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.