CLINICAL PRESENTATION AND COURSE OF ACUTE GOUTY-ARTHRITIS IN KIDNEY-TRANSPLANT RECIPIENTS AND OTHER HOSPITALIZED-PATIENTS

Kidney transplant recipients suffering from gouty arthritis often have shorter courses of persistent hyperuricemia: 6-14 months compared wit h 10-20 years in the general population. However; the effect of the im munosuppressive drugs used in kidney transplantation on the clinical p resentation of acute inflammatory gouty arthritis is unknown. We condu cted a retrospective chart review of all admissions during the precedi ng 5 years to detect differences in the clinical presentation/course o f gouty arthritis between kidney transplant recipients and the populat ion at large. There was a total of 17 separate episodes of gouty arthr itis in 11 kidney transplant recipients and 5 episodes in 4 non-transp lant patients. Podagra, the site of classic gouty arthritis, was prese nt in only 3 (18%) of 17 episodes of gouty arthritis in kidney transpl ant recipients. Gouty arthritis in kidney transplant recipients was so metimes (5/17, 30%) mistaken for cellulitis and treated with antibioti cs until uric acid crystals were found by joint aspiration. Therapy fo r gouty arthritis differed. kidney transplant recipients were given in creased steroids; only rarely were NSAIDs used. After a usual unsatisf actory response, subsequent successful therapy with colchicine was app lied. All 5 non-transplant patients were effectively treated with NSAI Ds. We conclude that kidney transplant recipients with acute gouty art hritis evince fever and leukocytosis, equivalent to the general popula tion. Additionally gouty arthritis in kidney transplant recipients may masquerade as infectious cellulitis. In kidney transplant recipients with severe gouty arthtitis, increasing the dose of steroids may not t erminate the attack.