One of the most common forms of inflammatory arthritis, gout, is caused by an accumulation of uric acid in between the synovium, bone, joint capsule, cartilage, and tissues. Individuals diagnosed with gout typically exhibit symptoms such as swollen and painful joints, elevated skin temperature, dysfunction of activity, and fever. Low-grade fevers, categorized between 100.4 and 102.9 degrees, are observed more frequently, though high-grade fevers (>103 degrees) are occasionally seen. The manifestation of gout with fever is similar to infective fevers, which can make the two conditions indistinguishable. While the clinical characteristics and risk factors of gout with fever are understudied, researchers compared the data of patients with and without fever, who did not have pathogenic and imaging evidence of infection and had not received antibiotic treatment.
The study, published in Biomed Research International, retrospectively analyzed the body temperature, sex, age, duration of disease, visual analog scale (VAS) scores, and the involved joints of 167 patients. The duration of gout was defined as the time between the first gout symptom and presentation to the hospital. If the patient had experienced three or more joints involved in their gout symptoms, they were classified as having polyarthritis. The authors of the study also conducted univariate logistic regression analysis to determine the influencing factors of gout with fever. Procalcitonin (PCT) levels, UA levels, white blood cell count, neutrophil proportion, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were also analyzed.
The incidence of fever in hospitalized gout patients was 31.1%. Compared with gout patients in the non-fever group, gout patients with a fever had significantly higher VAS scores, white blood cell counts, neutrophil proportion, CRP levels, and ESR. Fever patients had higher incidence rates of polyarthritis. There were no significant differences noted in age, uric acid levels, hypertension, diabetes mellitus, and cardiovascular disease between non-fever patients and fever patients. After logistic regression, polyarthritis, age ≥65 years, CRP levels, and VAS scores were found to be risk factors for concomitant gout and fever.
“Patients with acute gouty arthritis–fever have more severe pain and more intense inflammatory responses and hence require stronger anti-inflammatory and analgesic drug therapy,” the authors noted. “If systemic anti-infective therapy is ineffective in patients with unexplained fever or arthralgia without evidence of infection, they should be carefully queried regarding their past medical history, a detailed physical examination and with dual-energy CT should be performed to determine the presence of gout.”