Women are twice discriminated for diagnosis of gout in primary care


Fernando Perez-Ruiz, Elena Garmendia, Javier Aróstegui, Javier Duruelo, Joana Atxotegi, Nathali Rivas, Consuelo Modesto, Cristina Vazquez-Puente, Elena Barahona, Marta Gonzalez-Fernandez

Basque Health Department, Cruces University Hospital, Baracaldo


Objective: To ascertain whether diagnosis of gout is influenced by sex in primary care electronic codification.

Methods: Transversal analysis of a nested cohort of patients with gout consecutively included in a clinical follow-up database in a third level hospital-based rheumatology setting. From 1st jan 2017 to 31st dec 2021 any icd-10 codification for gout was considered as previous or posterior to the rheumatology codification at inclusion in cohort (first rheumatology visit). General variables (sex, age at entrance, time from onset) and disease variables (tophi, joint distribution, number of flares) were analyzed. Antinuclear antibodies testing (ANA) prior to rheumatology consultation were used as surrogate variable of sex bias. Statistically different comparisons are shown in results as (*).

Results: 365 patients; 48 women (13%) mean age 72±13* yr, time from onset 3±3* yr; 317 men (87%), mean age 60±13 yr, time from onset 7±7 yr. Gout codes were previous to rheumatology visit in 27% women vs. 41% in men (*), and posterior in 40% women vs. 70% men. There were no differences regarding clinical variables, except for numerical differences in posterior diagnosis for tophi and hospitalization. Previous ANA testing was retrieved in 24% patients: 41% of women (50% were positive) and 21% of men (25% were positive), in all but one <1/400 title, and only for a new diagnosis (sjögren´s syndrome). Absence of ANA testing was associated with improvement of gout coding from 22% to 41% in women and from 44% al 60% in men. Previous aan testing influenced gout coding as follows: ANA-negative results improved coding from 57% to 70% in men but induced no change in the rate of coding in women (steady 50%). ANA-positive results were associated to no change in the rates of coding in both gender, steady 22% in women and 44% in men.

Conclusions: Women are primarily discriminated by gender in gout diagnosis, even after hospital-based rheumatology evaluation. A second discrimination derives from aan testing, more frequently tested and positive in women, but also influencing diagnosis in women despite negative ANA testing results. We speculate that this happens due to academic background.