Why is gout relatively common in organ transplant recipients?
Impaired renal function and therapy with cyclosporine or tacrolimus, which reduces urinary urate excretion, are likely the most significant factors. Polyarticular flares and early tophi development have been reported. Treatment of flares and normalization of hyperuricemia are often challenging. NSAIDs are relatively contraindicated in the setting of cyclosporine or tacrolimus therapy or renal insufficiency, and xanthine oxidase inhibitors are contraindicated with concurrent use of azathioprine / 6-MP (see Question 31). Intraarticular or systemic glucocorticoids may be the safest treatment options for flares. Synovial fluid cultures should be performed routinely. Uricosurics are often ineffective in these patients as a result of impaired renal function. Finally, colchicine is relatively contraindicated in patients taking cyclosporine or tacrolimus due to rare cases of neuromyopathy that have been reported even in patients taking low-dose colchicine for brief periods.
