In the Journals

Patients with early-onset gout develop more severe joint symptoms

Patients who present with early-onset gout, prior to age 40 years, generally develop more severe joint involvement and earlier occurrence of metabolic disorders compared with those who present after age 40 years, according to findings published in Arthritis Care & Research.

“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 40s is unusual,” Tristan Pascart, MD, PhD, of the Université de Lille, France, and colleagues wrote. “Nonetheless, this observation does not apply to a significant proportion of patients; the prevalence of gout onset in adults between the age of 30 and 39 years reaching 1.3% in the United States. ... Apart from few studies of Asian patients, little is known of the clinical features of patients presenting with early onset gout in other populations, and particularly their comorbidity profile.”

To evaluate the characteristics and comorbidities of patients with early-onset gout, the researchers conducted a continuation of the cross-sectional, national GOSPEL survey, which included 1,003 adults aged 18 years and older who were treated for gout in outpatient facilities in France. For this study, GOSPEL 4, the researchers analyzed data from 120 patients who experienced their first gout flare prior to age 40 years — defined as the early-onset group — and 856 patients who developed gout after age 40 years — identified as the common gout group.

As part of the GOSPEL study, which ended in 2009, all patients’ clinical features, gout history, comorbidities and treatments were recorded by general practitioners and rheumatologists at baseline. In addition, physicians noted time from the first gout occurrence and the time from and to the diagnosis of comorbid conditions. Metabolic syndrome conditions were defined as obesity, high blood pressure, elevated triglycerides, low HDL and hyperglycemia.

According to the researchers, patients who presented with early-onset gout more often demonstrated prior polyarticular flares (P < .01), compared with those in the common gout group. However, they demonstrated a similar frequency of flares (P = .16), gout arthropathy (P = .79) and tophi (P = .53). Metabolic syndrome occurrence was also similar between early-onset and common groups.

For those who developed gout prior to age 40 years, all cardiovascular comorbidities were diagnosed after gout onset. In multivariate analysis, older age, low HDL and excessive alcohol consumption were associated with developing gout after 40 years. Familial history of gout, longer duration of urate lowering treatment, higher serum urate levels and metabolic syndrome occurrence were associated to the early-onset gout.

“In routine practice, patients with [early-onset gout] present during their evolution with slightly different joint involvement and similar disease severity than the more common middle-age onset gout patients,” Pascart and colleagues wrote. “Despite younger age on average, they present with similar prevalence of diabetes mellitus and metabolic conditions as their older counterparts but benefit from rather preserved renal function. Given these early joint and metabolic complications, this study advocates for an early management of patients with early onset gouts.” – by Jason Laday

Disclosure: Pascart reports consulting and expert appraisal fees from Ipsen Pharma and Mayoly-Spindler. Please see the study for all other authors’ relevant financial disclosures.

Patients who present with early-onset gout, prior to age 40 years, generally develop more severe joint involvement and earlier occurrence of metabolic disorders compared with those who present after age 40 years, according to findings published in Arthritis Care & Research.

“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 40s is unusual,” Tristan Pascart, MD, PhD, of the Université de Lille, France, and colleagues wrote. “Nonetheless, this observation does not apply to a significant proportion of patients; the prevalence of gout onset in adults between the age of 30 and 39 years reaching 1.3% in the United States. ... Apart from few studies of Asian patients, little is known of the clinical features of patients presenting with early onset gout in other populations, and particularly their comorbidity profile.”

To evaluate the characteristics and comorbidities of patients with early-onset gout, the researchers conducted a continuation of the cross-sectional, national GOSPEL survey, which included 1,003 adults aged 18 years and older who were treated for gout in outpatient facilities in France. For this study, GOSPEL 4, the researchers analyzed data from 120 patients who experienced their first gout flare prior to age 40 years — defined as the early-onset group — and 856 patients who developed gout after age 40 years — identified as the common gout group.

As part of the GOSPEL study, which ended in 2009, all patients’ clinical features, gout history, comorbidities and treatments were recorded by general practitioners and rheumatologists at baseline. In addition, physicians noted time from the first gout occurrence and the time from and to the diagnosis of comorbid conditions. Metabolic syndrome conditions were defined as obesity, high blood pressure, elevated triglycerides, low HDL and hyperglycemia.

According to the researchers, patients who presented with early-onset gout more often demonstrated prior polyarticular flares (P < .01), compared with those in the common gout group. However, they demonstrated a similar frequency of flares (P = .16), gout arthropathy (P = .79) and tophi (P = .53). Metabolic syndrome occurrence was also similar between early-onset and common groups.

For those who developed gout prior to age 40 years, all cardiovascular comorbidities were diagnosed after gout onset. In multivariate analysis, older age, low HDL and excessive alcohol consumption were associated with developing gout after 40 years. Familial history of gout, longer duration of urate lowering treatment, higher serum urate levels and metabolic syndrome occurrence were associated to the early-onset gout.

“In routine practice, patients with [early-onset gout] present during their evolution with slightly different joint involvement and similar disease severity than the more common middle-age onset gout patients,” Pascart and colleagues wrote. “Despite younger age on average, they present with similar prevalence of diabetes mellitus and metabolic conditions as their older counterparts but benefit from rather preserved renal function. Given these early joint and metabolic complications, this study advocates for an early management of patients with early onset gouts.” – by Jason Laday

Disclosure: Pascart reports consulting and expert appraisal fees from Ipsen Pharma and Mayoly-Spindler. Please see the study for all other authors’ relevant financial disclosures.