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Q. Are my symptoms due to gout or psoriatic arthritis?

Answered by
Dr. Divya Agarwal
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Feb 09, 2021 and last reviewed on: Mar 06, 2021

Hi doctor,

I am a 27-year-old female, and I have various inflammatory and autoimmune issues, but we are looking to find a more significant issue. I have severe asthma, especially to scents (sometimes not controlled by the use of several different puffers), anaphylaxis, especially to certain pollen, tree nuts, and many fruits. I have chronic idiopathic angioedema, especially in the tongue, cheeks, right arm, right thigh, and genitals (I see an allergist every two months). I frequently end up on Prednisone starting at 30 mg, sometimes tapering for months, chronic pain and inflammation.

Recently, I had several bouts of what doctors called gout (uric acid around 412) and could not walk on foot. The big toe joint inflamed and was super red, and it also happened in the knee. I have been back and forth to a rheumatologist, and he thinks it was not gout, but is leaning toward psoriatic arthritis (both conditions are prevalent in my family). I take four extra strength Cetirizine a day, Omeprazole (or 300 mg Zantac for H2 blockers), Singulair 10 mg, four puffs Avamys, two to eight puffs Symbicort, sometimes Apo-ketorolac when joints are especially bad, sometimes Colchicine when that gout-like thing happens (Rheumatologist says I do not need to take that because he thinks psoriatic attack, but three other doctors said gout, so I am not sure), sometimes Ventolin and sometimes, Prednisone.

I am a bit of a mess, and something is always hurting either, swelling or my lungs are terrible - I really want an overall diagnosis. They were looking at lupus, but ANA (antinuclear antibody) was fine, high red blood cell count sometimes, and high uric acid in ISH (in situ hybridization) test. All doctors convinced there is a larger autoimmune issue. Do you have any contributing thoughts or things I should ask my rheumatologist next time I see him? I am desperate to get it figured out and improve my quality of life. They are looking at putting me on Plaquenil, and they think a secondary immunosuppressant will help all my conditions because it will chill out my immune system, but they are reluctant because I am young, and they want to be sure it is psoriatic arthritis first. All my problems are related to inflammation. Any advice or direction at all would be so appreciated. Thank you so much.

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Hi,

Welcome to icliniq.com.

I think your rheumatologist is right because gout is extremely rare in a person of your age and gender. Psoriatic arthritis could be the likely diagnosis. If your rheumatologist sees you during acute pain episodes, he should not have much difficulty in diagnosing you. You may need to be on drugs stronger than Plaquenil (Hydroxychloroquine Sulfate) if the diagnosis is psoriatic arthritis and you have recurrent attacks. It may also help you with your overall health and tests to check for inflammation like ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) have to be conducted.


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