Patients with early onset gout have more severe disease

Patients with early onset gout develop earlier severe joint involvement and metabolic comorbid conditions, a French study has shown.

Gout onset before the age of 40 is unusual, but when it does occur patients have joint involvement as severe as seen in older patients with ‘classic’ gout that is typically diagnosed 15 years later, according the rheumatologists at the University of Lille.

In a study of 120 patients who experienced their first gout flare before the age of 40, they found that disease was mores severe as compared with a comparator group of 865 patients with classic gout whose average age was 64 years.

Published in Arthritis Care & Research, the study showed there was a significant greater proportion of patients having experienced other arthritis than the first metatarsophalangeal joint in the early-onset gout group (53.8%) than in the classic gout group (40.5%) Furthermore, more patients of the early-onset gout group versus the classic gout group had experienced polyarticular flares (50% vs 35%).

Patients with early-onset gout had a similar frequency of flares, gout arthropathy and tophi as the classic gout group.

The researchers said it was of particular concern that young patients with early onset gout showed a similar prevalence of diabetes mellitus (12% vs 15.5%) and individual items of the metabolic syndrome such as obesity and dyslipiadaemia as 65-year-old classical gout patients.

Metabolic syndrome rates were 64% for patients with classic gout and 53% for patients in the early-onset gout group. On multivariate analysis, the metabolic syndrome was significantly associated with early-onset gout.

“Whereas the first signs of gout usually appear around the diagnosis of other metabolic comorbidities, in our early onset patients, gout preceded most other comorbidities,” they noted.

The researchers said their findings suggested that early onset gout was driven by genetic factors, since on average they were not heavy drinkers, had better preserved renal function and took fewer diuretics than pateints with later onset gout.

“Overall, our study suggests that disease activity and severity of the joint involvement of early-onset gout are comparable to those of later-on onset gouts,” they concluded.

Given these early joint and metabolic complications, this study advocates for an early management of patients with early onset gouts …these results … suggest the existence of a window of opportunity for the rapid treatment of patients developing gout before the age of 40 advocated by EULAR,” they added.

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