A case of secondary gout associated with psoriasis vulgaris
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概要
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We reported a case with gouty attack auring tne course of psoriasis vulgaris.<BR>A male patient, aged 74 years old, was transferred to our clinic for fever and painful swelling of the left great toe. He has been treated for psoriasis vulgaris and hypertension over 20 years. Seven years before the admission, his blood pressure was 180-100 mmHg and proteinuria was not detected. Serum uric acid concentration was 9.2 mg/100 ml, although the blood urea N and creatinine levels were within normal limits. He was readmitted to the Department Of Dermatology for psoriasis two months before. Laboratory examinations showed mild azotemia(blood urea N 37, creatinine 2.8 mg/100 ml ) and hyperuricemia. PSP excretion was 6 per cent for 15 minutes and GFR 33 ml/min. After the administration of allopurinol 600 mg a day he was struck by recurrent fever and the left great toe pain with local swelling and redness. The intravenous pyelogram showed a right renal stone. Uric acid clearance was 2.67 ml/min and the ratio of urate clearance to creatinine clearance was 10.27 per cent, which was within normal limits. In pyrazinamide suppression test the urate secretion rate and the fractional urate excretion were also within normal range, in spite of the sustained hyperuricemia and the decreased GFR. These data were quite different from those of patients with chronic renal diseases, who showed a significantly decreased value of the fractional urate excretion after pyrazinamide administration. On the other hand, the fractional urate excretion in gouty patients with a decreased GFR was almost normal, in accord with this patient's data.<BR>It is generally believed to be difficult to diff e rentiate a secondary hyperuricemia due to chronic renal failure from a primary hyperuricemia of gouty nephropathy with a decreased renal function.<BR>Some patients with psoriasis vulgaris show hyperuricemia, which is caused by an increased nucleic acid turnover resulting from the marked acceleration of epidermal proliferation.<BR>It is a question in this patient which is a primary cause of hyperuircemia and gouty attacks, a decreased urate excretion from renal dysfunction or an increased urate synthesis in psoriasis vulgaris.<BR>This patient was proven to have a renal stone and had shown asymptomatic hyperuricemia even when his blood urea N and creatinine levels had been within normal limits. From these facts the hyperuricemia of this patient is considered to result from an increased urate synthesis in longstanding psoriasis vulgaris and not from a decreased urate excretion in chronic renal failure. The results of the pyrazinamide suppression test support this possibility.<BR>We concluded that this patient was struck by gouty attacks bacause of the sustained hyperuricemia resulting from an increased urate synthesis in longstanding psoriasis vulgaris.
- Japanese Society of Gout and Nucleic Acid Metabolismの論文