title: Epidemiology and health-related services.
abstract: OBJECTIVE
  This article presents recent epidemiologic contributions focusing on gout-related conditions, especially if controversial, to find plausible, despite hypothetical, mechanistic explanations from the clinician perspective.
  
  
  RESULTS
  The prevalence of gout is increasing, but it is only partially clear that the incidence may be increasing as well. Direct associations of gout with increased risk of diabetes, black races, neurodegenerative disorders, and sugar-enriched foods have been recently questioned. A negative association with smoking has been reported, and new evidence shows that the impact of diet may be independent of obesity. Kidney disease and diuretics have been confirmed to be associated with gout, whereas new data on aging and menopause have come to challenge apparently established disease mechanisms. Regarding treatments, increase in bladder cancer associated with chronic allopurinol use has been reported, and the positive effect of urate-lowering treatment on cardiovascular events has been contested.
  
  
  CONCLUSIONS
  Epidemiological data in gout-related conditions are still evolving and claim for future cohort or intervention studies to prove causality. Controversies in epidemiological results fertilize the ground for studies to prove mechanisms and causality and provides a unique opportunity for clinical intervention to improve outcomes, especially with regard to treatments.
authors.affiliation: aRheumatology Division, Biocruces Health Research Institute bRheumatology Division, Hospital Universitario Cruces, OSI EE-Cruces, Baracaldo cInstituto de Salud Musculoesquelética, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Perez-Ruiz
authors.forename: Irati
authors.initials: I
authors.lastname: Urionagüena
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona-Ortells
mesh_terms: D000493:Allopurinol / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D004232:Diuretics / Q000627:therapeutic use; D006073:Gout / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D006074:Gout Suppressants / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D019636:Neurodegenerative Diseases / Q000453:epidemiology; D009765:Obesity / Q000150:complications; D015995:Prevalence
chemical_list: D004232:Diuretics; D006074:Gout Suppressants; D000493:Allopurinol