Rheumatology International

, 28:1 | Cite as

Elderly-onset gout: a review

  • Francesco De Leonardis
  • Marcello Govoni
  • Matteo Colina
  • Marco Bruschi
  • Francesco Trotta


Elderly-onset gout (EOG), defined as a disease with onset at age 65 years or over, shows relevant epidemiological, clinical and therapeutic differences from the typical middle-age form. The main differences are the more frequent subacute/chronic polyarticular onset with hand involvement, the unusual localization of tophi on ostheoarthritis (OA) nodes, the increased female/male ratio and the frequent association with drugs that decrease renal urate excretion (diuretics and low-dose aspirin) and/or with primitive renal impairment. EOG has recently been confirmed as the most common inflammatory arthropathy in older people, with important demographic implications and substantial impact on daily clinical practice. Despite the high prevalence, gout, in the elderly, often remains misdiagnosed or diagnosed late in its clinical course. Even when correctly recognized, its treatment is often difficult or unsatisfactory.


Elderly-onset Hyperuricemia Gout Diuretics Tophi 


  1. 1.
    Ene-Stroescu D, Gorbien MJ (2005) Gouty arthritis. A primer on late-onset gout. Geriatrics 60:24–31PubMedGoogle Scholar
  2. 2.
    Mikuls TR, Farrar JT, Bilker WB, Fernandes S, Schumacher HR Jr, Saag KG (2005) Gout epidemiology: results from the UK general practice research database, 1990–1999. Ann Rheum Dis 64:267–272CrossRefPubMedGoogle Scholar
  3. 3.
    Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, Heyse SP, Hirsch R, Hochberg MC, Hunder GG, Liang MH, Pillemer SR, Steen VD, Wolfe F (1998) Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 41:778–799CrossRefPubMedGoogle Scholar
  4. 4.
    Wallace KL, Riedel AA, Joseph-Ridge N, Wortmann R (2004) Increasing prevalence of gout and hyperuricemia over 10 years among older adults in a managed care population. J Rheumatol 31:1582–1587PubMedGoogle Scholar
  5. 5.
    Arromdee E, Michet JC, Crowson CS, O’Fallon WM, Gabriel S (2002) Epidemiology of gout: is the incidence rising? J Rheumatol 29:2403–2406PubMedGoogle Scholar
  6. 6.
    Kim KY, Schumacher RH, Hunsche E, Wertheimer AI, Kong SX (2003) A literature review of the epidemiology and treatment of acute gout. Clin Ther 25:1593–1617CrossRefPubMedGoogle Scholar
  7. 7.
    Harrold LR, Yood R, Milkus TR, Andrade S, Davis J, Fuller K, Chan A, Roblin D, Raebel M, Von Worley A, Platt R, Saag K (2006) Sex differences in gout epidemiology: evaluation and treatment. Ann Rheum Dis 65:1368–1372CrossRefPubMedGoogle Scholar
  8. 8.
    De Souza AW, Fernandes V, Ferrari AJ (2005) Female gout: clinical and laboratory features. J Rheumatol 32:2186–2188PubMedGoogle Scholar
  9. 9.
    Effectiveness of interventions for the treatment of acute and prevention of recurrent gout––a systematic review. Rheumatology 2006;45:1422–1431Google Scholar
  10. 10.
    Renal function in gout. IV. An analysis of 524 gouty subjects including long-term follow-up studies. Am J Med 1975;59:605–613Google Scholar
  11. 11.
    Ter Borg EJ, Rasker JJ (1987) Gout in the elderly, a separate entity? Ann Rheum Dis 46:72–76PubMedGoogle Scholar
  12. 12.
    MacFarlane DG, Dieppe PA (1985) Diuretic-induced gout in elderly women. Br J Rheumatol 24:155–157CrossRefPubMedGoogle Scholar
  13. 13.
