Juvenile gout: rare and aggressive

A 32-year-old male patient presented with an acute polyarticular gout attack. Gout diagnosis was made 16 years before by isolation of monosodium urate crystals in synovial liquid. He had a frequency of four to five attacks of gout per year. Acute attacks were treated with non-steroidal anti-inflammatory drugs (ibuprofen) and colchicine. He was on no long-term medications. There was no family history of gout. On examination he was hypertensive (blood pressure of 162/91 mm Hg) and his body mass index was normal, of 19 kg/m2. He had important articular deformity of both hands …