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Drugs & Aging

, Volume 34, Issue 12, pp 873–880 | Cite as

Managing Gout Flares in the Elderly: Practical Considerations

  • Abhishek AbhishekEmail author
Therapy in Practice

Abstract

Gout is common in the elderly, affecting an estimated 4.7 million people aged > 60 years in the USA alone. The incidence and prevalence of gout increases, and male predisposition to gout reduces, with increasing age. The elderly have more comorbidities, and gout manifests differently, with more frequent involvement of knees, ankles, and wrists at disease onset, systemic upset, and tophi. Comorbidities and polypharmacy make the management of gout flares challenging in this population. Intra-articular corticosteroid injection remains the treatment of choice for accessible joints, oral prednisolone is preferred over low-dose colchicine, and non-steroidal anti-inflammatory drugs (NSAIDs) are best avoided. Xanthine oxidase inhibitors (XOI) remain the first-line treatment for hyperuricemia in the elderly. Arhalofenate, an emerging uricosuric anti-inflammatory drug, prevents gout flares while reducing serum urate. It may be particularly relevant in the treatment of gout in the elderly as they are unable to tolerate long-term colchicine for flare prophylaxis and frequently have contraindications to corticosteroids and NSAIDs. However, given its modest urate-lowering effect, it can only be used in combination with an XOI, and the safety and efficacy of this drug has not been examined in the elderly or in those with chronic kidney disease. Diuretics and beta-blockers should be discontinued where feasible, whereas low-dose aspirin can be continued if otherwise indicated.

Notes

Compliance with Ethical Standards

Funding

No funding was received for this study.

Conflict of interest

Dr. A. Abhishek has received departmental research grants from AstraZeneca and OxfordImmunotech.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Division of Rheumatology, Orthopaedics, and Dermatology, School of MedicineUniversity of NottinghamNottinghamUK
  2. 2.Academic Rheumatology, Clinical Sciences BuildingCity Hospital NottinghamNottinghamUK

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