Background: Gout is one of the most prevalent inflammatory rheumatic diseases in adults [1]. The prevalence of gout increases with age, and gout attacks before the age of 40 are uncommon. Although there is no universally accepted definition of early-onset gout (EOG), most studies classify it as gout occurring before the age of 40 [2].

Objectives: This study aimed to evaluate the clinical and laboratory features of patients with EOG and compare them with patients diagnosed with gout after the age of 40.

Methods: A retrospective review of 242 gout patients followed at Başkent University Ankara Hospital between 1998 and 2023 was conducted. All patients met the 2015 ACR/EULAR gout classification criteria [3]. Patients were divided into two groups: early-onset gout (age ≤40 years at diagnosis, Group 1) and late-onset gout (age >40 years at diagnosis, Group 2). Statistical analyses were performed using SPSS 15.0.

Results: Of the 242 patients, 34 (14%) were diagnosed with gout at age ≤40 years (Group 1) and 208 (86%) at age >40 years (Group 2). All Group 1 patients were male. The median age at diagnosis was 32.02 years in Group 1 and 62.18 years in Group 2 (Table 1). The prevalence of hypertension, coronary artery disease, and chronic kidney disease was significantly higher in Group 2. Serum uric acid levels during or outside of attacks were similar between groups (9.24 vs 8.72 mg/dL, respectively; p=0.81). Smoking, alcohol consumption, and family history of gout were more frequent in Group 2. The most commonly affected joint in both groups was the 1st metatarsophalangeal joint. Knee joint involvement was less frequent in Group 1 (6.9% vs 15.6%, respectively; p:0,003). The median erythrocyte sedimentation rate (ESR) during attacks was significantly higher in Group 2 (10.6 mm/h vs 20.87 mm/h; p=0.0001), whereas there was no significant difference in C-reactive protein (CRP) levels. Bilateral lower extremity involvement was observed in 15% of patients in both groups (p=0.1). The annual number of gout attacks and treatment protocols were similar between the groups. The median alanine transaminase (ALT) level was significantly higher in Group 1 (37 vs. 24 U/L, p=0.002).

Conclusion: EOG presents distinct clinical features compared to late-onset gout, including male predominance, and less frequent knee joint involvement. Despite more comorbidities in older patients, serum uric acid levels were similar across both groups, indicating that genetic predisposition may play a key role in EOG. Achieving optimal uric acid control remains a challenge in both groups, highlighting the importance of improving adherence to urate-lowering therapies. Future studies should explore personalized management strategies for EOG patients.

REFERENCES: [1] Kuo CF, et al. Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol. 2015.

[2] Tristan Pascart, et al. Early-onset gout, Joint Bone Spine, Volume 91, Issue 5, 2024.

[3] Neogi T, et al. 2015 Gout Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol. 2015 Oct;67(10):2557-68.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.