    Puig JG, Michan AD, Jimenez ML, Perez de Ayala C, Mateos FA, Capitan CF, de Miguel E, Gijon JB (1991) Female gout. Clinical spectrum and uric acid metabolism. Arch Intern Med 151:726–732CrossRefPubMedGoogle Scholar
  14. 14.
    Gurwitz JH, Kalish SC, Bohn RL, Glynn RJ, Monane M, Mogun H, Avorn J (1997) Thiazide diuretics and the initiation of anti-gout therapy. J Clin Epidemiol 50:953–959CrossRefPubMedGoogle Scholar
  15. 15.
    Hunter DJ, York M, Chaisson CE, Woods R, Niu J, Zhang Y (2006) Recent diuretic use and the risk of recurrent gout attacks: the online case-crossover gout study. J Rheumatol 33:1341–1344PubMedGoogle Scholar
  16. 16.
    Scott JT, Higgen CS (1992) Diuretic induced gout: a multifactorial condition. Ann Rheum Dis 51:259–261PubMedGoogle Scholar
  17. 17.
    Janssens HJEM, van de Linsdonk EH, Janssen M, van den Hoogen HJM, Verbeek ALM (2006) Gout, not induced by diuretics? A case-control study from primary care. Ann Rheum Dis 65:1080–1083CrossRefPubMedGoogle Scholar
  18. 18.
    Fang J, Alderman MH (2000) Serum uric acid and cardiovascular mortality. The NHANES 1 epidemiologic follow-up study, 1971–1992. JAMA 283:2404–2410CrossRefPubMedGoogle Scholar
  19. 19.
    Culleton BF, et al (1999) Serum uric acid and risk for cardiovascular disease and death: the Framingham heart study. Ann Int Med 131:7–13PubMedGoogle Scholar
  20. 20.
    Hall AP, Barry PE, Dawber TR, McNamara PM (1967) Epidemiology of gout and hyperuricemia: a long term population study. Am J Med 42:27–37CrossRefPubMedGoogle Scholar
  21. 21.
    Chen SY, Chen CL, Shen ML (2007) Manifestations of metabolic syndrome associated with male gout in different age strata. Clin Rheumatol January 26. doi:10.1007/s10067-006-0527-4 (in press)
  22. 22.
    Krishnan E, Baker JF, Furst DE, Schumacher HR (2006) Gout and the risk of acute myocardial infarction. Arthitis Rheum 8:2688–2696CrossRefGoogle Scholar
  23. 23.
    Wernick R, Winkler C, Campbell S (1992) Tophi as the initial manifestation of gout. Report of six cases and review of the literature. Arch Intern Med 152:873–876CrossRefPubMedGoogle Scholar
  24. 24.
    Doherty M, Dieppe P (1986) Crystal deposition disease in the elderly. Clin Rheum Dis 2:97–116Google Scholar
  25. 25.
    Foldes K, Petersilge CA, Weisman MH, Resnick D (1996) Nodal ostheoarthritis and gout: a report of four new cases. Skeletal Radiol 25:421–424CrossRefPubMedGoogle Scholar
  26. 26.
    Simkin PA, Campbell PM, Larson EB (1983) Gout in Heberden’s nodes. Arthritis Rheum 26:94–97CrossRefPubMedGoogle Scholar
  27. 27.
    Gerster JC, Landry M, Dufresne L, Meuwly JY (2002) Imaging of tophaceus gout: computed tomography provides specific images compared with magnetic resonance imaging and ultrasonography. Ann Rheum Dis 61:52–54CrossRefPubMedGoogle Scholar
  28. 28.
    Lopez Redondo MJ, Requena L, Macia M, Schoendorff C, Sanchez Yus E, Robledo A (1993) Fingertip tophi without gouty arthritis. Dermatology 187:140–143PubMedCrossRefGoogle Scholar
  29. 29.
    Chopra KF, Schneiderman P, Grossman ME (1999) Finger pad tophi. Cutis 64:233–236PubMedGoogle Scholar
  30. 30.
    Bomalaski JS, Schumacher HR (1984) Podagra is more than gout. Bull Rheum Dis 34:1–8PubMedGoogle Scholar
  31. 31.
    Kozin F, McCarty DJ (1977) Rheumatoid factors in the serum of gouty patients (letter). Arthritis Rheum 20:1559–1560CrossRefPubMedGoogle Scholar
  32. 32.
