Do Hyunsue, Son Chang-Nam, Choi Hyo Jin, Choi In Ah, Shin Kichul, Kim Min Jung, Kim Sang-Hyon, Ha You-Jung, Ahn Joong Kyong, Kim Hyun-Ok, Lee Sung Won, Lee Chang Hoon, Kim Se Hee, Son Kyeong Min, Moon Ki Won
Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon-si, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, Eulji University School of Medicine, Uijeongbu, Republic of Korea.
Drugs Aging. 2025 Aug 12. doi: 10.1007/s40266-025-01240-2.
Gout is an inflammatory arthritis caused by monosodium urate crystal deposition in the joints. Its clinical presentation varies by age of onset. This study compared the clinical features and treatment patterns of older-onset gout and common-age-of-onset gout.
We analyzed data from the Urate Lowering TheRApy in Gout registry. Eligible participants were aged ≥ 18 years and met the 2015 American College of Rheumatology/European League Against Rheumatism classification criteria for gout. Older-onset gout was defined as gout diagnosed at or after age 65 years, and common-age-of-onset gout as gout diagnosed before age 65 years. Demographics, clinical features, treatment patterns, quality of life, and laboratory findings were collected at baseline and 6 months.
Among 477 patients, 105 (22.0%) had older-onset gout and 372 (78.0%) had common-age-of-onset gout. The older-onset group included more women (25.7 versus 2.4%, P < 0.001) and showed higher frequencies of radiographic gout-related joint damage (erosion) (30.5 versus 19.6%, P = 0.018), comorbidities (e.g., hypertension, cardiovascular disease, chronic kidney disease, and malignancy), and glucocorticoid use for flare prophylaxis. In contrast, the common-age-of-onset group had higher body mass index (BMI), more frequent flares, unhealthier lifestyle habits (e.g., smoking, alcohol), and higher rates of nonsteroidal anti-inflammatory drug (NSAID) and benzbromarone use. Febuxostat was more frequently prescribed in the older-onset group (71.4 versus 58.9%, P = 0.019), while benzbromarone use was more common in the common-age-of-onset group (7.3 versus 0%, P = 0.004). The febuxostat dose was lower in the older-onset group. After 6 months, both groups showed similar follow-up adherence, flare frequency, and healthcare utilization.
Older-onset gout and common-age-of-onset gout have distinct clinical characteristics, particularly in comorbidities, lifestyle factors, and treatment patterns. Gout management should be tailored on the basis of age at onset.
痛风是一种由尿酸钠晶体沉积在关节中引起的炎症性关节炎。其临床表现因发病年龄而异。本研究比较了老年发病痛风和常见发病年龄痛风的临床特征及治疗模式。
我们分析了痛风降尿酸治疗登记处的数据。符合条件的参与者年龄≥18岁，且符合2015年美国风湿病学会/欧洲抗风湿病联盟痛风分类标准。老年发病痛风定义为65岁及以后诊断的痛风，常见发病年龄痛风定义为65岁之前诊断的痛风。在基线和6个月时收集人口统计学、临床特征、治疗模式、生活质量和实验室检查结果。
在477例患者中，105例（22.0%）为老年发病痛风，372例（78.0%）为常见发病年龄痛风。老年发病组女性更多（25.7%对2.4%，P<0.001），且痛风相关关节损伤（侵蚀）的影像学表现频率更高（30.5%对19.6%，P = 0.018），合并症（如高血压、心血管疾病、慢性肾脏病和恶性肿瘤）及用于预防发作的糖皮质激素使用频率更高。相比之下，常见发病年龄组体重指数（BMI）更高，发作更频繁，生活方式习惯更不健康（如吸烟、饮酒），非甾体抗炎药（NSAID）和苯溴马隆的使用比例更高。非布司他在老年发病组的处方频率更高（71.4%对58.9%，P = 0.019），而苯溴马隆的使用在常见发病年龄组更常见（7.3%对0%，P = 0.004）。老年发病组非布司他剂量更低。6个月后，两组的随访依从性、发作频率和医疗利用情况相似。
老年发病痛风和常见发病年龄痛风具有不同的临床特征，尤其是在合并症、生活方式因素和治疗模式方面。痛风管理应根据发病年龄进行调整。
