337: Chronic Multidimensional Pain in Advanced Tophaceous Gout: Frail Older Adult Case Report

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Pain in Special Populations , Treatment/management , Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Gout is the most common inflammatory arthritis worldwide, with increasing prevalence in older adults. While acute gout flares are dominated by intense inflammation, advanced tophaceous gout progresses to persistent chronic pain driven by urate crystal-induced inflammation, cumulative joint damage, and probable central sensitization mechanisms. In elderly patients, frailty and depression amplify pain perception and functional decline. Pain becomes multidimensional, exceeding purely nociceptive mechanisms. This case aims to illustrate the complex impact of severe gout in a frail geriatric patient and to emphasize the importance of comprehensive geriatric assessment in guiding individualized, multidisciplinary management strategies for pain control and functional preservation.

Methods: We report the case of an 81-year-old man with a 30-year history of gout, admitted for moderate diffused osteoarticular pain, progressive functional decline and gait impairment. His medical history included hypertension, dyslipidemia, benign prostatic hyperplasia, chronic alcohol use, prior tobacco exposure (30 pack-years), and long-term occupational exposure to wood dust and chemical agents used in carpentry, having worked for several decades as a carpenter. He had poor adherence to urate-lowering therapy in recent months, which was followed by worsening pain and progressive deformities.

Results: Clinical examination revealed extensive bilateral tophi involving the hands, elbows, knees, with impaired mobility. Pain intensity was moderate(VAS 7/10), and associated with functional dependence(IADL 1.5/8) and high fall risk on Tinetti testing. Frailty(Edmonton Scale 9/15), and malnutrition(MNA 11.5/30), coexisted with persistent hyperuricemia(9.7mg/dL), systemic inflammation(ESR 68mm/h), moderate anemia(Hb 8.9g/dL), vitamin D and B12 deficiency and stage II chronic kidney disease, all contributing to fatigue and pain amplification. Neuropsychological assessment showed depressive symptoms(GDS:8/15p), executive dysfunction with reduced verbal fluency, consistent with mild cognitive impairment(MMSE 27/30), compromising psychological resilience and adherence to therapy.

Conclusions: This case illustrates that chronic pain in advanced tophaceous gout represents a multidimensional, biopsychosocial syndrome, resulting from the interaction between persistent inflammation, irreversible joint destruction, frailty, mood disorders and cognitive impairment. In geriatric patients, coexistence of metabolic, inflammatory, renal and nutritional abnormalities further amplifies pain and restrict standard anti-inflammatory strategies, increasing the risk of inadequate pain control and functional decline. Effective management requires a multidisciplinary approach, including optimized urate-lowering therapy, individualized analgesics, correction of deficiencies, structured rehabilitation, and psychological support. Early recognition of biopsychosocial factors amplifying pain is essential to prevent disability and improve quality of life in frail patients.

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Presenting Author: Valeria Minascurta
Submitting Author: Valeria Minascurta

Senior Author: Sorina-Maria Aurelian

IASP 2026 Global Year theme of Neuropathic Pain: No

• Valeria Minascurta: Medical Resident, MD, in Geriatrics and Gerontology, and Master’s Student in Nutrition and Food Safety - 1.Saint Luke Chronic Disease Hospital; 2.University of Medicine and Pharmacy „Carol Davila”, Bucharest
• Theodor-Nicolae Popa: Medical Resident, MD, in Geriatrics and Gerontology - Saint Luke Chronic Disease Hospital, Bucharest
• Madalina-Ancuta Ghincu: Medical Doctor in Geriatrics and Gerontology - Prevencia Clinic, Bucharest
• Ana-Gabriela Prada: Asisstant Lecturer, PhD, MD in Geriatrics and Gerontology - University of Medicine and Pharmacy „Carol Davila”, Bucharest
• Costina Daniela Gita: Assistant Lecturer, PhD Candidate, MD, Geriatrics and Gerontology - 1. Saint Luke Chronic Disease Hospital, Bucharest; 2. University of Medicine and Pharmacy „Carol Davila”, Bucharest
• Monica Sandra Gidei: Assistant Lecturer, PhD Candidate, MD, Geriatrics and Gerontology - 1. Saint Luke Chronic Disease Hospital, Bucharest; 2. University of Medicine and Pharmacy „Carol Davila”, Bucharest
• Andreea Zamfirescu: Assistant Professor, PhD, MD, Geriatrics and Gerontology - 1. Saint Luke Chronic Disease Hospital, Bucharest; 2. University of Medicine and Pharmacy „Carol Davila”, Bucharest
• Sorina-Maria Aurelian: Associate Professor, PhD, MD in Geriatrics and Gerontology - 1. Saint Luke Chronic Disease Hospital, Bucharest; 2. University of Medicine and Pharmacy „Carol Davila”, Bucharest