Podagra in Cystic Fibrosis.

SESSION TYPE: Airway Student/Resident Case Report PostersPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: Joint disease affecting adults with Cystic Fibrosis (CF) may present as episodic arthritis and/or hypertrophic pulmonary osteoarthropathy (HPOA). Gout is rarely reported in adults with CF. We report an adult CF patient who presented to us with Podagra.CASE PRESENTATION: A thirty year old white man with CF presented with severe pain in left big toe and redness for one week. He denied trauma to left foot. There was no history of fever, infectious complications. Family history was insignificant for gout. He was prescribed Indomethacin by for seven days without relief. His exam showed red and swollen left first metatarsophalyngeal joint with excruciating pain on movement. His foot x rays showed mild hallux valgus with bunion formation without evidence of erosive periostitis. His serum uric acid level came elevated at ten mg/dl. He was diagnosed with classical podagra and started on Indomethacin followed by allopurinol with complete relief of his symptoms.DISCUSSION: Arthropathy occurs in up to 12% of patients with CF and appears to be caused by immunologic processes. Acute episodes may affect all joints, are usually asymmetric, present with swollen, hot, red, and tender joints, often cause incapacitating pain, typically last seven to ten days, and usually are not erosive. Serologic analysis to exclude other causes of arthritis should be considered such as Gout which is rare. Joint fluid analysis is usually nonspecific and may be non inflammatory. Non-steroidals and steroidals anti-inflammatory medications are used in management of CF arthritis. HPOA is characterized by chronic, proliferative long-bone periostitis, causing symmetrical bone pain and painful oligosynovitis in the large joints.Unlike arthritis, HPOA exacerbations tend to accompany pulmonary infectious exacerbations. Ourpatient had classic findings of Podagra, elevated serum urate and response to appropriate therapy. It is a hypothesis that pancreatic enzyme supplements which contain high levels of purine may be responsible for hyperuricemia in adult CF patients.CONCLUSIONS: Surviellance of serum urate is not routinely performed but consideration should be given to adding this to investigations. Review of pancreatic enzyme intake in those with confirmed gout or extreme hyperuricemia can be considered.1) Gout and hyperuricaemia in adults with cystic fibrosis. Horsley A, Helm J, Brennan A, Bright-Thomas R, Webb K, Jones A.Manchester Adult Cystic Fibrosis Centre, Wythenshawe Hospital, Manchester, UK. J R Soc Med. 2011 Jul;104 Suppl 1:S36-9.2) Cystic Fibrosis Adult Care. Consensus Conference Report. ( Chest 2004; 125: 1S-39S)3) Schidlow DV, Goldsmith DP, Palmer J, et al. Arthritis in cystic Fibrosis. Arch Dis of child 1984; 59:377-379DISCLOSURE: The following authors have nothing to disclose: Sumaira Malik, Nauman ChaudaryNo Product/Research Disclosure InformationUMC, Brandon, MS.