Gouty Arthritis in Pediatric Patients
Yes, gouty arthritis can occur in pediatric patients, though it is rare, with a prevalence of approximately 0.007% in children aged 0-18 years. 1
Epidemiology and Risk Factors
- Gout is uncommon but documented in the pediatric population, with the highest prevalence occurring in adolescent males at 0.135%. 1
- Approximately 43.8% of pediatric patients diagnosed with gout will develop gouty arthritis, with an incidence of 0.65 flares per person-year. 1
- The most common comorbidities associated with pediatric gout are metabolic syndrome (42.8%) and kidney disease (34.8%), making these high-risk populations that warrant increased clinical suspicion. 1
Clinical Contexts Where Pediatric Gout Occurs
Renal disease is a major predisposing factor:
- Post-streptococcal acute glomerulonephritis (PSAGN) can be complicated by gouty arthritis, particularly in obese pediatric patients where renal insufficiency combined with obesity leads to hyperuricemia. 2
- Pediatric renal transplant recipients can develop gouty arthritis 7-8.5 years post-transplantation, though asymptomatic hyperuricemia is more common in this population. 3
Obesity amplifies risk:
- Mild obesity in combination with renal insufficiency may precipitate hyperuricemia and gouty arthritis in pediatric patients, as demonstrated in case reports of PSAGN-associated gout. 2
Diagnostic Considerations
Atypical presentations are common:
- A high index of suspicion is needed because atypical presentation of gout can occur in pediatric patients, particularly those with skeletal pain following renal transplantation. 3
- As serum C3 levels normalize in PSAGN, urinary uric acid excretion increases and serum uric acid decreases, which can help resolve gouty symptoms and confirm the diagnosis retrospectively. 2
Treatment Approach
Off-label medication use is occurring in clinical practice:
- Approximately 35.1% of pediatric patients diagnosed with gout or asymptomatic hyperuricemia are treated with uric acid-lowering drugs, despite these medications not being approved for pediatric indications. 1
- Allopurinol has been successfully used in pediatric renal transplant recipients with gouty arthritis, keeping patients free of gouty symptoms. 3
Critical drug interaction:
- When allopurinol is used in pediatric transplant recipients on azathioprine, the azathioprine dose must be reduced by 50% to prevent severe bone marrow depletion due to drug interaction. 3
FDA labeling limitations:
- Colchicine is not recommended for pediatric use in prophylaxis or treatment of gout flares, as safety and effectiveness have not been established in pediatric patients for this indication. 4
- Gout is explicitly noted as rare in pediatric patients in FDA drug labeling for colchicine. 4
Clinical Pitfalls
- Do not dismiss joint pain in pediatric patients with renal disease or obesity as non-gouty, as these populations are at increased risk for true gouty arthritis. 2, 1
- Do not overlook the need for dose adjustment of immunosuppressants when initiating allopurinol in pediatric transplant recipients. 3
- Recognize that the off-label use of uric acid-lowering drugs in pediatric patients may indicate an unmet therapeutic need in this population, despite lack of formal approval. 1