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Tuesday, May 5, 2009

Gout , Lyme or Both?

A middle aged man came into the office with acute pain, swelling, warmth and redness of a knee. He had no other symptoms to suggest chronic Lyme disease. Past experience, as well as all major texts indicated that that gout was the most likely culprit. The patient was treated with typical gout therapy: Indocin and Colchicine. Blood was sent to help sort out the usual suspects which may cause "acute mono-articular arthritis."

His uric acid acid level was quite high- 9.6- definitely compatible with the gout diagnosis. But the diagnosis was a bit messy. His serum Lyme WB by Labcorp showed IgG bands present at the 30 and 41 positions. And then, one week later the patient came back for a follow up visit. The gout therapy had not worked. The knee was a little better but now there was swelling of the great toe, the metatarsal phalangeal joint. This is the classic finding of gout. I aspirated the fluid. I only obtained a few CCs of blood tinged fluid. I sent the fluid for Lyme Western Blots. The results: 6 IgG bands present and 2 IgM bands present.

Now the therapy was converted to antibiotics rather than anti-inflammatory agents.
The patient could be unlucky enough to have both Lyme arthritis and gouty arthritis. The only way to confirm gout is to analyze the joint fluid for the presence of uric acid crystals. Unfortunately this test was not performed.

I could imagine that gout triggered Lyme or the other way around. This is the second case I have seen with the same presentation.


Roy Schwartz said...

You can read more about gout here:

Dr. Elix said...

Thank you for sharing this complicated situation, i have experience with gout and now with Lyme disease, i have got great improvement with both of them, but not with the same patient, so Lyme bacteria is called the great imitator and it can induce a T cells joint attack and so arthritis or induce a kidney deficiency and so rised uric acid levels. In the case of gout i recommend usually to almost every gout sufferer a special gout lotion in addition to opting for a healthy lifestyle and a low purines gout diet, this lostion brings Immediate gout pain relief and removes uric acid crystals joint deposit and so contribute significantly in improving the gout sufferer personal and professional life quality as well as to save their joints from further complications like arthritis. My patient has Lyme disease that imitate the ALS disease.
Good cheers,
Stay Safe,

unknown said...

This is a great post and thanks for sharing information about gout pain. To reduce the gout pain and to manage increased uric acid level Gout medication is effective and useful.