Gout in the elderly

Abstract

Textbooks and general rheumatologic literature emphasize the classic clinical presentation of the patient with gout as well as his or her treatment. Quite often however, this presentation does not occur in the elderly patient or the diagnosis is missed or Is erroneously formulated. In women 60 years of age and older, gout can be polyarticular, can have an insidious, nonacute onset and may Involve the small joints of the hands, all of which may lead to diagnose rheumatoid or degenerative arthritis. Careful examination of synovial fluid along with identification of monosodium urate crystals are mandatory for an accurate diagnosis of gout. Possible drug interactions between anti-inflammatory and hypouricemic drugs with other medications have to be kept in mind. Asymptomatic hyperuricemia should not be treated. Once the diagnosis of gout is confirmed a strict follow-up is required to detect the frequent side effects of non- steroid anti-inflammatory drugs, colchicines and allopurinol that tend to take place in the elderly patients.