An Unusual Case of Gout in a Young Woman with Gitelman Syndrome.

Abstract

To the Editor: While gout is a very common and well-described disorder, it is rarely diagnosed in a young, premenopausal woman1. Overall, men are more than twice as likely to develop this condition over their lifetime as women. This sex difference is at its greatest in the 20- to 49-year age group, where incidence is 1.3% for men versus 0.4% for women2,3. The lower prevalence and incidence of gout in women has been attributed to the protective effects of estrogen and menstruation, which is consistent with the observation that it commonly manifests in women 10 to 15 years after menopause. When gout occurs in men under 30 years or in young women, investigation for a secondary cause is recommended4. This investigation should include checking for acquired risk factors and genetic disorders that exacerbate hyperuricemia (Table 1). View this table: Table 1. Secondary causes of hyperuricemia that should be considered in individuals with low risk for gout. A 27-year-old woman was referred by a nephrologist for chronic and intermittent right first toe pain, redness, and swelling for the past year. It was exacerbated by tight shoes, and relieved with nonsteroidal antiinflammatory drugs (NSAID). She also reported several episodes of pain, swelling, and redness in both ankles over the past year. She was constitutionally well and denied fevers, weight loss, or night sweats. Further history revealed psoriasis (PsO) treated with ultraviolet light therapy. She reported heavy alcohol use over the past 3 to 4 years, with binge drinking, and was previously hospitalized for acute pancreatitis. More recently she was diagnosed with Gitelman syndrome upon … Address correspondence to Dr. L. Rubin, Division of Rheumatology, St. Michael’s Hospital, Bond Wing 3-061, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. E-mail: rubin{at}smh.ca