| Objective:To explore the clinical characteristics and diagnosis and treatment compliance of elderly patients with gout in northeastern Sichuan,with a view to providing evidence for clinical diagnosis and treatment,prevention of complications,improvement of diagnosis and treatment compliance and prognosis of elderly patients with gout.Methods:1.The data of gout patients who were treated in the Affiliated Hospital of North Sichuan Medical College from December 2013 to October 2019 were retrospectively analyzed.According to different ages of onset,they were dividing into young,middle-aged and elderly groups,and contrast analyzed their general conditions,predisposing factors,initial joints and laboratory indicators,Bivariate logistic regression was used to analyze the related influencing factors of elderly patients with gout.2.Controlled analysis of the three groups in the acute phase,the prevention of seizures,and the uric acid lowering treatment.3.Collect patients who were treated in our rheumatology department from March 2018 to May 2019,and investigate the diagnosis and treatment compliance of patients through questionnaires and telephone follow-up.The patients who did not complete the questionnaire were excluded.The patients who actually completed the survey were divided into a compliance group and a non-compliance group according to the compliance scale.Bivariate logistic regression was used to analyze the related influencing factors of diagnosis and treatment compliance of patients with gout.Finally,the compliance of each group was compared according to the age of onset.4.Statistical analysis was performed using SPSS22.0 statistical software.Results:1.After screening according to the inclusion and exclusion criteria,a total of 790 patients with primary gout were finally included,including males(n=771)and females(n=19).Clinical characteristics and associated influence factors of elderly patients with gout in northeastern Sichuan:(1)The youngest group(n=458),middle-aged group(n=175)and the elderly group(n=157)were compared,the elderly group have the lowest BMI,the shortest course of disease.Drinking history and history of hyperlipidemia in the elderly group was the lowest ratios among the three groups,and hypertension was the highest ratios among the three groups.The difference was statistically significant(P<0.05);the number of affected joints and the ratios of combined diabetes in the elderly group were more than those in the young group,and the difference were statistically significant(P<0.05);the family history of gout and the ratios of kidney stones in the elderly group were lower than those in the young group and the difference was statistically significant(P<0.05);the three groups had no statistically significant differences in the ratios of gout stones,smoking history,history of plateau residence,and fatty liver.(2)The predisposing factors of the three groups were mainly high-purine diet and alcohol consumption.The ratios of high-purine diet and alcohol consumption in the elderly group was the lowest among the three groups,and the difference was statistically significant(P<0.05).The ratios of sugar drink and vigorous exercise was lower than that in the young group,and the difference were statistically significant(P<0.05).The other predisposing factors were not statistically significant.(3)The first joints of the three groups were mainly the first metatarsophalangeal joint and the ankle joint.The elderly group with the first joint was not statistically significant compared with the other two groups;(4)Compared with the three groups,the erythrocyte sedimentation ratio(ESR),urea,cystatin(CysC),creatinine(Crea),and C reactive protein(CRP)levels were highest in the elderly group,while the levels of red blood cell(RBC),lymphocyte(LY),hemoglobin(HGB),mean corpuscular-hemoglobin concentration(MCHC),alanine transaminase(ALT),albumin(ALB),triglyceride(TG),cholesterol(TC),low density lipoprotein cholesterin(LDL-C),very low density lipoprotein cholesterol(VLDL-C),and glomerular filtration ratio(eGFR)were lower than those of the other two groups,and the difference were statistically significant(P<0.05).The levels of neutrophile granulocyte(GR),mean corpuscular volume(MCV),and glucose(GLU)were higher than those of the young group,and the levels of uric acid(UA)were lower than those of the young group.The difference was statistically significant(P<0.05);white blood cell(WBC),monocyte(MO),aspartate transferase(AST),globulin(GLOB),and high density lipoprotein cholesterol(HDL-C)levels were not statistically significant among the three groups;(5)Compared with the three groups,24-hour urine volume and urine in the elderly disease group The levels of creatinine and creatinine clearance were lower than those of the other two groups,and the difference was statistically significant(P<0.05);The fraction excretion of uric acid(FEUA)was higher than the young disease group,and the 24-hour uric acid level was lower than the young disease group,the difference was statistically significant(P<0.05);there was no difference in the three groups of urine pH,uric acid clearance,and uric acid/urinary creatinine.Significance(P>0.05);(6)Binary logistic regression analysis showed that hypertension,eGFR,LY,Glu and ALB levels are the influencing factors of elderly patients with gout.2.Drugs for gout in elderly patients from northeast Sichuan in China:(1)Non-steroidal anti-inflammatory drugs are the mainstay of acute and prophylactic drugs in 790 patients;(2)Compared with the three groups,the ratio of non-steroidal anti-inflammatory drugs is the lowest in the elderly group.The ratio of hormone use was higher than that of the young group,and the difference was statistically significant(P<0.05).There was no significant difference in the use of colchicine among the three groups(P>0.05).(3)790 patients with gout treated with uric acid to suppress uric acid production(n=475);(4)The ratio of uric acid lowering treatment in the elderly group was lower than that in the young group,and the difference was statistically significant(P<0.05).There was no statistically significant in the use ratio of benzbromarone,febutastat,and allopurinol in the three groups(P>0.05);(5)The blood uric acid had reduced obviously before and after treatment in the three groups,and the difference was statistically significant(P<0.05).3.Compliance analysis of gout in elderly patients from northeast Sichuan in China:(1)After screening according to the inclusion and exclusion criteria,a total of 132 patients with primary gout were included,14 patients who did not complete the questionnaire were excluded,and 118 patients were actually completed;(2)Disease duration,pain often affects work or life,accompanied by smoking history,combined with kidney stones and diagnosis and treatment compliance of gout patients were closely related,and the difference was statistically significant(P<0.05);(3)The results of binary logistic regression analysis showed that a long course of disease combined with kidney stones was an independent influencing factor for the compliance of patients with gout(P<0.05).(4)After grouping according to the age of onset,the difference of compliance among the three groups was not statistically significant(P>0.05).Conclusion:1.The elderly patients with gout from northeast Sichuan in China have the shortest course of disease,and more affected joints than younger patients.Drinking and high purine diet are the two most common triggers.Arthritis takes the first metatarsophalangeal joint as the common starting site,and uric acid level is lower than that of young and middle-aged patients.Elderly gout patients often be accompanied by hypertension,diabetes and impaired renal function;2.The three groups differed in their performance in ESR,GR,RBC,MCHC,MCV,CRP and lipid metabolism related indicators.Hypertension,eGFR,LY,Glu and ALB levels are the influencing factors of elderly patients with gout.Therefore,patients with abnormal laboratory indicators should be alert to the risk of gout in the elderly,and their uric acid changes should be monitored more closely.3.Compared with young and middle-aged patients,elderly patients with gout often suffer from renal impairment,and hormones are often used to control inflammation during the onset of acute gout;4.Patients with gout from northeast Sichuan in China have lower compliance in diagnosis and treatment,and the long course of disease and kidney stones are independent influencing factors for patients with gout.Therefore,we should strengthen the health education and daily life management of patients to improve the disease cognitive and therapeutic confidence to improve compliance in clinical work. |
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