Epidemiology of Gout

Gout is the most prevalent inflammatory arthritis in men. The findings of several epidemiologic studies from a diverse range of countries suggest that the prevalence of gout has risen over the past few decades. Although incidence data are scarce, data from the United States suggests that the incidence of gout is also rising. Evidence from prospective epidemiologic studies has confirmed dietary factors (animal purines, alcohol, and fructose), obesity, the metabolic syndrome, hypertension, diuretic use, and chronic kidney disease as clinically relevant risk factors for hyperuricemia and gout. Low-fat dairy products, coffee, and vitamin C seem to have a protective effect.

Key points

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Gout has become more prevalent over the past few decades, affecting over 3% of adults in the United States. The limited incidence data in the United States suggest a similarly increasing trend.
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Excessive consumption of meat, seafood, sugar-sweetened soft drinks, fructose, and alcohol increases the risk of developing hyperuricemia and gout, whereas low-fat dairy products, coffee, and vitamin C seem to be protective against these conditions.
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Obesity, hypertension, the metabolic syndrome, chronic renal failure, and use of diuretics, β-blockers, as well as angiotensin II (AII) receptor antagonists (other than losartan) are independent risk factors for the development of hyperuricemia and gout, whereas diabetes mellitus, calcium channel blockers, and losartan seem to reduce the risk of developing these conditions.

Introduction

Gout is a crystal deposition disease that arises when supersaturation of body tissues with urate occurs, leading to the formation of monosodium urate (MSU) crystals in and around joints. Gout is the most prevalent inflammatory arthritis in men and is associated with impaired quality of life. Clinical manifestations include excruciatingly painful acute attacks of gouty arthritis, formation of tophaceous MSU crystal deposits in joints and other body tissues, chronic joint damage, renal stone formation, and potential renal insufficiency.

This article reviews trends in the prevalence and incidence of gout and the epidemiologic evidence underpinning our understanding of etiologic factors for its development including hyperuricemia, dietary factors, comorbidities (metabolic syndrome, renal disease, and osteoarthritis [OA]), and medications. The burden of comorbidity associated with and caused by gout is discussed elsewhere in this issue. Where possible, priority has been given to population-based prospective epidemiologic studies ( Table 1 ).

Table 1

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