Crystal arthritis. Gout and pseudogout in the geriatric patient

Abstract

Gout and pseudogout are inflammatory arthritides due to monosodium urate and calcium pyrophosphate dihydrate crystal formation. Both are prevalent among geriatric patients, and can present as acute mono- or oligoarticular disease, or as a chronic polyarthropathy resembling osteoarthritis or rheumatoid arthritis. Gout in the geriatric patient is a disease affecting women, commonly associated with diuretic usage, often involves the fingers, may be complicated by the development of masses of uric acid crystals (tophi) in soft tissues, and is frequently polyarticular. Pseudogout in the geriatric patient has a variety of clinical presentations, may be acute or chronic, and should be considered in evaluating any patient with osteoarthritis occurring in an atypical distribution. Treatment includes the use of nonsteroidal anti-inflammatory drugs, colchicine, or corticosteroids. Gout may be impacted by dietary factors, weight reduction, and avoidance of certain forms of alcohol; uric acid-lowering agents are effective for refractory or chronic tophaceous disease.