Musculoskeletal
Dylan M. Wood, MD
Resident Physician
University of Miami Jackson Health
Miami, Florida, United States
Jonathan Paul, MD
Resident Physician
University of Miami / Jackson Memorial Hospital
Miami, Florida, United States
Diana Molinares, MD
Associate Professor, Program Director
University of Miami Miller School of Medicine
Miami, Florida, United States
Dylan M. Wood, MD
University of Miami Jackson Health
Miami, Florida, United States
Polyarticular gout refers to gout in which multiple joints are affected and often associated with poorly controlled hyperuricemia. Diagnosis can be difficult due to mimicry to other inflammatory arthritis etiologies and is associated with chronic joint damage.
Case Description:
61-year-old male from the Virgen Island with a history of chronic kidney disease and right hip osteonecrosis, admitted to acute inpatient rehabilitation after an uncomplicated right-sided Total Hip Arthroplasty. He was making functional improvements but suddenly developed fevers on the day of discharge. No leukocytosis urinary or respiratory symptoms were identified. No evidence of venous thrombosis or surgical site infection. Uric acid was mildly elevated to 8.7, hemoglobin 6.9, LDH 300, CRP 23.4, ESR 113. He was placed on broad spectrum antibiotics without resolution of fevers and began to require blood transfusions for hemolytic anemia. Patient was initiated on a prednisone taper which resolved both his fever, and stabilization of his hemolytic anemia.
Discussions:
Similar to the report above, a different article also reported a 64-year-old African American male who had polyarticular gout mimicking sepsis with fever, leukocytosis of 18,700, and elevated ESR/CRP. The patient was also started on broad-spectrum antibiotics and IV fluid resuscitation without improvement in fevers, pains, or leukocytosis. While it is known that excessive dehydration, alcohol intake, or red meats increase the precipitation of gout, it is also important to remember the epidemiologic variability in affected subjects, mostly from the Pacific islander region, Taiwan, and New Zealanders.
Conclusions: Polyarticular gout is a difficult diagnosis due to its mimicry with other types of inflammatory arthropathies. During workup, it is important to rule out other arthropathies that could respond well to immune-modulating therapies, such as rheumatoid arthritis, psoriatic arthritis, or lupus. Identifying the disease early on can help prevent chronic joint damage, improve the symptom burden and minimize barriers during the rehabilitation process.
