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Cited by 37Gout, Hyperuricemia, Uric AcidDrug-Induced Adverse ReactionsPharmaceutical Practices and Patient Outcomes

Management of Gout in the Older Adult

Fravel, Michelle A., Ernst, Michael E.·2011·The American Journal of Geriatric Pharmacotherapy
DOI 10.1016/j.amjopharm.2011.07.004
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Abstract

Background Gout affects 3 million people in the United States, with rates almost 5 times higher in those aged 70 to 79 years compared with those aged < 50 years. Management of gout in elderly subjects can be complicated by comorbidities and polypharmacy.Objective The purpose of this article was to review the unique clinical presentation, treatment, and prevention of gout in the older adult, with attention to the age-related factors that may affect outcomes in this population.Methods PubMed and the Iowa Drug Information Service were searched (1944-January 14, 2011) for clinical studies of gout using the following search terms: gout, elderly, colchicine, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid, prednisone, prednisolone, methylprednisolone, triamcinolone, allopurinol, febuxostat, probenecid, sulfinpyrazone, uricosuric, fenofibrate, and losartan. Articles were limited to clinical trials in humans, published in English. Citations of these articles were analyzed for additional relevant studies, and current guidelines were also consulted.Results Twenty-nine citations were reviewed. Evidence suggests that colchicine, NSAIDs, and corticosteroids are all efficacious in the treatment of acute gout in the older adult. Relevant limitations to colchicine use in the older adult include high cost, dosing restrictions in severe renal and hepatic dysfunction, gastrointestinal intolerance, and potential drug interactions. NSAID therapy is not recommended in older patients with congestive heart failure, renal failure, or gastrointestinal problems. Corticosteroids pose little risk when used in the short-term and may be preferred in patients with contraindications to colchicine or NSAIDs. Urate lowering with allopurinol for prevention of gout is well tolerated and has minimal cost per month; however, dose reduction is recommended in patients with renal impairment, which often results in failure to achieve target serum urate concentrations. Febuxostat does not require dose adjustment in mild to moderate renal disease and may be preferred in older people with this condition.Conclusion Management of gout in the older adult involves careful selection of treatment based on potential benefits and consequences of therapy, considered in tandem with individual patient-specific characteristics. ClinicalTrials.gov identifiers NCT00549549, NCT01101035, NCT00241839, NCT01157936, NCT00997542, NCT00288158, and NCT00987415.

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Authors
Fravel, M. A., & Ernst, M. E.
Affiliations
University of Iowa (US)
Corresponding author
Fravel, Michelle A.
ORCID
Venue
The American Journal of Geriatric Pharmacotherapy
Publisher
Elsevier BV
Published
2011-10
Volume
9
Issue
5
Pages
271-285
ISSN
1543-5946 (ISSN-L)
DOI
10.1016/j.amjopharm.2011.07.004
OpenAlex
W1989903518
Cited by
37
References
65
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2021: 2 · 2020: 1 · 2018: 2 · 2017: 4 · 2016: 3 · 2015: 9 · 2014: 5 · 2013: 4 · 2012: 3
FWCI
0.51
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The American Journal of Geriatric Pharmacotherapy (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Nephrology › Gout, Hyperuricemia, Uric Acid
  • Health Sciences › Medicine › Pharmacology › Drug-Induced Adverse Reactions
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
gout, older adults, gout prevention, colchicine, nonsteroidal anti-inflammatory drugs, corticosteroids, allopurinol, febuxostat, probenecid, urate-lowering therapy, renal dysfunction, drug interactions, polypharmacy, comorbidities, age-related factors, serum urate target, congestive heart failure
MeSH terms
Age Factors, Aged, Aging, Clinical Trials as Topic, Gout, Gout Suppressants, Humans, Middle Aged, Recurrence, Risk Factors, Comorbidity, Treatment Outcome, Risk Assessment, Patient Selection, Evidence-Based Medicine, Polypharmacy

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