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

Elderly Patients Exhibit Stronger Inflammatory Responses during Gout Attacks

• Lee JH
• Yang JA
• Shin K
• Lee GH
• Lee WW
• Lee EY
• Song YW
• Lee EB
• Park JK

• KMID: 2396373
• DOI: http://doi.org/10.3346/jkms.2017.32.12.1967

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.

Keyword

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

MeSH Terms

Aged*
Aging
Arthritis, Infectious
Blood Sedimentation
C-Reactive Protein
Fever
Flow Cytometry
Gout*
Humans
Inflammation
Monocytes
Retrospective Studies
Uric Acid
C-Reactive Protein
Uric Acid

Figure

• 

  Fig. 1 Systemic inflammatory response in gout according to age. The elderly patients (> 65 years) were more likely than the younger patients to have (A) fever and (B) high ESR and CRP levels; however, the three groups had similar WBC counts. Fever was defined as body temperature > 37.8°C and the three groups were compared in terms of the frequency of fever by χ2 test. In (B), the bars indicate the median, the error bars indicate interquartile range, and the three age groups were compared by Kruskal-Wallis test followed by Dunn's multiple comparison test.. (C) Age at gout attack correlated with ESR and CRP but not with WBC. ESR = erythrocyte sedimentation rate, CRP = C-reactive protein, WBC = white blood cell. P values for the post hoc comparisons: *P = 0.002; † P < 0.001.

• 

  Fig. 2 Age-dependent IL-1β production by monocytes following activation with urate crystal. (A) Monocytes from 10 consecutive gout patients were stimulated with MSU crystals or LPS as described in Materials and Methods. MSU induced the monocytes to preferentially secrete IL-1β as compared to LPS. The bars indicate the mean, and the error bars indicate standard error. (B) The IL-1β production but not that of IL-6 or TNF-α correlated with patients' age. Correlation between cytokine production and age was assessed using Spearman's correlation. MSU = monosodium urate, LPS = lipopolysaccharide, IL = interleukin, TNF = tumor necrosis factor.

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