Can gout cause an elevated white blood cell (WBC) count?

Can Gout Cause Elevated White Blood Cell Count?

Yes, gout can cause an elevated white blood cell count (WBC), particularly during acute gout flares due to the inflammatory response triggered by monosodium urate crystal deposition in joints. 1, 2

Inflammatory Response in Gout

• Gout is characterized by the deposition of monosodium urate crystals in joints and tissues, which triggers an intense inflammatory response 3, 4
• The inflammatory cascade in gout involves activation of the NLRP3 inflammasome and release of pro-inflammatory cytokines, particularly interleukin-1β, which leads to recruitment of inflammatory cells 3, 4
• During acute gout attacks, laboratory findings typically show leukocytosis (elevated white blood cell count) along with other markers of inflammation 1

Evidence of WBC Elevation in Gout

• Studies have demonstrated that white blood cell counts are elevated during acute gout flares as part of the acute phase response 1
• In some cases, the synovial fluid white blood cell count can be markedly elevated, with reports of counts as high as 168,500 WBC/μL and even 500,000 WBC/μL in gout patients without infection 2
• Postsurgical gout attacks have been associated with significant increases in WBC counts, particularly in patients admitted for non-inflammatory conditions 5

Clinical Significance and Differential Diagnosis

• Elevated WBC counts during gout flares can sometimes lead to diagnostic confusion with septic arthritis, which is a medical emergency requiring different management 2
• The presence of fever along with leukocytosis is common in acute gout attacks, further complicating differentiation from infection 5
• Joint aspiration with synovial fluid analysis for monosodium urate crystals remains the reference standard for diagnosing acute gout and differentiating it from other inflammatory conditions 6

Monitoring and Management Implications

• Leukocytosis typically resolves rapidly with appropriate treatment of the gout attack using anti-inflammatory medications such as colchicine, NSAIDs, or corticosteroids 1, 5
• The acute inflammatory response in gout, including elevated WBC, correlates with the number of involved joints and tends to resolve with effective treatment 1
• When evaluating a patient with suspected gout and elevated WBC, clinicians should consider both gout and infection in the differential diagnosis, particularly when synovial fluid WBC counts are extremely high 2

Pitfalls to Avoid

• Assuming that markedly elevated synovial fluid WBC counts (>50,000/μL) are always indicative of infection can lead to unnecessary surgical interventions in patients with acute gout 2
• Failure to consider gout in the differential diagnosis of a patient with fever and leukocytosis, especially in the postoperative setting, can lead to delayed diagnosis and treatment 5
• Relying solely on serum uric acid levels for diagnosis is problematic as levels may not correlate with acute attacks and can sometimes be normal during flares 5