Comparison of Clinical Characteristics in Older-Onset and Common-Age-of-Onset Gout: A Prospective Gout Cohort Study

Abstract

Objectives Gout is an inflammatory arthritis caused by monosodium urate crystal deposition in the joints. Its clinical presentation varies by age of onset. This study compared the clinical features and treatment patterns of older-onset gout and common-age-of-onset gout. Methods We analyzed data from the Urate Lowering TheRApy in Gout registry. Eligible participants were aged >= 18 years and met the 2015 American College of Rheumatology/European League Against Rheumatism classification criteria for gout. Older-onset gout was defined as gout diagnosed at or after age 65 years, and common-age-of-onset gout as gout diagnosed before age 65 years. Demographics, clinical features, treatment patterns, quality of life, and laboratory findings were collected at baseline and 6 months. Results Among 477 patients, 105 (22.0%) had older-onset gout and 372 (78.0%) had common-age-of-onset gout. The older-onset group included more women (25.7 versus 2.4%, P < 0.001) and showed higher frequencies of radiographic gout-related joint damage (erosion) (30.5 versus 19.6%, P = 0.018), comorbidities (e.g., hypertension, cardiovascular disease, chronic kidney disease, and malignancy), and glucocorticoid use for flare prophylaxis. In contrast, the common-age-of-onset group had higher body mass index (BMI), more frequent flares, unhealthier lifestyle habits (e.g., smoking, alcohol), and higher rates of nonsteroidal anti-inflammatory drug (NSAID) and benzbromarone use. Febuxostat was more frequently prescribed in the older-onset group (71.4 versus 58.9%, P = 0.019), while benzbromarone use was more common in the common-age-of-onset group (7.3 versus 0%, P = 0.004). The febuxostat dose was lower in the older-onset group. After 6 months, both groups showed similar follow-up adherence, flare frequency, and healthcare utilization. Conclusions Older-onset gout and common-age-of-onset gout have distinct clinical characteristics, particularly in comorbidities, lifestyle factors, and treatment patterns. Gout management should be tailored on the basis of age at onset.