Rheumatoid arthritis and gouty arthritis in an adult patient with Down's syndrome

Down’s syndrome is a chromosomal disorder caused by trisomy of chromosome 21. It presents with different phenotypes including autoimmune diseases and arthritis. The aim of this case report is to describe and document rheumatoid arthritis and gouty arthritis in patient with Down's syndrome. Here we are reporting a case of 44 year-old female with Down's syndrome who was diagnosed with epilepsy 10 months ago. She presented with a one-year history of swelling of knees, bilateral big toes and the metacrpopharyngal joints. In addition, on examination she had ulnar deviation of her hands, limited range of motion and severe tenderness of the noted joints, hair loss and scoliosis. Her serum uric acid, ESR and CRP levels were elevated and rheumatoid factor was strongly positive; however, ANA profile and anti CCP antibodies were negative. Therefore, she was diagnosed with rheumatoid arthritis and gouty arthritis. Currently she is on hydroxychoroquine, allopurinl, baclofen, methotrexate, folic acid and sodium valproate.