title: Optimal management of gout in older patients.
abstract: 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.
authors.affiliation: Emory University School of Medicine, Department of Medicine, Atlanta, Georgia.
authors.forename: E B
authors.initials: EB
authors.lastname: Gonzalez
authors.forename: S B
authors.initials: SB
authors.lastname: Miller
authors.forename: C A
authors.initials: CA
authors.lastname: Agudelo
mesh_terms: D000368:Aged; D006073:Gout / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D014527:Uric Acid / Q000097:blood
chemical_list: D014527:Uric Acid