Dr Singh is Assistant Professor, Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock.

Dr Torralba is Assistant Professor of Medicine, Division of Rheumatology, Keck School of Medicine, University of Southern California, Los Angeles.

Disclosures: The authors disclose that they do not have any financial relationships with any manufacturer in this area of medicine.

Gout is the most common inflammatory arthritis in the elderly population. Management in the elderly requires special consideration. Physiologic changes associated with aging and co-morbidities make the elderly prone to adverse effects of drugs otherwise successfully used in younger counterparts. Use of colchicine, non-steroidal anti-inflammatory drugs, and urate-lowering therapies may be restricted in those with limited renal reserve. Corticosteroids are safe alternatives for short-term use in acute gout. Elderly patients need laboratory monitoring for side effects more frequently than usual. Non-pharmacologic measures such as dietary modifications, regular exercise, and ice therapy should be considered vital adjunctive treatments. A brief review of future therapies is also discussed.

Singh H, Torralba KD. Therapeutic challenges in the management of gout in the elderly. Geriatrics. 2008;63(7):13-20.

Key words: gout, hyperuricemia, elderly

Drugs discussed: anakinra, azathioprine, allopurinol, benzobromarone, colchicine, cyclosporine, etanercept, etoricoxib, febuxostat, fenofibrate, hydrochlorothiazide, ibuprofen, indomethacin, infliximab, ketorolac, losartan, lumiracoxib, naproxen, prednisone, probenecid, rasburicase, sulfinpyrazone, triamcinolone

Gout is the most common inflammatory arthritis affecting the elderly.¹ The incidence and prevalence of gout in the elderly is increasing.^2,3 This appears related to improved lifespan leading to similar increases in age-related diseases (eg, hypertension) and their associated adverse effects of treatment (eg, diuretics) which can lead to gout. "Elderly gout" includes gout commencing at >65 years of age (elderly onset gout, EOG) and those with chronic persistent gout that started before age 65. This differs from classical gout found in middle-aged men in several respects: equal gender distribution, polyarticular presentation with upper-extremity-joint involvement, fewer acute gouty episodes, indolent clinical course, and an increased incidence of tophi.⁴

It is important to address gout in the elderly population for several reasons. Gout has been associated with other conditions including metabolic syndrome and acute myocardial infarction (AMI). Although the study was not confined to the geriatric population, the prevalence of metabolic syndrome among those with gout was 62%.⁵ Gouty arthritis and hyperuricemia proved to be independent risk factors for AMI among 12,866 men with no previous history of coronary artery disease involved in the Multiple Risk Factor Intervention Trial (MRFIT).⁶ Obesity, diuretic use, aspirin use, renal function, alcohol use, insulin resistance, metabolic syndrome, serum uric acid (SUA) level, and other traditional risk factors did not account for this association in this study. It is also well known that gout can lead to renal complications such as nephrolithiasis and nephropathy. Gouty arthritis itself, when not adequately attended to, can be a functionally disabling disease that can lead to a substantial decrease in quality of life.