TOPHACEOUS GOUT MANAGEMENT IN A 78-YEAR-OLD FEMALE PATIENT: A CASE REPORT

Gout is a prevalent form of inflammatory arthritis that primarily affects the older population. Treatment of gout in the older is more complex and difficult than in younger patients. The therapeutic agents remain consistent; nevertheless, effective treatment is hindered by the increase of comorbidities with age, decreased renal function, and polypharmacy. There are no specific treatment guidelines for the older for acute attacks, uric acid-lowering therapy, and prophylaxis. Treatment is based on general gout treatment recommendations. Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided, and colchicine should be given at appropriate doses for acute attacks, taking into account comorbidities and decreased renal clearance. Low-dose oral steroid therapy or intra-articular steroids in appropriate patients are often recommended for the treatment of acute attacks. Allopurinol is still the first-line agent for uric acid-lowering therapy in the older. Although there are concerns about the use of febuxostat in older patients, if allopurinol is ineffective or developed adverse effect, febuxostat can be used in appropriate patients. In this article, we present an older woman with chronic tophaceous gout and try to emphasize the importance of treatment for gouty arthritis and hyperuricemia in the older.