allopurinol and Arthralgia

Gout is a painful inflammatory arthropathy caused by crystallization of monosodium urate within the joints. We present the case of a patient with primary gout who had positive results of joint aspiration and synovial biopsy for monosodium urate crystals in the third metacarpophalangeal joint but false-negative results of dual-energy computed tomography.

Topics: Allopurinol; Arthralgia; Biopsy; False Negative Reactions; Gout; Gout Suppressants; Humans; Magnetic Resonance Imaging; Male; Metacarpophalangeal Joint; Middle Aged; Predictive Value of Tests; Synovial Fluid; Tomography, X-Ray Computed; Uric Acid

Topics: Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthralgia; Arthritis, Gouty; Diagnosis, Differential; Gout; Gout Suppressants; Humans; Kidney Function Tests; Male; Middle Aged; Recurrence; Uric Acid

Topics: Aged; Allopurinol; Anti-Inflammatory Agents, Non-Steroidal; Arthralgia; Biopsy; Gout; Gout Suppressants; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Pain Measurement; Radiography; Treatment Outcome

Topics: Acute Disease; Adult; Allopurinol; Ankle Joint; Anti-Inflammatory Agents, Non-Steroidal; Arthralgia; Arthritis, Gouty; Celecoxib; Cyclooxygenase 2 Inhibitors; Diagnosis, Differential; Edema; Gout Suppressants; Humans; Male; Pyrazoles; Sulfonamides

A 67-year-old man presented to a rheumatology clinic with a 1-week history of severe pain and swelling of his right knee. He had been receiving allopurinol for about 5 months for the treatment of chronic gouty arthropathy of more than 30 years' duration. On examination, his right knee was warm and swollen. The aspirated fluid contained intracellular and extracellular monosodium urate crystals, but Gram staining and culture were negative. The affected knee was injected with triamcinolone, but the patient continued to experience severe pain and complained of locking of the knee 3 weeks after the onset of his initial symptoms. Physical examination at this time showed no sign of inflammation, but the knee had a very limited range of motion.. Physical examination; routine laboratory investigations, including CBC, complete metabolic panel, measurement of serum uric acid levels, and synovial fluid analysis; radiological investigations, including radiography of the right knee and CT of the right knee with intra-articular contrast.. CT showed no internal derangement, but revealed extensive intra-articular and extra-articular amorphous soft tissue calcifications, compatible with gouty tophi.. The patient declined an arthroscopic procedure to remove the gouty tophi. Treatment consisted of continuous allopurinol therapy and narcotics for symptomatic pain relief. Over the next 12 months, the patient's serum uric acid levels, and presumably his total-body urate pool, were substantially reduced. The knee unlocked and the pain subsided. Follow-up CT about 3 years after the initial examination showed complete resolution of the calcified intra-articular and extra-articular tophi.

Topics: Aged; Allopurinol; Arthralgia; Gout; Gout Suppressants; Humans; Knee Joint; Male; Radiography

We report a case of DRESS syndrome also called drug hypersensitivity reaction occurring a 47 years old Senegalese man who has been taking allopurinol for 3 months. That drug was prescribed for peripheric arthralgias associated to a hyperuricemia. He presented a generalised pruritus, cutaneous lesions, fever and facial oedema. On the biological examens, hyperleucocytosis with hypereosinophilia and hyperlymphocytosis associated to the presence of segmented basophiles. In addition, a hepatic cytolysis and cholestasis were documented. Liver ultrasound was normal. The hemocults were negative. These following serologies have been performed and were negative: hepatitis B and C, Epstein Barr-virus, cytomegalovirus, syphilis, toxoplasma and parvovirus B19. The anti-nuclear and anti-DNA antibodies were negative. A favourable clinical evolution was remarked after allopurinol treatment withdrawal. A desquamation occurred after 6 days and hemogram turned out to the normal as well as the hepatic tests after 2 weeks. The virologic examens performed 2 months later were unremarkable. This case point out the importance of the early diagnosis and quick withdrawal of the drug in order to prevent serious forms leading to the 10% of death.

Topics: Allopurinol; Antimetabolites; Arthralgia; Drug Eruptions; Edema; Fever; Humans; Hyperuricemia; Male; Middle Aged; Senegal; Syndrome