Introduction: The costs of treating an elderly patient with gout are largely related to the treatment of concomitant pathological conditions and complications. Determining the costs of treating the disease is made by clinical and economic analysis, the task of which is to calculate the "cost of the illness". Material and methods: A descriptive, selective study of 237 patients with gout. In order to study the clinical characteristics of gout in the elderly, all those included in the study was divided according to age at the time of examination: group I made up of patients with gout up to and including 59 years n=91, average age 48.1 +/- 7.4 years (from 30 years to 59 years), group II - over the age of 60 years inclusive n=146, average age 69.2 +/- 6.0 years, (60-86 years, p<0.01). Results: For calculations, the hospitalisation rate during the year was used, which had significant differences in groups: in group I it was 0.7; in group II - 1.2 (p=0,001). The costs of clinical management of gout and each of the diseases that accompany it for 1 calendar year have been determined. Conclusions: The direct costs for the treatment of patients with gout, calculated taking into account National Clinical Protocol and comorbid pathology, increase significantly with the age of the patients: the average cost per year of the treatment of gout in patients of mature age was 1337 Euro without and 7320 Euro taking into account the concomitant pathology, and in the elderly 2067 Euro and, respectively, 15230 Euro.

Introduction: Metabolic disorders are a public health issue because of the complications they cause, but they are also a major risk factor for the onset of gout. Aim: The current study set out to demonstrate clinically how the clinical-paraclinical evaluation methodology had advanced as well as to assess comorbidity in gout patients using diabetes mellitus (DM). We also wanted to examine the pancreatic dysfunction in gout patients of different ages (by assessing the glucose and glycolated Hb analyses). Materials and methods: Two hundred gout patients (mean age, men 60±8.0 years, women 63±9.0 years) were included in a descriptive, cross-sectional study. The diagnosis of gout was made according to the classification criteria for gout according to ACR and EULAR 2015. The raw data were analyzed using SPSS v. 26.0. Results: In the study, type 2 diabetes mellitus (DM2) was encountered with a comparable frequency among both middle-aged and elderly patients (33.8% and 41.8%, respectively, p=0.26). In only 15% of cases, DM2 preceded the development of gout (in 3% with the beginning and 12% with late onset), while the developmental age of the DM2 prior to gout was comparable (50.9±2.8 years in age group 1 and 55.1±6.9 years in age group 2). We found that elderly people experience gout much more frequently (up to 41%) when DM2 is present. However, DM2 is not considered a predictor of gout. Conclusions: In gout patients under the age of 59 inclusive, the mean age at diabetes onset is significantly lower than the age (37.49.6 years) at which diabetes develops in the general population. Early onset of diabetes is associated with early development of gout.

Introduction. The definition of metabolic syndrome is not yet consistent. However, many studies have been conducted in the latest decades about the effect of increased uric acid on metabolic syndrome development. Large epidemiological studies on the association between hyperuricemia and MS showed that increased concentration of serum urea is often observed in subjects with metabolic syndrome. The aim of the study was to characterize specific dysmetabolic changes and features of extraarticular evolution in patients with gout. Materials and methods. A descriptive study was conducted that included 501 patients with gout. The mean age of gout (423 men and 78 women) was 49.2 (36.9; 59.9). The diagnosis of gout was established according to the classification criteria for gout ACR/EULAR 2015. The raw data was processed in SPSS version 26.0. Results. According to our data, the highest severity of obesity and LDL-cholesterol was detected in those with tophaceous gout, which also caused an increase in the frequency of high blood pressure and type 2 diabetes, with age differences in the frequency of detection of metabolic syndrome and insulin resistance. Our data have noted that serum levels of uric acid correlated with the risk of developing both metabolic syndrome as well as its components - obesity, hypertension, and dyslipidemia, but inversely correlated with hyperglycemia. Conclusions. Gout is associated with a severe lipid metabolism dysfunction, significantly increasing the rate of metabolic syndrome especially among patients with chronic tophaceous gout, than in the group of patients with gout under the age of 59 years. On the other hand, in patients with the onset of gout who are ≤59 years lipid metabolism disorders occur significantly earlier than in patients with the onset of gout at the age of ≥60 years.

