OPTIMAL MANAGEMENT OF GOUT IN OLDER PATIENTS

Gout in older patients tends to be sub-acute to chronic, often tophace ous, polyarticular, erosive, symmetrical, and causes persistent, recur rent and chronic arthritis. Clinically, it may closely mimic rheumatoi d arthritis; thus, a correct diagnosis requires a high index of clinic al suspicion and the identification of uric acid crystals. An optimal therapeutic strategy for most older patients with chronic tophaceous g out could involve the following: avoidance of alcohol and diuretic use if possible; avoidance of long term nonsteroidal anti-inflammatory dr ug (NSAID) therapy; use of short term corticosteroids (systemic or int ra-articular) for acute exacerbations; prophylactic colchicine daily o r every other day according to the degree of renal dysfunction present ; and long term allopurinol therapy in dosages adjusted to the degree of hyperuricaemia and renal dysfunction.