Trends in physician diagnosed gout and gout therapies in the US: results from the national ambulatory health care surveys 1993 to 2009

Introduction: Gouty arthritis (gout) is primarily cared for in ambulatory care settings. Although the prevalence of gout in the US is thought to be increasing, there have been few data on this as well as temporal changes in gout medication use. Methods: We analyzed annual visit and drug utilization data from national sample surveys of physician practices and hospital outpatient clinics in the US from 1993 to 2009. Gout diagnosis was recorded by individual physicians. Result: The frequency of visits for gout increased three-fold from 1993 through 2009; most of the increases were observed from 2003 onwards. The increase was only partly explained by changes in age and gender composition of the surveys over time. A concomitant increase in prescriptions for allopurinol and colchicine and decrease in prescriptions for anti-inflammatories was observed. Aspirin use, a putative risk factor for gout and gout flares, increased substantially over this period. Probenecid use was negligible. Frequency of systemic steroid use has not changed over time. Conclusions: The number of ambulatory visits for gout has increased almost three fold in the first decade of the millennium coinciding with increases in physician and patient awareness. This increase was primarily due to visits among the elderly. Uricosuric use remained negligible whereas the uses of allopurinol and colchicine have increased rapidly. Use of traditional non-steroidals has declined, possibly due to safety concerns whereas glucocorticoid use remains unchanged.