Consider the following statements regarding Gout in old age.
1. Most of older patients have gout secondary to diuretic use and chronic kidney disease
2. Joints of the upper limbs are more frequently affected
3. Presentation is typical with acute attack of gout
Which of the statements given above are correct?
(a) 1 and 2 only
(b) 2 and 3 only
(c) 1 and 3 only
(d) 1, 2 and 3
ANS- (a) 1 and 2 only
Gout in old age:
• Aetiology: a higher proportion of older patients have gout secondary to diuretic use and chronic kidney disease. Gout is often associated with osteoarthritis.
• Presentation: may be atypical, with painful tophi and chronic symptoms, rather than acute attacks. Joints of the upper limbs are more frequently affected.
• Management: acute attacks are best treated by aspiration and intra-articular injection of glucocorticoids, followed by early mobilisation. Non-steroidal anti-inflammatory drugs and colchicine should be used with caution because of increased risk of toxicity. Low doses of allopurinol (50 mg/day) should be given and increased gradually to avoid toxicity.