    Zhang W, Doherty M, Pascal E, Bardin T, Barskova V, Conaghan P, Gerster J, Jacobs J, Leeb B, Liote F, McCarthy G, Netter P, Nuki G, Perez-Ruiz F, Pignone A, Pimentao J, Punzi L, Roddy E, Uhlig T, Zimmermann-Gorska I (2006) Eular evidence based recommendations for gout––part I. Diagnosis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 65:1301–1311CrossRefPubMedGoogle Scholar
  33. 33.
    Zhang W, Doherty M, Pascal E, Bardin T, Barskova V, Conaghan P, Gerster J, Jacobs J, Leeb B, Liote F, McCarthy G, Netter P, Nuki G, Perez-Ruiz F, Pignone A, Pimentao J, Punzi L, Roddy E, Uhlig T, Zimmermann-Gorska I (2006) Eular evidence based recommendations for gout––part II. Management: report of task force of the EULAR standing committee for international clinical studies including therapeutics. Ann Rheum Dis 55:1312–1324CrossRefGoogle Scholar
  34. 34.
    Martinon F, Petrilli V, Mayor A, Tardivel A, Tschopp J (2006) Gout-associated crystals activate the NALP3 inflammasome. Nature 440:237–241CrossRefPubMedGoogle Scholar
  35. 35.
    Chun CJ, Shi Y, Hearn A, Fitzgerald K, Golenbock D, Reed G, Akira S, Rock KL (2006) My D88-dependent IL-1 receptor signaling is essential for gouty inflammation stimulated by monosodium urate crystals. J Clin Invest 116:2262–2271CrossRefGoogle Scholar
  36. 36.
    Spilberg I, Mandell B, Mehta J, Simchowitz L, Rosenberg D (1979) Mechanism of action of colchicine in acute urate crystal-induced arthritis. J Clin Invest 64:775–780PubMedCrossRefGoogle Scholar
  37. 37.
    Roberge CJ, Gaudry M, de Medicis R, Lussier A, Poubelle PE, Naccache PH (1993) Crystal-induced neutrophil activation. IV. Specific inhibition of tyrosine phosphorylation by colchicine. J Clin Invest 92:1722–1729PubMedGoogle Scholar
  38. 38.
    Wilbur K, Makowsky M (2004) Colchicine myotoxicity: case reports and literature review. Pharmacotherapy 24:1784–1792CrossRefPubMedGoogle Scholar
  39. 39.
    Groff GD, Franck WA, Raddatz DA (1990) Systemic steroid therapy for acute gout: a clinical trial and review of the literature. Semin Arthritis Rheum 19:329–336CrossRefPubMedGoogle Scholar
  40. 40.
    Fernandez C, Noguera R, Gonzalez JA, Pascual E (1999) Treatment of acute attacks of gout with a small dose of intraarticular triamcinolone acetonide. J Rheumatol 26:2285–2286PubMedGoogle Scholar
  41. 41.
    Arellano F, Sacristan JA (1993) Allopurinol hypersensitivity syndrome: a review. Ann Pharmacother 27:337–343PubMedGoogle Scholar
  42. 42.
    Hande KR, Noone RM, Stone WJ (1984) Severe allopurinol toxicity. Description and guidelines for prevention in patients with renal insufficiency. Am J Med 76:47–56CrossRefPubMedGoogle Scholar
  43. 43.
    Becker MA, Schumacher HR Jr, Wortmann RL, MacDonald PA, Palo WA, Eustace D, Vernillet L, Joseph-Ridge N (2005) Febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase. Arthritis Rheum 52:916–923CrossRefPubMedGoogle Scholar
  44. 44.
    Schumacher H, Becker M, Wortmann RL, MacDonald PA, Palo WA, Eustace D, Vernillet L, Joseph-Ridge N (2005) Febuxostat vs allopurinol and placebo in subjects with hyperuricemia and gout: the 28-week APEX study. Arthritis Rheum 52:S680Google Scholar
  45. 45.
    Ganson NJ, Kelly SJ, Scarlett E, Sundy JS, Hershfield MS (2006) Control of hyperuricemia in subjects with refractory gout, and induction of antibody against poly(ethylene glycol) (PEG), in a phase I trial of subcutaneous PEGylated urate oxidase. Arthritis Res Care 8:R12CrossRefGoogle Scholar
  46. 46.
    Schumacher HR Jr, Chen LX (2006) Newer therapeutic approaches: gout. Rheum Clin Dis North Am 32:235–244CrossRefGoogle Scholar
  47. 47.
