Background/Purpose: Inflammatory polyarticular gout occurs in clinical practice. However, only very few single case reports have been published as yet. This case series aims at describing this previously poorly defined entity.

Methods: This is a retrospective analysis of all consecutive patients of a single rheumatology center between January 2013 and April 2015. Patients were included with polyarticular gout with at least 5 joint regions involved (1^st MTP joints, other MTP joints, ankles, knees, wrists, digits, elbows) and highly elevated inflammatory markers (CRP >80 mg/l and/or ESR > 80mm/h). Joint involvement was considered if clinical examination revealed swelling or tophi, or if imaging (ultrasound, dual energy CT or x-ray) showed features consistent with gout. Demographic, laboratory, imaging, clinical parameters and treatment regimens were recorded.

Results: Of the 22 included patients, 18 were male; mean age 67 years (standard deviation (SD), ±11 years); mean BMI 29 (SD ±6). The diagnosis was confirmed in 19 patients by polarization microscopy. All patients fulfilled the new ACR/EULAR classification criteria for gout. Fourteen (64%) patients were newly diagnosed with gout. The other patients had been diagnosed with gout for a mean of 10 years (SD ±10).

All patients except one were admitted to hospital due to the inflammatory syndrome. The median duration of the acute symptoms before presentation to our institution was 13 days (minimal / maximal, 2-90). A mean of 10 joint regions (minimal / maximal, 5-14) were affected. Of note, only 3 patients (14%) had fever (37.8, 38.1, 39°C, respectively). Mean visual analogue scale (VAS) for pain, disease activity and fatigue was 8.3, 8.1, and 6.7.

The mean CRP was 172 mg/l (SD ±83.6 mg/l); mean ESR, 91 mm/h (SD ±24 mm/h). All patients had anemia (mean hemoglobin, 7.2 mmol/l; SD± 0.9mmol/l). Leukocytosis was found in only 6 patients (27%; mean, 14.8 G/l), thrombocytosis in 7 patients (32%; mean 405 G/l) and neutrophilia in 12 patients (54%; mean, 9.9 Gpt/l). In 12 (55%) of patients serum ferritin was elevated (mean 391 µg/l). Procalcitonin was normal in all 11 patients in whom it had been determined. Mean uric acid levels were 531 µmol/l (8.9 mg/dl). In 8 patients (36%) acute renal failure was observed, defined as >1.5 fold increase of creatinine. Ten patients had a glomerular filtration rate (GFR) of 30-60 ml/min; in 2 patients GFR was <30 ml/min.

Seven patients received NSAID, 13 colchicine, and 2 glucocorticoids (GC) as first-line anti-inflammatory drugs. NSAID were replaced by colchicine in all 7 patients because of inefficacy. Colchicine was replaced by GC in 14 of 20 cases, and canakinumab was administered in 2 patients who had not responded well to GC. CRP values of <20 mg/l were reached by 82% of patients after a mean of 26 days (SD ±23 days) after onset of symptoms.

Conclusion: Patients with inflammatory syndrome in polyarticular gout with CRP >80 mg/l and/or ESR >80 mm/h are severely affected but rarely exhibit fever. Anemia is common. Leucocytosis and thrombocytosis are rare. Procalcitonin is usually normal. Renal failure occurs in

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/inflammatory-syndrome-in-polyarticular-gout-description-of-a-previously-neglected-entity/