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      Gota en el anciano

      case-report

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          Abstract

          La gota es la artritis crónica más común en el anciano. Puede ser fácilmente diagnosticada por la presencia de cristales de urato monosódico al examen microscópico del líquido articular. Existen algunas diferencias clínicas entre la gota del adulto y la del anciano. El tratamiento es altamente efectivo pero puede ocasionar serias reacciones adversas si no se tiene en cuenta la comorbilidad de este grupo.

          Translated abstract

          Gout is the most common chronic arthritis in older people that can lead to significant and severe disability. It can be easy diagnosed with the presence of crystals of urate monosodic in the articular fluid. The clinical stages of gout include asymptomatic hyperuricemia, intermittent gouty arthritis, intercritical period and chronic tophaceous gout. There are some differences necessary to recognize to avoid errors in the management. Treatment of acute gout involves the use of NSAIDs, colchicine, corticosteroids or corticotropin (adrenocorticotropic hormone). Profilactic treatment includes the use of allopurinol and uricosuric agents; but all of these drugs could cause serious reactions in the elderly.

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          Most cited references146

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          Febuxostat compared with allopurinol in patients with hyperuricemia and gout.

          Febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase, is a potential alternative to allopurinol for patients with hyperuricemia and gout. We randomly assigned 762 patients with gout and with serum urate concentrations of at least 8.0 mg per deciliter (480 micromol per liter) to receive either febuxostat (80 mg or 120 mg) or allopurinol (300 mg) once daily for 52 weeks; 760 received the study drug. Prophylaxis against gout flares with naproxen or colchicine was provided during weeks 1 through 8. The primary end point was a serum urate concentration of less than 6.0 mg per deciliter (360 micromol per liter) at the last three monthly measurements. The secondary end points included reduction in the incidence of gout flares and in tophus area. The primary end point was reached in 53 percent of patients receiving 80 mg of febuxostat, 62 percent of those receiving 120 mg of febuxostat, and 21 percent of those receiving allopurinol (P<0.001 for the comparison of each febuxostat group with the allopurinol group). Although the incidence of gout flares diminished with continued treatment, the overall incidence during weeks 9 through 52 was similar in all groups: 64 percent of patients receiving 80 mg of febuxostat, 70 percent of those receiving 120 mg of febuxostat, and 64 percent of those receiving allopurinol (P=0.99 for 80 mg of febuxostat vs. allopurinol; P=0.23 for 120 mg of febuxostat vs. allopurinol). The median reduction in tophus area was 83 percent in patients receiving 80 mg of febuxostat and 66 percent in those receiving 120 mg of febuxostat, as compared with 50 percent in those receiving allopurinol (P=0.08 for 80 mg of febuxostat vs. allopurinol; P=0.16 for 120 mg of febuxostat vs. allopurinol). More patients in the high-dose febuxostat group than in the allopurinol group (P=0.003) or the low-dose febuxostat group discontinued the study. Four of the 507 patients in the two febuxostat groups (0.8 percent) and none of the 253 patients in the allopurinol group died; all deaths were from causes that the investigators (while still blinded to treatment) judged to be unrelated to the study drugs (P=0.31 for the comparison between the combined febuxostat groups and the allopurinol group). Febuxostat, at a daily dose of 80 mg or 120 mg, was more effective than allopurinol at the commonly used fixed daily dose of 300 mg in lowering serum urate. Similar reductions in gout flares and tophus area occurred in all treatment groups. Copyright 2005 Massachusetts Medical Society.
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            A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy.

            To evaluate the proposed relationship between persistent reduction of serum urate into the subsaturating range and reduction in the frequency of acute gouty attacks. We retrospectively examined data derived from 267 patients who had experienced at least 1 gouty attack before their first visit to our clinic. Serum urate concentration, history of recurrent gouty attacks, and information about antihyperuricemic drug use were collected on each visit for up to 3 years from the first visit of each patient. Data derived from visits >1 year after study entry were subjected to statistical analysis. When adjusted for baseline serum urate level and the number of gouty attacks prior to study entry, reduction of followup serum urate concentration and antihyperuricemic drug use were each significantly associated with a reduced risk of gouty attacks (odds ratio [OR] 0.42, 95% confidence interval [95% CI] 0.31-0.57; OR 0.22, 95% CI 0.10-0.47, respectively). The data indicate that reduction of serum urate concentrations to 6 mg/dl or lower will eventually result in a reduced frequency or prevention of future gouty attacks.
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              Increasing prevalence of gout and hyperuricemia over 10 years among older adults in a managed care population.

              To determine whether the prevalence of gout and/or clinically significant hyperuricemia increased in a managed care population over 10 years. The study was a descriptive analysis utilizing an administrative claims database to ascertain 10-year trends in prevalence of gout and/or hyperuricemia. Prevalence rates were calculated cross-sectionally for each year (1990-99) and expressed/compared as rates per 1000 enrollees. The prevalence of gout and/or hyperuricemia in the overall population increased by about 2 cases per 1000 enrollees over 10 years. In the > 75 year age group, rates increased from 21 per 1000 persons in 1990 to 41 per 1000 in 1999. In the 65-74 year age group, prevalence increased from between 21 and 24 per 1000 persons in the years 1990-92 to over 31 per 1000 during the years 1997-99. Prevalence rates in younger age groups ( 65), the gender gap narrowed to 1 woman to every 3 men with gout and/or hyperuricemia (3:1 ratio).
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                Author and article information

                Journal
                rcre
                Revista Colombiana de Reumatología
                Rev.Colomb.Reumatol.
                Asociación Colombiana de Reumatología (Bogotá, Distrito Capital, Colombia )
                0121-8123
                January 2008
                : 15
                : 1
                : 55-58
                Affiliations
                [02] Alicante orgnameUniversidad Miguel Hernández orgdiv1Hospital General Universitario de Alicante orgdiv2sección de reumatología España
                [01] orgnameInternista y Reumatólogo orgdiv1Universidad de Caldas orgdiv2Universidad de Antioquia Colombia
                Article
                S0121-81232008000100002 S0121-8123(08)01500102
                0bf27fd5-e973-412a-b13b-0752f1a37c77

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 07 March 2008
                : 04 January 2008
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 91, Pages: 4
                Product

                SciELO Colombia

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                Presentación de Casos

                gout,uricase,febuxostat,treatment,urate monosodic crystals,elderly,uricasa,tratamiento,cristales de urato monosódico,anciano,gota

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