Early joint, metabolic complications occur in younger patients with gout
medwireNews: Patients who develop gout before the age of 40 years may experience similar metabolic comorbidities and joint complications as their counterparts with later-onset disease, researchers report.
“Unsurprisingly, given the natural history of the disease, epidemiological studies agree that gout incidence increases with age until the age of 70 years and that onset before the forties is unusual,” say Frédéric Lioté (Hôpital Lariboisière, Paris, France) and colleagues.
“Nonetheless, this observation does not apply to a significant proportion of patients,” they add, noting that the prevalence of gout in adults aged 30–39 years has been reported as 1.3% in the USA.
In the GOSPEL-4 French national cohort study, Lioté and team evaluated data from 120 gout patients who experienced their first flare before the age of 40.0 years, and 865 patients with later disease onset (common gout group). Participants were aged an average of 49.5 years in the early-onset group and 64.4 years in the common gout group.
Patients with early-onset gout were significantly more likely than those with common gout to have a history of polyarticular flares and to have arthritis other than that in the first metatarsophalangeal joint, with rates of 49.6 versus 34.8% and 53.8% versus 40.5%, respectively. However, patients in both groups experienced a comparable number of flares per year, and there was no significant association between age of gout onset and disease activity or severity of joint involvement on multivariate analysis.
These findings suggest that “notwithstanding their younger age, patients with [early-onset gout] presented with joint involvement as severe as patients 15-years older with the so-called classical profile,” say the researchers.
Patients with early-onset gout had significantly fewer renal and cardiovascular comorbidities, and significantly lower rates of the metabolic syndrome than those in the common gout group. Nevertheless, the prevalence of the individual components of the metabolic syndrome – high blood pressure, hyperglycemia/type 2 diabetes, abdominal obesity, low levels of high density lipoprotein cholesterol, and hypertriglyceridemia – was not significantly different between the two groups.
It is “concerning” that the younger gout patients “shared the same prevalence of diabetes […] and individual items of the metabolic syndrome as 65-year-old classical gout patients,” write the researchers in Arthritis Care & Research.
Moreover, they note that gout preceded most comorbidities in the early-onset group, “[w]hereas the first signs of gout usually appear around the diagnosis of other metabolic comorbidities.”
Taken together, these findings support “the existence of a window of opportunity for the rapid treatment of patients developing gout before the age of 40 [as] advocated by EULAR,” they conclude.
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