Ten cases of gouty arthritis are described in association with psoriasis. Eight were receiving intensive inpatient treatment for their skin condition. Diagnosis was based on clinical grounds or, in 3 cases, by compensated polarizing microscopy (CPM) of synovial fluid. All patients were male and 5 of them had conditions other than psoriasis known to predispose to hyperuricaemia. The patients appeared to fit into three groups: five had typical lower limb gout occurring in conjunction with long-standing extensive psoriasis; 3 patients had preceding features of inflammatory synovitis, one of whom subsequently developed typical distal interphalangeal involvement of peripheral psoriatic arthritis; two patients appeared to have coincident gout and psoriasis.
We believe that an association of gout with extensive long-standing psoriasis may exist particularly in male patients with an additional cause for hyperuricaemia. Long-term studies of a large population of psoriatics are required. Previous reports may have underestimated the incidence of gout because of failure to examine synovial fluid for crystals particularly from those patients with a subacute large joint arthropathy.