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J Korean Med Sci. 2017 Dec;32(12):1967-1973. doi: 10.3346/jkms.2017.32.12.1967.

Elderly Patients Exhibit Stronger Inflammatory Responses during Gout Attacks.

Author information

1
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
2
Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
3
Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea.
4
Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.
5
WCU Department of Molecular Medicine and Biopharmaceutical Sciences, Medical Research Institute, Seoul National University College of Medicine, Seoul, Korea.
6
WCU Department of Molecular Medicine and Biopharmaceutical Sciences, Medical Research Institute, Seoul National University College of Medicine, Seoul, Korea. jinkyunpark@gmail.com.
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Contributed equally

Abstract

Gout attacks are often accompanied by systemic inflammatory response. The aim of the retrospective study was to compare gout patients in different age groups in terms of their clinical features at gout attacks. Patients, who were treated for gout attack in two tertiary medical centers between January 2000 and April 2014, were divided into young (≤ 50 years), middle-aged, and elderly (> 65 years) groups. Patients in three age groups were compared in terms of presence of fever (> 37.8°C), C-reactive protein (CRP) levels, and erythrocyte sedimentation ratio (ESR) at the gout attacks. Monocytes, which were isolated from 10 consecutive patients who previously experienced gout attacks, were stimulated with monosodium urate (MSU) crystals and cytokine production was measured by flow cytometry. Among 254 patients analyzed in this study, 48 were young, 65 were middle-aged, and 141 were elderly. The elderly patients were more likely to have fever (51.1%) during the attack than the young (20.8%) and middle-aged (30.8%) patients (P < 0.001 by χ² test). They were also more likely to have higher ESR and CRP levels than the young patients (P = 0.002 for ESR, P < 0.001 for CRP). Patients' age correlated significantly with CRP and ESR levels (both P < 0.001). After stimulation with MSU, the production of interleukin-1β by monocytes increased with patients' age (r = 0.670, P = 0.03). In conclusion, gout attacks in elderly patients are associated with fever and higher ESR and CRP levels, often resembling a septic arthritis.

KEYWORDS:

Aging; C-reactive Protein; Fever; Gout; Inflammation

PMID:
29115078
PMCID:
PMC5680495
DOI:
10.3346/jkms.2017.32.12.1967
[Indexed for MEDLINE]
Free PMC Article

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