PMID- 31577714 OWN - NLM STAT- MEDLINE DCOM- 20191021 LR - 20220410 IS - 1536-5964 (Electronic) IS - 0025-7974 (Print) IS - 0025-7974 (Linking) VI - 98 IP - 40 DP - 2019 Oct TI - Chlamydia-induced reactive arthritis diagnosed during gout flares: A case report and cumulative effect of inflammatory cytokines on chronic arthritis. PG - e17233 LID - 10.1097/MD.0000000000017233 [doi] LID - e17233 AB - RATIONALE: The pathology of gouty arthritis and reactive arthritis (ReA) partially overlaps, and both diseases are characterized by the production of inflammatory cytokines associated with the activation of monocytes and macrophages. However, the precise cytokine profile of cases with a coexistence of both diseases is unknown, and there are few reports on the course of treatment in patients with both gouty arthritis and ReA. PATIENT CONCERNS: A 39-year-old man with a recurrent episode of gouty arthritis presented prednisolone-resistant polyarthritis with high level of C-reactive protein (CRP). He had the features of gouty arthritis such as active synovitis of the first manifestation of metatarsophalangeal (MTP) joints and the presence of monosodium urate (MSU) crystals from synovial fluid. But he also had the features of ReA such as the presence of tenosynovitis in the upper limb, the positivity of human leukocyte antigen (HLA)-B27, a history of sexual contact and positive findings of anti-Chlamydia trachomatis-specific IgA and IgG serum antibodies. DIAGNOSES: He was diagnosed with HLA-B27 associated Chlamydia-induced ReA accompanied by gout flares. INTERVENTIONS: He was treated with 180 mg/day of loxoprofen, 1 mg/day of colchicine, and 10 mg/day of prednisolone for gout flares. However, his polyarthritis worsened with an increased level of CRP (23.16 mg/dL). Accordingly, we added 500 mg/day of salazosulfapyridine followed by adalimumab (ADA) 40 mg once every 2 weeks. OUTCOMES: After starting ADA, the patient's symptoms and laboratory findings showed rapid improvement and he achieved clinical remission 1 month after initiation of ADA treatment. As of this writing, the patient's clinical remission has been maintained for >1 year. LESSONS: This case suggests that with exacerbation of arthritis during gouty arthritis, coexistence with other pathologies such as peripheral spondyloarthritis should be considered, and early intensive treatment including tumor necrosis factor inhibitors may be necessary. FAU - Sumiyoshi, Remi AU - Sumiyoshi R AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. FAU - Koga, Tomohiro AU - Koga T AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. AD - Center for Bioinformatics and Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences. FAU - Tsuji, Sosuke AU - Tsuji S AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. FAU - Endo, Yushiro AU - Endo Y AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. FAU - Takatani, Ayuko AU - Takatani A AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. FAU - Shimizu, Toshimasa AU - Shimizu T AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. FAU - Igawa, Takashi AU - Igawa T AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. FAU - Umeda, Masataka AU - Umeda M AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. AD - Medical Education Development Center, Nagasaki University Hospital. FAU - Fukui, Shoichi AU - Fukui S AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. FAU - Nishino, Ayako AU - Nishino A AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. AD - Center for Comprehensive Community Care Education. FAU - Kawashiri, Shin-Ya AU - Kawashiri SY AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. AD - Department of Community Medicine, Unit of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. FAU - Iwamoto, Naoki AU - Iwamoto N AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. FAU - Ichinose, Kunihiro AU - Ichinose K AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. FAU - Tamai, Mami AU - Tamai M AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. FAU - Nakamura, Hideki AU - Nakamura H AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. FAU - Origuchi, Tomoki AU - Origuchi T AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. FAU - Kawakami, Atsushi AU - Kawakami A AD - Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology. LA - eng PT - Case Reports PT - Journal Article PL - United States TA - Medicine (Baltimore) JT - Medicine JID - 2985248R RN - 0 (Cytokines) RN - 0 (Inflammation Mediators) RN - 0 (PHB2 protein, human) RN - 0 (Prohibitins) RN - 0 (Tumor Necrosis Factor-alpha) RN - 9007-41-4 (C-Reactive Protein) SB - IM MH - Adult MH - Arthritis, Reactive/drug therapy/*etiology MH - C-Reactive Protein/analysis MH - Chlamydia Infections/*complications/drug therapy MH - Chlamydia trachomatis MH - Cytokines/metabolism MH - Gout/*complications/drug therapy MH - Humans MH - Inflammation Mediators/metabolism MH - Male MH - Prohibitins MH - Tumor Necrosis Factor-alpha/antagonists & inhibitors PMC - PMC6783181 COIS- The authors have no conflicts of interest to disclose. EDAT- 2019/10/03 06:00 MHDA- 2019/10/23 06:00 PMCR- 2019/10/04 CRDT- 2019/10/03 06:00 PHST- 2019/10/03 06:00 [entrez] PHST- 2019/10/03 06:00 [pubmed] PHST- 2019/10/23 06:00 [medline] PHST- 2019/10/04 00:00 [pmc-release] AID - 00005792-201910040-00020 [pii] AID - MD-D-19-01022 [pii] AID - 10.1097/MD.0000000000017233 [doi] PST - ppublish SO - Medicine (Baltimore). 2019 Oct;98(40):e17233. doi: 10.1097/MD.0000000000017233.