Polyarticular gout with recurrent flares following gastrointestinal bleed: A case report

Background: Gout is a metabolic disorder caused by urate crystal deposition in joints, leading to acute and chronic arthritis. The disease may be complicated by polyarticular involvement and recurrence, particularly in patients with comorbidities or exposure to diuretics. This case report highlights a complex presentation of gout in an elderly male with gastrointestinal bleeding and multiple relapses.Case Presentation: A 61-year-old man with a history of hypertension presented with recurrent polyarticular arthritis following treatment for a duodenal ulcer bleed. He had multiple hospital admissions with severe joint pain, initially misdiagnosed as osteoarthritis, and subsequently confirmed as gout. His management included corticosteroids, colchicine, and urate-lowering therapy. Recurrent flares occurred upon steroid withdrawal, requiring rheumatology input and immunomodulatory therapy. The patient achieved clinical improvement with a tapered corticosteroid regimen and urate-lowering prophylaxis.Result: The patient’s symptoms resolved with sustained remission following careful medication titration and discontinuation of diuretics. He regained mobility and was planned for outpatient rheumatology follow-up.Conclusion: Gout may present atypically as polyarthritis, particularly in elderly patients with comorbidities or renal impairment. Accurate diagnosis, cautious use of NSAIDs in patients with gastrointestinal risk, and gradual steroid tapering are critical for preventing recurrence.