Unusual Clinical Presentations of Gout

Tony C. Ning; Robert T. Keenan

Disclosures

Curr Opin Rheumatol. 2010;22(2):181 

In This Article

Transplantation Gout

Hyperuricemia and gout have been prevalent in 5–84% of the patient population receiving transplant organs.[22–24] In addition to the common risk factors for gout, immunosuppressant therapy also poses an additional risk in this population. Cyclosporine is notoriously associated with an increased risk of gout, but tacrolimus has also been implicated. Both, cyclosporine and tacrolimus are thought to increase in serum urate through similar mechanisms.[3,25] Studies have shown that the medications cause an increase in renal-tubular reabsorption with decreased glomerular filtration, hypertension, and interstitial nephropathy. Cyclosporine is notoriously the one most associated with gout as shown in a report examining gout in heart-transplant patients treated with cyclosporine.[26] The study showed 43% of patients developed definite gout and clinical manifestations were similar to primary gout with the most common presentation being a monoarticular flare in the first metatarsal joint.[26] Even though gout occurs with both liver and heart transplants, it seems to be less common in patients receiving a liver transplant.[27] This clinical difference may be attributed to different baseline patient populations and medical regimens.

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