    Hoskison TK, Wortmann RL (2006) Advances in the management of gout and hyperuricemia. Scand J Rheumatol 35:251–260CrossRefPubMedGoogle Scholar
  48. 48.
    Puig JG, Mateos F, Buno A, Ortega R, Rodriguez F, Dal-Re R (1999) Effect of eprosartan and losartan on metabolism in patients with essential hypertension. J Hypertens 17:1033–1039CrossRefPubMedGoogle Scholar
  49. 49.
    Wurzner G, Gerster JC, Chiolero A, Maillard M, Fallab-Stubi CL, Brunner HR, Burnier M (2001) Comparative effects of losartan and irbesartan on serum in hypertensive patients with hyperuricaemia and gout. J Hypertens 19:1855–1860CrossRefPubMedGoogle Scholar
  50. 50.
    Schmidt A, Gruber U, Bohmig G, Koller E, Mayer G (2001) The effect of ACE inhibitor and angiotensin II receptor antagonist therapy on serum levels and potassium homeostasis in hypertensive renal transplant recipients treated with CsA. Nephrol Dial Transplant 16:1034–1037CrossRefPubMedGoogle Scholar
  51. 51.
    Bastow MD, Durrington PN, Ishola M (1988) Hypertriglyceridemia and hyperuricemia: effects of two fibric acid derivatives (bezafibrate and fenofibrate) in a double-blind, placebo-controlled trial. Metabolism 37:217–220CrossRefPubMedGoogle Scholar
  52. 52.
    Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G (2004) Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med 350:1093–1103CrossRefPubMedGoogle Scholar
  53. 53.
    Choi HK, Liu S, Curhan G (2005) Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the third national health and nutrition examination survey. Arthritis Rheum 52:283–289CrossRefPubMedGoogle Scholar
  54. 54.
    Lee SJ, Terkeltaub RA, Kavanaugh A (2006) Recent developments in diet and gout. Curr Opin Rheumatol 18:193–198PubMedGoogle Scholar
  55. 55.
    Milkus TR, Kenneth GS (2006) New insights into gout epidemiology. Curr Opin Rheumatol 18:199–203CrossRefGoogle Scholar
  56. 56.
    Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G (2004) Alcohol intake and risk of incident gout in men: a prospective study. Lancet 363:1277–1281CrossRefPubMedGoogle Scholar
  57. 57.
    Loenen HM, Eshuis H, Lowik MR, Schouten EG, Hulshof KF, Odink J, Kok FJ (1990) Serum uric acid correlates in elderly men and women with special reference to body composition and dietary intake (Dutch nutrition surveillance system). J Clin Epidemiol 43:1297–1303CrossRefPubMedGoogle Scholar
  58. 58.
    Nicholls A, Scott JY (1972) Effect of weight-loss on plasma and urinary levels of uric acid. Lancet 2:1223–1224CrossRefPubMedGoogle Scholar
  59. 59.
    Yamashita S, Matsuzawa Y, Tokunaga K, Fujioka S, Tarui S (1986) Studies on the impaired metabolism of uric acid in obese subjects: marked reduction of renal urate excretion and its improvement by a low-calorie diet. Int J Obes 10:255–264PubMedGoogle Scholar
  60. 60.
    Dessein PH, Shipton EA, Stanwix AE, Joffe BI, Ramokgadi J (2000) Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 59:539–543CrossRefPubMedGoogle Scholar
  61. 61.
    Choi HK, Atkinson K, Karlson EW, Curhan G (2005) Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Arch Intern Med 165:742–748CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Francesco De Leonardis
    • 1
  • Marcello Govoni
    • 1
  • Matteo Colina
    • 1
  • Marco Bruschi
    • 1
  • Francesco Trotta
    • 1
  1. 1.Section of Rheumatology, Department of Clinical and Experimental MedicineUniversity of FerraraFerraraItaly

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