Management of gout in older people

Abstract

Gout is an inflammatory musculoskeletal disorder with a prevalence of 1.6–6.8% in Australia. Gout is characterised by acute attacks of severe joint pain secondary to raised serum concentrations of uric acid and joint deposits of monosodium urate crystals. Recurrent attacks can affect quality of life and lead to irreversible joint damage. The prevalence of gout is increased in older people, and age‐related renal impairment, altered drug distribution and increased prevalence of comorbidities have significant consequences for safe and effective gout pharmacotherapy. For treatment of acute attacks in older people, dose reduction of colchicine may be needed due to renal impairment, and potential drug interactions require consideration. Use of non‐steroidal anti‐inflammatory drugs is limited by peptic ulceration, ischaemic heart disease, hypertension and renal impairment. Short courses of oral glucocorticoids may be preferable. For long‐term urate‐lowering therapy, allopurinol, probenecid and febuxostat are available in Australia. Lower starting doses of allopurinol are recommended in patients with renal impairment, but dose escalation to achieve target urate should follow. Concerns regarding increased cardiovascular risk with febuxostat are relevant to older patients. Despite the availability of effective therapy, gout remains undertreated, with maintenance of urate‐lowering therapy a major challenge. Education of patients and health professionals is essential to improve adherence to therapy.

Preventative and therapeutic potential of tocotrienols on musculoskeletal diseases in ageing

“…Gout is an inflammatory musculoskeletal condition with an incidence of between 1.6% and 6.8% ( Day et al, 2019 ). This condition is defined by episodes of intense joint pain triggered by high levels of uric acid in the bloodstream and the accumulation of monosodium urate crystals in the joints.…”

“…This condition is defined by episodes of intense joint pain triggered by high levels of uric acid in the bloodstream and the accumulation of monosodium urate crystals in the joints. Recurring attacks can adversely impact the quality of life and lead to irreversible joint damage ( Day et al, 2019 ). The frequency of gout increases with age, while age-related renal impairment increases with age.…”

Surgical Treatment of Patients with Tophus Gout

“…В останні роки розповсюдженість подагри збільшилась у 10-20 разів порівняно із XX ст. На сьогодні поширеність подагри серед населення у світі становить від 0,06 до 4,2% [2,4].…”

The association of allopurinol with persistent physical disability and frailty in a large community based older cohort

“…The prevalence of gout and hyperuricemia in the US population over 65 years of age is estimated to be 10% and 21%, respectively 2 . The main clinical manifestations of gout in older adults include acute gout attacks, frequent symmetric or asymmetric polyarticular involvement, and tophi formation that can lead to excruciating joint pain and severe swelling and irreversible joint damage 3 . Gout and hyperuricemia in older adults have also been linked to cardiometabolic syndromes, cardiovascular disease, impaired renal function, and possibly dementia 4,5 .…”

“…2 The main clinical manifestations of gout in older adults include acute gout attacks, frequent symmetric or asymmetric polyarticular involvement, and tophi formation that can lead to excruciating joint pain and severe swelling and irreversible joint damage. 3 Gout and hyperuricemia in older adults have also been linked to cardiometabolic syndromes, cardiovascular disease, impaired renal function, and possibly dementia. 4,5 These complications and associated comorbidities, if left untreated, may result in new onset or progressive physical disability and frailty, severely compromised quality of life, and ultimately the loss of independence and death.…”