AIM: To determine the specific feature of gout at its onset in the elderly/MATERIAL AND METHODS: The investigation included 100 patients (74 men and 26 women) with primary gout on the basis of the criteria proposed by S. Wallace et al. (1977). The patients were divided into 2 groups: 1) 51 patients aged over 60 years; 2) 49 patients aged less than 60 years. In Groups 1 and 2, the mean age at gout onset was 66.1±4.8 and 41.6±10.0 years, respectively. A comparative retrospective analysis was made to analyze the detection rate for the site of onset gout, the pattern of arthritis, the number of tophus forms, the use of diuretics, small-dose acetylsalicylic acid (ASA), comorbidities, such as hypertension, type 2 diabetes mellitus (T2DM), obesity, chronic renal failure, coronary heart disease, chronic heart failure, and prior myocardial infarction/RESULTS: The disease duration in both groups averaged 8 years. In Groups 1 and 2, first metatarsophalangeal joint arthritis was diagnosed at its onset in 77 and 61%, respectively. In these groups, chronic arthritis was also diagnosed in 19 (37%) and 19 (39%). Examinations revealed tophi in 21 and 37% of cases in Groups 1 and 2, respectively. The administration of diuretics was recorded in 25 (49%) and 17 (35%) patients in these groups. Group 1 patients took low-dose ASA more frequently than Group 2 ones (19 (37%) and 7 (14%) patients, respectively; p=0.013). Hypertension was identified in 23 (45%) examinees in Group 1 and 17 (40%) ones in Group 2. Both groups were matched for the number of patients with obesity (41 and 43%) and for that of patients with T2DM (15 and 10%, respectively). There were significant differences between the compared groups in the incidence of coronary heart disease, myocardial infarction, and chronic heart disease/CONCLUSION: The patients' age of gout onset does not affect substantial differences in the clinical features of gout with its comparable duration in the young and elderly patients. The main clinical features of gout are unique to both young and elderly patients. Cardiovascular diseases are more common at gout onset in the elderly.