title: Clinical characteristics of and relationship between metabolic components and renal function among patients with early-onset juvenile tophaceous gout.
abstract: OBJECTIVE
  Age of onset of gout has recently decreased; however, patients with early-onset gout remain uncommon, and relevant information is scant. We hypothesized that these patients might exhibit differences in serum urates and other comorbidities compared with adult-onset patients.
  
  
  METHODS
  Early-onset gout patients (i.e., juveniles) with (n = 40) and without tophi (n = 47) were enrolled for study. Their clinical characteristics were compared with those of 353 patients with middle-age-onset tophaceous gout and 64 age-matched healthy participants.
  
  
  RESULTS
  Early-onset gout patients with tophi exhibited significantly higher body mass indices and serum urate levels and lower estimated glomerular filtration rates (eGFR) than did those without tophi. Early-onset gout patients with or without tophi demonstrated significantly abnormal lipid profiles and impaired liver or renal function compared with healthy patients. Serum urate levels and gout duration were identified as the principal determinants of tophi development. The presence of tophi might be crucial in decreasing eGFR, which is inversely related to tophi duration or gout duration. Unexpectedly, the most common site of initial gout attacks in early-onset tophaceous gout patients was the ankle, not the toe, which was the most common site in middle-age-onset tophaceous gout patients. The most common site of first tophi occurrence in early-onset patients was a finger, not a toe, which was the most common site in middle-age-onset patients.
  
  
  CONCLUSIONS
  Early-onset tophaceous gout patients are more likely to exhibit comorbidities and renal dysfunction than middle-age-onset patients and exhibit distinct first sites of gout attack and tophi occurrence patterns.
authors.affiliation: From the Department of Rheumatology, Taichung Hospital, Executive Yuan; and the Department of Physical Therapy, HungKuang University, Taichung, Taiwan.C.C. Lu, MD, Department of Rheumatology, Taichung Hospital, Executive Yuan, Department of Physical Therapy, Hung Kuang University; S.K. Wu, PhD, Associate Professor, Department of Physical Therapy, Hung Kuang University; H.Y. Chen, PhD, Assistant Professor, Department of Physical Therapy, Hung Kuang University; W.S. Chung, MD, Department of Internal Medicine, Taichung Hospital; M.C. Lee, Professor, Department of Family Medicine, Taichung Hospital; C.J. Yeh, PhD, Associate Professor, School of Public Health, and Center for Education and Research on Geriatrics and Gerontology; Chung Shan Medical University.
authors.forename: Chuan-Chin
authors.initials: CC
authors.lastname: Lu
authors.affiliation: From the Department of Rheumatology, Taichung Hospital, Executive Yuan; and the Department of Physical Therapy, HungKuang University, Taichung, Taiwan.C.C. Lu, MD, Department of Rheumatology, Taichung Hospital, Executive Yuan, Department of Physical Therapy, Hung Kuang University; S.K. Wu, PhD, Associate Professor, Department of Physical Therapy, Hung Kuang University; H.Y. Chen, PhD, Assistant Professor, Department of Physical Therapy, Hung Kuang University; W.S. Chung, MD, Department of Internal Medicine, Taichung Hospital; M.C. Lee, Professor, Department of Family Medicine, Taichung Hospital; C.J. Yeh, PhD, Associate Professor, School of Public Health, and Center for Education and Research on Geriatrics and Gerontology; Chung Shan Medical University.
authors.forename: Shyi-Kuen
authors.initials: SK
authors.lastname: Wu
authors.affiliation: From the Department of Rheumatology, Taichung Hospital, Executive Yuan; and the Department of Physical Therapy, HungKuang University, Taichung, Taiwan.C.C. Lu, MD, Department of Rheumatology, Taichung Hospital, Executive Yuan, Department of Physical Therapy, Hung Kuang University; S.K. Wu, PhD, Associate Professor, Department of Physical Therapy, Hung Kuang University; H.Y. Chen, PhD, Assistant Professor, Department of Physical Therapy, Hung Kuang University; W.S. Chung, MD, Department of Internal Medicine, Taichung Hospital; M.C. Lee, Professor, Department of Family Medicine, Taichung Hospital; C.J. Yeh, PhD, Associate Professor, School of Public Health, and Center for Education and Research on Geriatrics and Gerontology; Chung Shan Medical University.
authors.forename: Han-Yu
authors.initials: HY
authors.lastname: Chen
authors.affiliation: From the Department of Rheumatology, Taichung Hospital, Executive Yuan; and the Department of Physical Therapy, HungKuang University, Taichung, Taiwan.C.C. Lu, MD, Department of Rheumatology, Taichung Hospital, Executive Yuan, Department of Physical Therapy, Hung Kuang University; S.K. Wu, PhD, Associate Professor, Department of Physical Therapy, Hung Kuang University; H.Y. Chen, PhD, Assistant Professor, Department of Physical Therapy, Hung Kuang University; W.S. Chung, MD, Department of Internal Medicine, Taichung Hospital; M.C. Lee, Professor, Department of Family Medicine, Taichung Hospital; C.J. Yeh, PhD, Associate Professor, School of Public Health, and Center for Education and Research on Geriatrics and Gerontology; Chung Shan Medical University.
authors.forename: Wei-Sheng
authors.initials: WS
authors.lastname: Chung
authors.affiliation: From the Department of Rheumatology, Taichung Hospital, Executive Yuan; and the Department of Physical Therapy, HungKuang University, Taichung, Taiwan.C.C. Lu, MD, Department of Rheumatology, Taichung Hospital, Executive Yuan, Department of Physical Therapy, Hung Kuang University; S.K. Wu, PhD, Associate Professor, Department of Physical Therapy, Hung Kuang University; H.Y. Chen, PhD, Assistant Professor, Department of Physical Therapy, Hung Kuang University; W.S. Chung, MD, Department of Internal Medicine, Taichung Hospital; M.C. Lee, Professor, Department of Family Medicine, Taichung Hospital; C.J. Yeh, PhD, Associate Professor, School of Public Health, and Center for Education and Research on Geriatrics and Gerontology; Chung Shan Medical University.
authors.forename: Meng-Chih
authors.initials: MC
authors.lastname: Lee
authors.affiliation: From the Department of Rheumatology, Taichung Hospital, Executive Yuan; and the Department of Physical Therapy, HungKuang University, Taichung, Taiwan.C.C. Lu, MD, Department of Rheumatology, Taichung Hospital, Executive Yuan, Department of Physical Therapy, Hung Kuang University; S.K. Wu, PhD, Associate Professor, Department of Physical Therapy, Hung Kuang University; H.Y. Chen, PhD, Assistant Professor, Department of Physical Therapy, Hung Kuang University; W.S. Chung, MD, Department of Internal Medicine, Taichung Hospital; M.C. Lee, Professor, Department of Family Medicine, Taichung Hospital; C.J. Yeh, PhD, Associate Professor, School of Public Health, and Center for Education and Research on Geriatrics and Gerontology; Chung Shan Medical University. alexyeh@csmu.edu.tw.
authors.forename: Chih-Jung
authors.initials: CJ
authors.lastname: Yeh
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D002648:Child; D005260:Female; D006073:Gout / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D033461:Hyperuricemia / Q000378:metabolism / Q000503:physiopathology*; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D014527:Uric Acid / Q000097:blood*; D055815:Young Adult
chemical_list: D014527:Uric Acid
keywords: COMORBIDITY; GOUT; HYPERURICEMIA; RENAL DYSFUNCTION; TOPHI