the end of 2010 the incidence rate was 107 per 100,000 patient-years. That's more than double. We can conclude that more people are getting gout but is gout different? The answer is yes ... less people are presenting with classic podagra (67 vs 80%). More people are presenting with large joint or multiple joint involvement.

Second result - Surprise, surprise, co-morbidities are increasing. We are becoming fatter. The average BMI has increased from 28.6 to 32. Assuming an average male height of 177 cm, this means that average weight has increased by 22lbs. Wow! Not surprisingly, this study also found statistically significant increases in the risk of hypertension, diabetes, and hyperlipidemia.

This study provides further evidence that gout rarely occurs as a standalone problem but is a manifestation of serious metabolic disease. If you see a patient with denovo gout, make sure to check their blood pressure, blood sugars, and lipid levels.

May the force be with you!

More reports from ACR 2015