Letters to the Editor
Consider Gout in Patients with Risk Factors, Regardless of Age
Original Article: Gout: An Update
Issue Date: September 15, 2007
Available at: http://www.aafp.org/afp/20070915/801.html
TO THE EDITOR: Thank you for the informative overview of gout provided in the article by Dr. Eggebeen. I am particularly pleased that he emphasized the importance of initiating non-pharmacologic treatment of hyperuricemia to reduce the frequency of recurrence and chronic sequelae.
Physicians should also have a high clinical suspicion in young adult men whose lifestyle involves the consumption of red meat, seafood, alcohol, and exercises that may trigger the onset of gout. Although epidemiologic studies continue to support a higher prevalence of gout in older men, with peak incidence in the fifth decade (51 to 59 years),1 it is important to remember that prevalence is dependent on the incidence and duration of the disease. Also, serum urate levels change dramatically in males from mean childhood values to adult levels during puberty.1 Although the disease has a low prevalence in young adults, those with a genetic predisposition and lifestyle risk factors may experience their first episode of gout in their early 20s.
The perception that acute gout is a disease that only affects older men may lead to a delay in the identification of new cases in young men. This may delay the start of treatment beyond the first 36 hours of the attack when treatment with colchicine and nonsteroidal anti-inflammatory drugs are most effective in reducing the duration of symptoms.
Author disclosure: Nothing to disclose.
The opinions and assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the U.S. Air Force or U.S. Army Medical Departments, or the U.S. Air Force or U.S. Army Services at large.
REFERENCES
1. Terkeltaub RA. Gout: epidemiology, pathology, and pathogenesis. In: Klippel JH, Weyand CM, Wortmann R. Primer on the Rheumatic Diseases. 11th ed. Atlanta, Ga.: Arthritis Foundation; 1997:230-234.
The Practice Guideline "ACIP Releases Recommendations for Hepatitis B Vaccine Use in Adults" (August 15, 2007, page 585) incorrectly listed saliva as the body fluid with the highest concentration of hepatitis B virus (HBV). On page 585, the first sentence of the "Epidemiology" section should have read: "Serum, semen, and saliva have been shown to be infectious, with serum containing the highest concentration of HBV." The article has been corrected online.
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