Optimal management of gout in older patients.
Gout in older patients tends to be sub-acute to chronic, often tophaceous, polyarticular, erosive, symmetrical, and causes persistent, recurrent and chronic arthritis. Clinically, it may closely mimic rheumatoid arthritis; thus, a correct diagnosis requires a high index of clinical suspicion and the identification of uric acid crystals. An optimal therapeutic strategy for most older patients with chronic tophaceous gout could involve the following: avoidance of alcohol and diuretic use if possible; avoidance of long term nonsteroidal anti-inflammatory drug (NSAID) therapy; use of short term corticosteroids (systemic or intra-articular) for acute exacerbations; prophylactic colchicine daily or every other day according to the degree of renal dysfunction present; and long term allopurinol therapy in dosages adjusted to the degree of hyperuricaemia and renal dysfunction.
Gonzalez
E B
EB
Emory University School of Medicine, Department of Medicine, Atlanta, Georgia.
Miller
S B
SB
Agudelo
C A
CA
D000368:Aged; D006073:Gout / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D014527:Uric Acid / Q000097:blood
D014527:Uric Acid