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[Phenobarbital rheumatism associated with gouty arthritis. Case report with 18-month follow-up]
G Saviola1, L Abdi Ali, S Avanzi
1Fondazione Salvatore Maugeri I.R.C.C.S. Istituto Scientifico di Castel Goffredo, Mantova. gsaviola@fsm.it
Abstract:
Anticonvulsivant-induced rheumatism has been described in the literature mostly in relation to phenobarbital therapy. We report the case of an 85-year-old male affected by generalized seizures and treated with phenobarbital for some months, who came to our observation on account of a long-lasting arthropathy which was diagnosed as unknown gouty arthritis. After treatment however, a clinical picture of shoulder-hand syndrome persisted: this latter disappeared after substitution of phenobarbital with phenytoin. The association of a syndrome of rheumatism induced by barbiturates with gouty arthritis has not been previously described in the literature.
Insights
Phenobarbital can induce rheumatism, and this case report details a rare association with gouty arthritis in an elderly patient. Symptoms resolved after switching to phenytoin, suggesting a link between barbiturates and arthropathy.
Area of Science:
- Rheumatology
- Neurology
- Pharmacology
Background:
- Anticonvulsant-induced rheumatism is a known complication, primarily linked to phenobarbital.
- Gouty arthritis is a common form of inflammatory arthritis.
Observation:
- An 85-year-old male with generalized seizures was treated with phenobarbital.
- He presented with arthropathy initially diagnosed as gouty arthritis.
- A persistent shoulder-hand syndrome was noted during phenobarbital therapy.
Findings:
- The shoulder-hand syndrome resolved after discontinuing phenobarbital and initiating phenytoin treatment.
- This case presents a novel association between barbiturate-induced rheumatism and gouty arthritis.
Implications:
- Phenytoin may be a safer alternative for patients experiencing rheumatic side effects from phenobarbital.
- Further research is warranted to explore the mechanisms underlying anticonvulsant-induced rheumatic syndromes.
- This highlights the importance of considering drug-induced conditions in complex rheumatological presentations.
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