allopurinol and Arthritis--Psoriatic

Topics: Allopurinol; Antirheumatic Agents; Arthritis, Gouty; Arthritis, Psoriatic; Diagnosis, Differential; Finger Joint; Finger Phalanges; Gout Suppressants; Humans; Interleukin 1 Receptor Antagonist Protein; Male; Middle Aged; Radiography

We report the case of a 36-year-old man with psoriatic arthritis and miliary tuberculosis, whose serum uric acid (SUA) level increased after the initiation of antituberculosis treatment, which included pyrazinamide. Most strikingly and paradoxically, the patient's SUA level increased after treatment with allopurinol. On cessation of allopurinol, his SUA level decreased substantially, and complete normalisation was observed following the discontinuation of pyrazinamide treatment.

Topics: Adult; Allopurinol; Arthritis, Psoriatic; Humans; Hyperuricemia; Male; Pyrazinamide; Treatment Outcome; Tuberculosis, Miliary; Uric Acid

Of 9,108 consecutive new patients seen in an outpatient rheumatology clinic, 155 (1.7%) were diagnosed as having gout. But 164 (1.8%) had been incorrectly diagnosed as having gout in the community. Misdiagnosis was more likely in those with psoriatic arthritis (odds ratio 3.841, 1.944-7.590) and pseudogout (odds ratio 4.152, 2.422-7.119) and less common in patients with nonspecific arthralgias (odds ratio 0.536, 0.326-0.881). Seventy-six percent of incorrectly diagnosed patients received allopurinol while slightly more than 15% were treated with uricosuric agents.

Topics: Adult; Aged; Allopurinol; Analysis of Variance; Arthritis, Psoriatic; Chondrocalcinosis; Colchicine; Databases, Factual; Diagnostic Errors; Female; Gout; Humans; Male; Middle Aged; Prevalence; Probenecid; Prospective Studies; Uremia