Case report Arthritis in Down's syndrome

SUMMARY A 31 year old man with Down's syndrome presented with a 10 year history of an inflammatory polyarthritis resembling juvenile chronic arthritis. This case was similar to those already reported of an arthropathy associated with Down's syndrome but was eventually found to be gout. This emphasised the importance of serum uric acid estimation in patients with Down's syndrome and coexistent arthritis. Key word: gout. Musculoskeletal problems are well documented in Down's syndrome. Developmental anomalies including hypermobility are not uncommon and may lead to osteoarthritis.1 2 An arthropathy resembling juvenile chronic arthritis has been reported,3 but in the cases described treatment was not discussed and the outcome of the arthropathy was not stated. Our patient with Down's syndrome developed an arth-ropathy which was similar to those described. Case report A 31 year old man with classical Down's syndrome presented with a 10 year history of pains in large joints, particularly in the left elbow, knee, and ankle. He had also experienced some pain in the right elbow and knee. At first the arthritis came in attacks each lasting for about two weeks. One or more joints were involved and were often red, hot, and swollen. There was never any involvement of the small joints of the hands and feet. These attacks had become more frequent, and at the time of presentation he was rarely pain free. Although he had Down's syndrome, he had no other significant medical problems. A heart murmur had been noted at birth but had resolved spontaneously. Neonatal intestinal obstruction had been relieved surgically. On examination at presentation he had a painfu