Is there any expanded diagnostic workup that you pursue for a young female patient with gout?

In 45 years of practice, and with a strong focus on gout, I can count the number of premenopausal women with gout I’ve seen (or, perhaps better stated, recognized) on one hand.

Of the last two, one had chronic renal failure due to acute kidney injury incurred secondary to an alcoholic binge a few years earlier. Her serum creatinine hovered in the 3-4 range.

The second woman was evaluated in the immediate postoperative period following intestinal bypass surgery for morbid obesity. Gout in both patients was crystal-proven.

I agree with Dr. Nandan that other causes of arthritis need to be ruled out or a definitive diagnosis of gout be made with microscopic or ultrasound criteria met.

Dr. @Dr. First Last' suggestion of possible genetic testin...

Gout is very uncommon in pre-menopausal women. Would consider other diagnoses of inflammatory arthritis, such as rheumatoid arthritis or seronegative spondyloarthropathies. That said, if suspicion for gout is still very high- you may consider checking a uric acid. A low number (<6 mg/dl), further would make gout unlikely.

I've had one patient in her 20s, and her workup demonstrated autosomal dominant tubulointerstitial kidney disease.

She really had severe, hard-to-control attacks, not subtle at all.

If truly gout, she'd need a UA with micro, renal US, and consider genetic testing in the appropriate setting.

In this situation, it is appropriate to recall that some disorders characterized by excessive cell turnover (e.g., psoriasis) can contribute to hyperuricemia, and even potentially gout. A review of gout in hemolytic hemoglobinopathies (Ballou et al., PMID 602929) included two young women with documented gout, who were found to have previously unrecognized hemoglobin SC and hemoglobin CC disorders.