AB0892 ACUTE POLYARTICULAR GOUT WITH SYSTEMIC INFLAMMATORY RESPONSE – A SINGLE TERTIARY CENTRE COHORT

Abstract

Background Gout is a common, inflammatory, crystal-induced disease with increasing prevalence and incidence. Typical monoarticular involvement can be quite easily and effectively treated. In recent years, we have observed more frequently gout cases with severe polyarticular manifestation and with systemic inflammatory response syndrome (SIRS). In clinical practice such a complicated gout attack used to be identified with delay and therapy is not adequate. Objectives To assess clinical and laboratory parameters of systemic inflammatory polyarticular gout and to identify risk factors and convenient therapeutic strategy. Methods Retrospective analysis of 133 consecutive new patients (14 females) with gout (according to the classification criteria ACR/EULAR 2015) on the presence of acute polyarticular involvement (≥ 4 joints) and fullfilling criteria for SIRS. Results Seventeen (12.8%) of 133 gout patients had polyarticular manifestation and met SIRS criteria; 2 females and 15 males, average age 73.2±11.3 years, BMI 29.9±3.8. All these patients had to be admitted to inpatient department because of gout severity. Mean CRP was 204±113 mg/l, leucocytes 15.2±6.8 109/l, serum uric acid 401±140 µmol/l. Procalcitonin was slightly positive in 2 patients (with concurrent respiratory infection). Mean 6 joints were affected, 13 (76,5%) patients had involvement of both upper and lower limbs, tophi were present in 7 of 17 patients. Synovial fluid analysis was performed with proving urate crystals and leukocyte count 24.4±17.3 109/l. Typical gout features were found in 70.6% patients on joint X-ray and in 52.9% ones on musculoskeletal ultrasound. Risk factors for systemic inflammatory polyarticular manifestation were preceding renal function impairment, long-term diuretic therapy and alcohol above-average consumption. Monotherapy was not effective in any patients, combination of NSAID with colchicin or systemic glucocorticoids was used with success. Conclusion Acute polyarticular gout with systemic inflammatory response mimics septic status and mostly requires hospitalization. Complex management with combination therapy should be guided by an experienced rheumatologist. Reference [1] Schafer VS, Krause A, Trauzeddel RF, Schmidt WA. Systemic Inflammatory Polyarticular Gout Syndrome – Description of a Previously Neglected Entity. JSM Arthritis 2017; 2: 1024. Disclosure of Interests None declared