Ian K. Tsang, MB, FRCPC, Clinical Professor, Division of Rheumatology, Faculty of Medicine, University of British Columbia, Vancouver, BC.
Gout is more prevalent in older adults than middle-age adults, and it affects women almost as commonly as men. An important clinical consideration regarding gout is that while hyperuricemia is commonly associated with gouty arthritis, a diagnosis of asymptomatic hyperuricemia does not generally require treatment. In addition, the clinical presentation and course of gout in older patients differ from the typical cases of middle-aged patients. Moreover, older gout patients present a challenge for physicians who manage them because of the high incidence of comorbid conditions and the likely occurrence of reduced renal function among this age group. This article reviews the diagnosis and management of asymptomatic hyperuricemia and gout in the older adult.
Key words: gout, hyperuricemia, NSAID, allopurinol, arthritis.
Klaus Turnheim, MD
Department of Pharmacology,
University of Vienna,
Hyperuricemia is present in approximately 5% of asymptomatic adults and 10% of hospitalized patients. The prevalence of hyperuricemia and gout increases with age because of changes in body composition, renal excretory function and treatment with diuretics.1 In addition, risk factors for crystal deposition, for instance degenerative joint diseases and osteoarthritis, are magnified in old age.2 Gout found in the elderly differs from classical gout in middle-aged men in several respects. These include the fact that it has a more equal gender distribution, a frequent polyarticular presentation with an involvement of the joints of the upper extremities, fewer acute gouty episodes, a more indolent chronic clinical course, and an increased incidence of tophi.3 Decreased renal excretion of uric acid appears to be a major cause for hyperuricaemia and gout in advanced age.4
The treatment of established gout requires long-term control of hyperuricemia. Uricosuric drugs are poorly tolerated in the elderly, and the frequent presence of renal impairment in these patients renders these drugs impractical or ineffective.
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