Rates of gout continue to rise in UK, but GP care has not improvedBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g239 (Published 16 January 2014) Cite this as: BMJ 2014;348:g239
Although the prevalence of gout in the United Kingdom has risen by about two thirds over the past 15 years, the care provided by GPs for the condition has “remained essentially the same” and of a poor standard, says a study in the Annals of the Rheumatic Diseases.
The research found that the UK now had the highest prevalence of gout in Europe, with one in 40 people having been given a diagnosis.1 However, the proportion of patients with gout being treated with urate lowering drugs has remained constant over the past 15 years, at just a third.
Researchers from the University of Nottingham used the Clinical Practice Research Datalink to estimate the prevalence and incidence of gout in the UK between 1997 and 2012 and to look at the treatment of gout patients to see how well the condition was managed.
Of more than 4.5 million eligible people on the database in 2012, the researchers found that almost 116 000 had gout, giving a prevalence of 2.5%. Men were more likely than women to have gout diagnosed.
From 1997 to 2012 the prevalence of gout rose by 64%, increasing by around 4% each year. Over that period the number of new cases diagnosed each year rose by 30%, increasing by around 1.5% each year. More than 7000 new cases of gout were diagnosed in 2012, giving an overall incidence of 2.26 per 1000 person years, and 3.5 per 1000 person years among men.
Weiya Zhang, associate professor and reader in musculoskeletal epidemiology at the University of Nottingham and one of the study researchers, said, “Unfortunately, despite this rising prevalence and the publication of European and UK guidelines in 2006 and 2007, respectively, the management of gout appears to be [worse] than suboptimal, with only one in three prevalent patients receiving urate lowering drugs, and only one in four newly diagnosed patients receiving urate lowering drugs within one year of diagnosis.”
Zhang added, “Although patient adherence to urate lowering drugs has improved in the past decade, this remains poor.”
The study found that in 2012 only 38% (95% confidence interval 37.3% to 39.0%) of gout patients received urate lowering drugs. Among those with newly diagnosed gout, only 19% (17.6% to 19.6%) received urate lowering drugs within six months of diagnosis, and 27% (26.1% to 28.5%) received them within 12 months.
However, the proportion of patients adhering to treatment improved over the study period from 28% (27.3% to 29.3%) in 1997 to 40% (39.1% to 40.2%) in 2012.
Although existing guidelines “do not explicitly advise discussion of urate lowering drugs with every gout patient around the time of diagnosis,” Zhang said, most patients would have specific indications—such as further attacks, renal impairment, or a long term need for diuretics—at diagnosis or within 12 months, where best practice would warrant some consideration of the use of these drugs.
The findings also showed wide geographical variation in the prevalence and incidence of gout across the UK. Prevalence was highest in the north east of England and in Wales and lowest in Scotland and Northern Ireland. Incidence was also highest in Wales and the north east of England but lowest in the east of England and in Northern Ireland.
Zhang said, “The reasons for current geographic variation in gout most likely relate to differences in socioeconomic status, lifestyle, and nutrition, and although gout historically was considered a disease of affluence, the converse may now be true.”
Cite this as: BMJ 2014;348:g239