Kim Hoe Chan,* Murugasu Segasothy†
* Medical Registrar, † Associate Professor of Medicine, NT Clinical School of Medicine of Flinders University, Alice Springs Hospital, PO Box 2234, Alice Springs, NT 0871 m.segasothyATnt.gov.au
To the Editor: A recent review suggests that acute rheumatic fever, osteoarthritis and systemic lupus erythematosus account for most rheumatic disease in Australian Aboriginals, and comments on the rarity of gout.1 Although the increased prevalence of hyperuricaemia in Aboriginals compared with non-Aboriginals has been described,2 clinical attacks of gout in Aboriginals have so far been extremely rare.1,3 This is in sharp contrast to various Polynesian and other indigenous populations, including Mäori in New Zealand, Filipinos in Hawaii and Alaska, Chamorros and Carolinians in the Marianas Islands, and Taiwanese aborigines. In these populations, increased prevalences of both hyperuricaemia and gout have been documented.4,5
In an extensive literature search, we found only one report of confirmed acute gouty arthritis in an Australian Aboriginal with normal renal function,3 although there have been several Aboriginals in the “Top End” with crystal-confirmed gout in association with chronic renal impairment.1
Between January 2001 and April 2004, we identified seven new cases of acute gouty arthritis in Aboriginals (Box), confirmed by joint aspiration revealing monosodium urate monohydrate crystals. Three of these patients had confirmed acute gouty arthritis without renal impairment. This series also includes the first reported cases of gouty arthritis in Aboriginal women.
Our findings suggest that the prevalence of acute gouty arthritis in Australian Aboriginals is much higher than previously reported. Discussion with physicians at Alice Springs Hospital revealed that they too have encountered gouty arthritis in Aboriginals, but whether this was confirmed by joint aspiration is not known. It appears that gout has been misdiagnosed or under-reported, or both. Further epidemiological studies should be undertaken to confirm this hypothesis, and we must have a higher index of suspicion for gout when an Aboriginal patient presents with an arthropathy, as gout is a potentially disabling and yet easily treatable condition.
Aboriginals with acute gouty arthritis, Alice Springs Hospital, January 2001 – April 2004
Age (years) |
Sex |
UA level (mmol/L) |
Site of joint aspiration |
Possible precipitating factors |
Joints involved |
||||||||||
46 |
M |
0.37 |
Right knee |
Alcohol |
Right knee |
||||||||||
44 |
M |
0.45 |
Right knee |
Acute renal failure, alcohol |
Right knee, left first metatarsophalangeal joint, left ankle |
||||||||||
65 |
M |
0.23 |
Right knee |
Renal transplant, cyclosporin |
Right knee, right foot |
||||||||||
64 |
F |
0.50 |
Right knee |
Chronic renal impairment |
Both ankles and first metatarsophalangeal joints, right knee |
||||||||||
61 |
F |
N/A |
Right knee |
Acute-on-chronic renal failure, alcoholism |
Right knee |
||||||||||
51 |
M |
0.48 |
Left knee |
None identified |
Left knee |
||||||||||
35 |
M |
0.54 |
Right knee |
None identified |
Both ankles, right knee |
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UA = uric acid. Reference range, 0.20–0.45 mmol/L. N/A = not available. |
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- Kim Hoe Chan
- Murugasu Segasothy
- NT Clinical School of Medicine of Flinders University, Alice Springs Hospital, PO Box 2234, Alice Springs, NT 0871
- 1. Roberts-Thomson RA, Roberts-Thomson PJ. Rheumatic disease and the Australian Aborigine. Ann Rheum Dis 1999; 58: 266-270.
- 2. Emmerson BT, Douglas W, Doherty RL, Feigl P. Serum urate concentrations in the Australian Aboriginal. Ann Rheum Dis 1969; 28: 150-155.
- 3. Chin G, Segasothy M. Gouty arthritis in Australian Aborigines. Aust N Z J Med 2000; 30: 639-640.
- 4. Prior IAM, Rose BS, Harvey HPB, Davidson F. Hyperuricaemia, gout and diabetic abnormality in Polynesian people. Lancet 1966; 1: 333-338.
- 5. Chou CT, Lai JS. The epidemiology of hyperuricaemia and gout in Taiwan Aborigines. Br J Rheumatology 1998; 37: 258-262.