Distinguishing tuberculous spondylodiscitis (TS) from pyogenic spondylodiscitis (PS) on imaging remains clinically important because the two entities differ in antimicrobial strategy, surgical timing, and the urgency of microbiological workup, yet no single imaging sign is pathognomonic for either diagnosis. When tissue confirmation is delayed, imaging becomes the primary tool that shifts pre-test probability and guides biopsy strategy—a role that is particularly critical in culture-negative disease, in antibiotic-exposed patients, and in settings with limited access to rapid mycobacterial diagnostics. This narrative review maps the imaging evidence most useful for routine TS-versus-PS differentiation, synthesizes recent prediction models and quantitative tools, and evaluates the adjunctive role of ¹⁸F-FDG PET/CT in biopsy-oriented decision-making. PubMed/MEDLINE was searched from inception to 31 March 2026 using pre-specified search terms across three concept blocks. This was a narrative review without formal pooling of quantitative estimates or prospective protocol registration. A secondary Scopus search identified no additional eligible records. Priority was given to comparative TS-versus-PS imaging cohorts, meta-analyses of MRI and CT features, prediction-model studies, and the recent radiomics and PET/CT literature; radiomics and deep-learning studies are appraised as a distinct evidence tier given their retrospective single-center derivation and predominantly internal-only validation. In total, 14 comparative TS-versus-PS imaging cohorts, three meta-analyses, and 14 prediction-model, quantitative-scoring, radiomics, or deep-learning studies formed the core evidence base. MRI yields the greatest differentiating information and is the recommended first-line modality. Features favoring TS include thoracic predominance, multilevel or non-contiguous involvement, relative early disc preservation, subligamentous spread, intraosseous abscesses, thin-walled paravertebral collections, and severe vertebral collapse with kyphotic deformity. Features favoring PS include lumbar predominance, early disc-endplate destruction, homogeneous inflammatory enhancement, facet-joint arthritis, and epidural phlegmon. CT adds osseous detail—including sequestra, subligamentous bone erosion, and paravertebral calcification—and remains the primary guidance modality for biopsy. Recent prediction models combining imaging and laboratory variables have shown high discriminative performance in derivation cohorts; however, most remain internally validated and locally calibrated. Pending external validation, none should be considered ready for unmodified clinical adoption, and they should therefore be used as probability modifiers rather than stand-alone diagnostic rules. ¹⁸F-FDG PET/CT is complementary rather than primary and is most useful when MRI is contraindicated or equivocal, in hardware-associated infection, and for whole-body staging in suspected disseminated tuberculosis. Non-infectious mimics and alternative infectious diagnoses should be considered when the imaging pattern is internally inconsistent or when standard cultures remain negative. Imaging findings should refine etiological probability and guide biopsy strategy, but should not replace tissue confirmation when tissue is feasible. Non-imaging evidence complementing this review is addressed in the companion manuscript, Part I.

Introduction. The incidence and prevalence of gout have increased worldwide in recent decades. Scientists at the Rochester Epidemiology Project (MN, USA) have seen a two-fold increase in the incidence of primary gout (patients without diuretic exposure) over a 20-year period, which ended in 1996. The increase of incidence may be related due to the difficulty and often unsatisfactory treatment options. The aim of the study was to systematize the recommendations on dietary treatment, and medication for patients with gout. Materials and methods. An analytical, qualitative, and secondary study was performed in the form of a synthesis article. 115 sources were identified and analyzed; from this list, 44 sources were selected according to the impact score during the publication period and according to the level of recommendations. Results. 44 articles were included. Most studies were small, retrospective analyses performed in single centers, with concerns for bias. Eleven studies (including five randomized controlled trials) reported improved patient outcomes following pharmacological interventions with known efficacy in gout, including allopurinol, prednisolone, NSAIDs and anakinra. Eight studies reported improved outcomes associated with non-pharmacological interventions: inpatient rheumatology consultation and a hospital gout management protocol. No studies to date have prospectively evaluated strategies designed to prevent re-admissions of patients hospitalized for gout flares. Conclusions. Urate crystals is completely soluble when we can lower the serum level of uric acid to normal values, but this often requires long-term treatment. The early onset of rehabilitation of affected joints helps to reduce the articular inflammatory process, the pain syndrome and it delays the progression of the underlying pathology while improving the quality of life in patients with gout. Further research is needed to enable healthcare providers to individualize and optimize gout treatment strategies, ensuring that patients with gout receive effective, safe, and high-quality care.