Learn More. A retrospective cross-sectional study using data from an outpatient clinic in China was conducted to investigate the clinical features of early-onset gout patients. All patients diagnosed with gout were asked about clinical characteristics of their gout and comorbid diseases.
Patients presenting with acute flares were asked about common triggers before the flare. Major joint involvement, flare frequency before presentation, the cumulative number of involved joints, proportions of tophi complications at presentation, flare triggers, as well as any metabolic, cardiovascular, cerebrovascular, and renal comorbidities, were compared between the 2 groups.
A total of gout patients were enrolled in this study, including Early- and late-onset gout patients had different clinical features. Early-onset seems to be influenced more by lifestyle, while late-onset patients have more complications because of comorbidities. Gout is a common form of chronic arthritis with distinct clinical features.
In addition to resulting in erosive arthritis, gout is also a risk factor for renal, cardiovascular, and cerebrovascular diseases, causing a decreased quality of life and increased social and medical burdens. Studies on early-onset gout, however, are lacking.
Chen and Shen [ 6 ] published a cohort study on juvenile gout, finding that a significant percentage of these patients were overweight and had a family history. Yamanaka [ 7 ] reviewed the causes of gout and hyperuricemia in the young, emphasizing secondary and genetic diseases. All other literature on this topic consists of case reports. However, the clinical features of early-onset gout are still poorly characterized. We retrospectively reviewed data from the GOUT clinic with the aim of studying the clinical and genetic characteristics of gout patients with an early disease onset.
Patients with microscopically identified monosodium urate crystals, or with at least 6 of the 12 classification criteria of the American College of Rheumatology criteria for gout, were consecutively enrolled.
Patients with prior tumors, secondary gout, or missing information regarding the age of onset were excluded. All patients enrolled were asked about demographic and geographic local or nonlocal based on residential address information, clinical characteristics of their gout, and comorbid diseases. Demographic information included sex, birth, and race. Clinical features included the age of gout onset, disease duration years , self-reported gout flare frequency during the year following the first gout flare first year flare frequency, times per year and self-reported gout flare frequency during the year before presentation recent flare frequency, times per year , the cumulative number of joints involved joint number , the pattern of joint involvement, the presence of tophi yes or no , and the peak serum uric acid SUA level.
Comorbid diseases included previously physician-diagnosed hypertension, type 2 diabetes, cardiovascular diseases, cerebrovascular diseases, and chronic renal diseases caused by hyperuricemia or gout. In addition, patients presenting with acute gouty flares, characterized by acute pain, redness, and swelling of 1 joint as assessed by an experienced physician, were asked whether they had encountered the following triggers 48 hours before the flare: alcohol intake, high-purine food ingestion, diuretics or aspirin intake, sports, or trauma.
The genetic study started in January , after which patients enrolled in this study were asked to sign an additional informed consent to participate in the genetic study if they agreed to do so. The ABCG2 gene abnormality, assessed by 2 single nucleotide polymorphisms SNPs rs and rs, has been reported to be associated with early-onset gout.
Linear regression analysis was used to analyze the association between gout severity recent flare frequency and cumulative number of involved joints and disease parameters gout age of onset, disease duration, and SUA. Sex, BMI, metabolic syndrome, and eGFR were then adjusted for analyzing the association between gout severity and the 3 disease parameters. Missing data were omitted. Stata All patients were ethnic Chinese Han. Women constituted 2.
The average age of gout onset in the whole cohort was The average disease duration was 6. The average SUA was First metatarsophalangeal MTP1 involvement is characteristic of gouty arthritis. Ankle and mid-foot involvement are also among the most commonly involved joints in patients with gout.
Thus, we analyzed the involvement pattern of these joints. More than half of the patients had ankle or mid-foot involvement, with a higher incidence in the early-onset gout patients The flare frequency increased as the disease course progressed.
Although the flare frequency during the first year was similar in the 2 groups, the self-reported recent gout flare frequencies were higher in the early-onset group, The cumulative number of joints involved at presentation was also higher in the early-onset group 5. In subgroup analysis, disease duration was consistently associated with both disease severity parameters in both early- and late-onset groups; however, SUA was significantly associated with recent flare frequency and was marginally significantly associated with cumulative number of involved joints only among early-onset group Supplementary table.
Crude and adjusted linear regression analysis for recent flare frequency and cumulative number of involved joints. A total of patients presented with acute flares, confirmed by an experienced physician. Among these patients, Compared with the late-onset group, a higher proportion of patients in the early-onset group had consumed alcohol The proportions of patients reporting high-purine food intake before gout flare were similar in the 2 groups.
In contrast, the proportions of hypertension, diabetes mellitus, and metabolic syndrome at presentation were significantly lower in the early-onset group The proportions of coronary artery disease and cerebrovascular disease were also significantly lower in the early-onset group 1.
Compared with the late-onset group, patients in the early-onset group had relatively preserved renal function, with higher eGFR levels A total of patients consented to the genetic study. An ABCG2 protein function abnormality was detected in They compared 87 patients with a first diagnosis of gout at age 30 years or younger group 1 and patients initially diagnosed at age years group 2 to a randomly selected group of patients diagnosed after age 40 years group 3.
Body-mass index was also higher Obesity was also higher in group one, but not significantly so compared to either two or three. Those in group 1 were significantly more likely than individuals in either groups two or three to have a family history of gout 30 percent vs. Patients in group one had significantly higher uric acid levels at diagnosis 9. As expected, coronary artery disease, hypertension, hyperlipidemia, and diabetes were all significantly higher among those older than 40 years.
But, those characteristics were also found in substantial numbers of the younger groups. Hypertension was found in 41 percent of both groups 1 and 2, and hyperlipidemia in 48 percent and 46 percent, respectively. Pascart T, et al. Arthritis Care Res. 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, 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 patients who experienced their first gout flare prior to age 40 years — defined as the early-onset group — and patients who developed gout after age 40 years — identified as the common gout group.
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.
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.
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