Bilateral Gouty Arthritis Developing After Covid-19 Infection: A Case Report

Abstract

Introduction and Purpose: SARS-CoV-2 virus started in Wuhan, China in 2019 and caused the COVID-19 pandemic by affecting the whole world in a short time. Arthralgia is one of the symptoms that can be seen after Covid-19 infection and can be seen in 14.9% of the cases. However, data on rheumatic and inflammatory symptoms such as arthritis are scarce. Viral infections are known causes of acute arthralgia and arthritis. In the literature, there are many examples of reactive arthritis cases developing after Covid-19 infection. Gouty arthritis is the most common form of inflammatory arthritis. Acute gouty arthritis most often affects the first metatarsophalangeal joint in the foot. Case Presentation: A 76-year-old male patient with chronic kidney disease, hypertension, and a history of coronary artery bypass using both leg saphenous 12 years ago was admitted to the emergency service with chest pain and increasing fatigue. Since the Covid-19 PCR result was positive, he was hospitalized for further examination and treatment. On the 14th day of hospitalization, the patient complained about pain around both big toes that started suddenly at night and worsened in the morning. In the patient's history, he stated that he had completely similar complaints several times with an interval of one year in the last 3 years and he recovered spontaneously in 10-15 days. Discussion and Conclusion: Although developing gouty arthritis etiology is not clear for our patient in this case, it is thought to be a secondary condition due to the development of the disease after Covid-19 infection. It was considered that our patient has bilateral gouty arthritis triggered primarily by COVID-19. Due to the limited number of studies, more case reports should be added to the literature on this subject.

Keywords

• COVİD-19
• gout
• arthritis

References

1. Rothan H, Byrareddy S. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020 May;109:102433. doi: 10.1016/j.jaut.2020.102433.
2. Wang C, Horby P, Hayden F, Gao G. A novel coronavirus outbreak of global health concern. Lancet. 2020 Feb 15;395(10223):470-3. doi: 10.1016/S0140-6736(20)30185-9.
3. GuanWJ,NiZY,HuY,LiangWH,OuCQ,HeJX,LiuL, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708-20. doi: 10.1056/ NEJMoa2002032.
4. Parisi S, Borrelli R, Bianchi S, Fusaro E. Viral arthritis and COVID-19. Lancet Rheumatol. 2020 Nov;2(11):e655-e657. doi: 10.1016/S2665-9913(20)30348-9.
5. Saricaoglu EM, Hasanoglu I, Guner R. The first reactive arthritis case associated with COVID-19. J Med Virol. 2021 Jan;93(1):192- 3. doi: 10.1002/jmv.26296.
6. Hønge BL, Hermansen MLF, Storgaard M. Reactive arthritis after COVID-19. BMJ Case Rep. 2021 Mar 2;14(3):e241375. doi: 10.1136/bcr-2020-241375.
7. Ono K, Kishimoto M, Shimasaki T, Uchida H, Kurai D, Deshpande GA, Komagata Y, Kaname S. Reactive arthritis after COVID-19 infection. RMD Open. 2020 Aug;6(2):e001350. doi: 10.1136/rmdopen-2020-001350.
8. Shokraee K, Moradi S, Eftekhari T, Shajari R, Masoumi M. Reactive arthritis in the right hip following COVID-19 infection: a case report. Trop Dis Travel Med Vaccines. 2021 Jun 15;7(1):18. doi: 10.1186/s40794-021-00142-6.

9. Mishima E, Anzai N, Miyazaki M, Abe T. Uric acid elevation by favipiravir, an antiviral drug. Tohoku J Exp Med. 2020 Jun;251(2):87-90. doi: 10.1620/tjem.251.87.
10. Hase R, Kurata R, Ishida K, Kurita T, Muranaka E, Mito H. Acute gouty arthritis during favipiravir treatment for coronavirus disease 2019. Intern Med. 2020 Sep 15;59(18):2327-9.
11. Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJ, Lioté F, Naden RP, Nuki G, Ogdie A, Perez-Ruiz F, Saag K, Singh JA, Sundy JS, Tausche AK, Vaquez-Mellado J, Yarows SA, Taylor WJ. 2015 Gout classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2015 Oct;74(10):1789- 98. doi: 10.1136/annrheumdis-2015-208237.
12. Gaffo AL. Clinical manifestations and diagnosis of gout. UpToDate 2021. Avaliable at: https://www.uptodate.com/ contents/clinical-manifestations-and-diagnosis-of-gout/print. Accessed January, 2022.
13. Raddatz DA, Mahowald ML, Bilka PJ. Acute polyarticular gout. 1983 Apr;42(2):117-22. doi: 10.1136/ard.42.2.117.
14. Neogi T, Jansen TL, Dalbeth N, Fransen J, Schumacher HR, Berendsen D, Brown M, Choi H, Edwards NL, Janssens HJ, Lioté F, Naden RP, Nuki G, Ogdie A, Perez-Ruiz F, Saag K, Singh JA, Sundy JS, Tausche AK, Vazquez-Mellado J, Yarows SA, Taylor WJ. 2015 Gout Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheumatol. 2015 Oct;67(10):2557-68. doi: 10.1002/art.39254.