Gouty Arthritis Rarely Occurs in Patients with SLE

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Gouty Arthritis Rarely Occurs in Patients with Systemic Lupus

Erythematosus

A DGReview of : " Systemic lupus erythematosus and gouty arthritis: an

uncommon association "

Rheumatology

01/22/2004

By Deanna M Green, PhD

The coexistence of systemic lupus erythematosus (SLE) and gouty

arthritis is rare and is generally seen in patients with long-standing

SLE and nephritis, according to an American, single centre,

retrospective review.

Lupus patients frequently have coexisting renal disease and hypertension

that often requires diuretic therapy. Renal insufficiency and diuretics

can cause hyperuricaemia, which may increase the risk of gout. However,

the coexistence of SLE and gout is rarely reported.

Bajaj, MD, and colleagues at the University of Alabama at

Birmingham, United States, evaluated the incidence and potential risk

factors associated with gouty arthritis in patients with SLE.

The retrospective chart review identified 1,453 patients with SLE who

were admitted over a 12 year period. Ten of these patients met American

College of Rheumatism criteria for SLE and had crystal-proven gout or a

self-limited inflammatory arthritis felt to be crystal-induced.

Overall, 0.55% of patients with SLE in this study also had gouty

arthritis. Most patients were in their 40s or 50s, 80% were African

American and 70% were women.

In 90%, SLE had been present for 9 to 36 years before gout was

diagnosed. However, lupus activity was low in all patients at the time

of initial gout attack.

Lupus nephritis was also present in 90% patients and 40% were renal

transplant recipients. Notably, there was record of an acute

exacerbation of renal function before nearly all gout flares in 90% of

patients, as indicated by elevated serum creatinine levels.

Sixty percent of patients were taking diuretics at the time of initial

gout attack. Furthermore, 80% were on a tapering schedule of prednisone

and were taking a mean prednisone dose of almost 10 mg per day.

The authors conclude that " gouty arthritis is uncommon in SLE patients "

and is " typically observed in patients with long-standing SLE. " They

further recommend that " lupus patients presenting with monoarticular

arthritis should always have arthrocentesis performed and synovial fluid

should be examined for crystals in addition to being cultured and

stained to rule out infection. "

Rheumatology (Oxford) 2004 Jan 6;[Epub ahead of print]. " Systemic lupus

erythematosus and gouty arthritis: an uncommon association "

http://www.docguide.com/news/content.nsf/news/8525697700573E1885256E160039A7C8?O\

penDocument & c=Lupus & count=10

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org