Rheumatoid Arthritis And Gout: Hospitalization Trends Flip Flop In U.S. Study

Anya Wassenberg

Rheumatoid arthritis and gout can cause similar symptoms, but have shown opposite trends when it comes to hospitalizations over the last 20 years. A research paper published in a U.S. medical journal found that as hospitalizations for rheumatoid arthritis fell, hospital admissions caused by gout rose, raising questions as to why.

Rheumatoid arthritis and gout are the two most common arthritides, or types of inflammatory arthritis, in North America. Researchers from the Massachusetts General Hospital, in Boston, and Arthritis Research Canada in Vancouver, British Columbia, studied a database that is representative of hospitalizations throughout the United States. The research letter, titled "Trends in Gout and Rheumatoid Arthritis Hospitalizations in the United States, 1993-2011" was published in The Journal of the American Medical Association this past week.

What they found was that during the study period of 1993 to 2011, hospitalizations due to rheumatoid arthritis decreased significantly from 13.9 to 4.6 per 100,000 adults. During the same period, rates of hospitalization due to gout doubled, rising from 4.4 to 8.8 per 100,000 adults. In terms of absolute numbers, in 1993 more patients were admitted to hospitals due to rheumatoid arthritis; by 2011 that trend had reversed as well.

While the study can look at the numbers, researchers could not pinpoint a specific cause from the hospitalization data alone. However, the research letter does propose a theory.

"The findings may reflect suboptimal care received by gout patients and its increasing prevalence."

Rheumatoid arthritis is caused by a dysfunction of the immune system, where the patient's body begins attacking its own joints. The membranes that line and cushion the joints deteriorate, causing the damage that leads to pain and other symptoms. Treatment generally includes medications and may involve surgery.

Gout occurs when there is too much uric acid circulating in the bloodstream. Uric acid is a waste product that is produced as the body digests organic compounds called purines. Purines are found in certain kinds of foods and beverages – notably beer. According to the CDC (Centers for Disease Control,) diets high in meat and seafood are also risk factors for developing gout. In previous eras, gout was associated with wealth for that reason. The uric acid crystallizes and deposits into the joints, which causes the inflammation. Symptoms of gout often first appear in the big toe as redness, swelling and pain.

The incidence of gout in the United States has increased over roughly the same 20-year period by about 1.2 percent. It is now at 3.9 percent overall – or 5.9 percent among men and 2 percent among women – involving over 8 million people.

There are many medications available to treat gout and manage the levels of uric acid in the blood. Treating gout also involves lifestyle changes such as limiting alcohol intake, dietary restrictions and losing weight. While effective treatments exist, according to the Arthritis Foundation, the two biggest challenges to effective treatment of gout are misdiagnosis by the physician – since the symptoms of gout can point to other inflammatory diseases like rheumatoid arthritis – and the fact that people who suffer from gout often don't follow the proper treatment plan.

While neither rheumatoid arthritis nor gout is by itself a fatal disease, both conditions are associated with heart disease and an increase in mortality rates from any cause.

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