Global epidemiology of gout: prevalence, incidence and risk factors

Key Points

  • Gout is the most common form of inflammatory arthritis and is caused by the deposition of monosodium urate crystals in and around the joints

  • The reported prevalence of gout worldwide ranges from 0.1% to approximately 10%, and the incidence from 0.3 to 6 cases per 1,000 person-years

  • Both prevalence and incidence of gout are increasing in many developed countries

  • The prevalence and incidence of gout is highly variable across various regions of the world, with developed countries generally having higher prevalence than developing countries

  • A combination of genetic and environmental factors contribute to the development of gout

  • Major risk factors for gout include hyperuricaemia, genetics, dietary factors, medications, comorbidities and exposure to lead

Abstract

Gout is a crystal-deposition disease that results from chronic elevation of uric acid levels above the saturation point for monosodium urate (MSU) crystal formation. Initial presentation is mainly severely painful episodes of peripheral joint synovitis (acute self-limiting 'attacks') but joint damage and deformity, chronic usage-related pain and subcutaneous tophus deposition can eventually develop. The global burden of gout is substantial and seems to be increasing in many parts of the world over the past 50 years. However, methodological differences impair the comparison of gout epidemiology between countries. In this comprehensive Review, data from epidemiological studies from diverse regions of the world are synthesized to depict the geographic variation in gout prevalence and incidence. Key advances in the understanding of factors associated with increased risk of gout are also summarized. The collected data indicate that the distribution of gout is uneven across the globe, with prevalence being highest in Pacific countries. Developed countries tend to have a higher burden of gout than developing countries, and seem to have increasing prevalence and incidence of the disease. Some ethnic groups are particularly susceptible to gout, supporting the importance of genetic predisposition. Socioeconomic and dietary factors, as well as comorbidities and medications that can influence uric acid levels and/or facilitate MSU crystal formation, are also important in determining the risk of developing clinically evident gout.

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Figure 1: The estimated prevalence of gout across the world.
Figure 2: Prevalence of gout in seven representative countries.
Figure 3: Age-specific and sex-specific incidence of gout in the UK in 2012.

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All authors made a substantial contribution to discussion of content and reviewed/edited the manuscript before submission. C.-F.K. researched data for and wrote the article.

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W.Z. declares that he has received personal fees from Daiichi Sankyo and is a member of guideline development groups for gout and osteoarthritis for the National Institute for Health and Care Excellence (NICE), EULAR and the British Society for Rheumatology (BSR). M.D. declares that he has received fees from ad hoc advisory activities related to gout and osteoarthritis (outside the submitted work) for Astrazeneca, Menarini, Nordic Biosciences, Novartis and Pfizer; he also declares that he is a clinical expert adviser on gout and osteoarthritis for NICE and a member of guideline development groups for gout for EULAR and BSR. The other authors declare no competing interests.

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Kuo, C., Grainge, M., Zhang, W. et al. Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol 11, 649–662 (2015). https://doi.org/10.1038/nrrheum.2015.91

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