Gout in a 15-year-old boy with juvenile idiopathic arthritis: a case study

Hallie Morris,Geetika Khanna,Kristen Grant,Andrew J White

doi:10.1186/1546-0096-12-1

Hallie Morris, Geetika Khanna + Show 2 more

Open Access

https://doi.org/10.1186/1546-0096-12-1

Copy DOI

Abstract

Joint pain is a common complaint in pediatrics and is most often attributed to overuse or injury. In the face of persistent, severe, or recurrent symptoms, the differential typically expands to include bony or structural causes versus rheumatologic conditions. Rarely, a child has two distinct causes for joint pain. In this case, an obese 15-year-old male was diagnosed with gout, a disease common in adults but virtually ignored in the field of pediatrics. The presence of juvenile idiopathic arthritis (JIA) complicated and delayed the consideration of this second diagnosis. Indeed, the absence of gout from this patient’s differential diagnosis resulted in a greater than two-year delay in receiving treatment. The patients’ BMI was 47.4, and he was also mis-diagnosed with osteochondritis dissecans and underwent medical treatment for JIA, assorted imaging studies, and multiple surgical procedures before the key history of increased pain with red meat ingestion, noticed by the patient, and a subsequent elevated uric acid confirmed his ultimate diagnosis. With the increased prevalence of obesity in the adolescent population, the diagnosis of gout should be an important consideration in the differential diagnosis for an arthritic joint in an overweight patient, regardless of age.

Highlights

In the pediatric population, there are numerous causes of joint pain, stiffness, and swelling
These typically fall into two categories in children and adolescents: bony or structural causes [2], or rheumatologic conditions [3]
Joint pain is a common complaint in pediatrics and in the face of persistent, severe, or recurrent symptoms, the differential typically expands to include bony or structural causes versus rheumatologic conditions

Summary

Background

There are numerous causes of joint pain, stiffness, and swelling. His initial work-up consisted of radiographs of his right ankle, showing evidence of a healing osteochondritis dissecans (OCD) lesion He was instructed to continue physical therapy and follow up in three months with the possibility of arthroscopy of the affected joint if there was no improvement. After recovery from surgery, the patient returned to the rheumatology service for further management of his JIA He continued to have pain and stiffness of his right ankle as well as several other joints that was difficult to manage. The patient spontaneously noted that his ankle pain seemed to worsen following the ingestion of red meat With this new data in hand, a uric acid level was sent and was extremely elevated at 13.3 mg/dL. He continues to be treated for both JIA and gout

Discussion

Conclusion