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 with 10-20 years in the general population. However, the effect of the immunosuppressive drugs used in kidney transplantation on the clinical presentation of acute inflammatory gouty arthritis is unknown. We conducted a retrospective chart review of all admissions during the preceding 5 years to detect differences in the clinical presentation/course of gouty arthritis between kidney transplant recipients and the population at large. There was a total of 17 separate episodes of gouty arthritis in 11 kidney transplant recipients and 5 episodes in 4 non-transplant patients. Podagra, the site of classic gouty arthritis, was present in only 3 (18%) of 17 episodes of gouty arthritis in kidney transplant recipients. Gouty arthritis in kidney transplant recipients was sometimes (5/17, 30%) mistaken for cellulitis and treated with antibiotics until uric acid crystals were found by joint aspiration. Therapy for gouty arthritis differed: kidney transplant recipients were given increased steroids; only rarely were NSAIDs used. After a usual unsatisfactory response, subsequent, successful therapy with colchicine was applied. All 5 non-transplant patients were effectively treated with NSAIDs. We conclude that kidney transplant recipients with acute gouty arthritis evince fever and leukocytosis, equivalent to the general population. Additionally, gouty arthritis in kidney transplant recipients may masquerade as infectious cellulitis. In kidney transplant recipients with severe gouty arthritis, increasing the dose of steroids may not terminate the attack.