Q: 42 years old male is admitted to ICU with possible polyarticular septic arthritis. Subsequent workup turned it out to be gout instead of sepsis. Initial gout presentation can be polyarticular in which conditions?
Answer: In primary gout, the initial presentation is mostly uniarticular but polyarticular gout can happen in few conditions where hyperuricemia occurs. The two most prominent clinical situations are:
1. Myeloproliferative disorder or lymphoproliferative disorder. This was first described more than five decades ago.
2. Patients on immunosuppressant drugs such as cyclosporine or tacrolimus. Cyclosporine is more common than tacrolimus to cause polyarticular gout, and in few cases switching cyclosporine to tacrolimus may help.
Another feature of polyarticular gout flare is its sequential or migratory nature. It may also occur in a cluster form i.e., involving adjacent joints, tendons, and bursas.
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References:
1. Yü TF. Secondary gout associated with myeloproliferative diseases. Arthritis Rheum 1965; 8:765.
2. Stamp L, Searle M, O'Donnell J, Chapman P. Gout in solid organ transplantation: a challenging clinical problem. Drugs. 2005;65(18):2593-611. doi: 10.2165/00003495-200565180-00004. PMID: 16392875.
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