Shujaat Hussain, Tanveer Sajid, Safi Ullah, Hadi Meeran Hussain.
A rare case of co-existent Rheumatoid Arthritis and Tophaceous Gout
Pak Armed Forces Med J Dec 2004;54(2):259-64.
Army Medical College, Rawalpindi
A 53 years old man presented with 7 day history of arthritis affecting small joints of hands, wrist, elbow, knees and feet. He was diagnosed as a case of gout 5 years back when he suffered from acute inflammatory monoarthritis involving 1st metacarpophalangeal joint, which on aspiration showed monosodium urate crystals, and was taking allopurinol intermittently. He was also diagnosed as a case of medullary sponge kidneys and underwent pyelolithotomy 8 years back. On examination, he had arthritis of joints with skin nodules over some joints. There were tophaceous deposits in the ear lobules. Excision biopsy of skin nodule were suggestive of gout tophus. Hand radiographs showed minimal erosion with minimal juxta-articular osteopenia. Foot radiograph revealed erosive changes along with medial margin of 2nd metatarsal bone. Elbow joint radiograph revealed elevation of anteriofatpad at elbow joint which indicated the intrasynovial effusion typical of rheumatoid arthritis.
Category: Case Reports
Keywords: Rheumatoid Arthritis. Tophaceous Gout. Gout. Arthritis.
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USER COMMENTS
I am a rheumatologist and am visiting this site for the first time. I dont know why he is calling it a rare case. Gout is common and anyone with gout can have RA too and i have seen quite a few cases. Other thing which i am not quite sure is that how he diagnosed RA. There is never a synovial fluid which is "typical" for RA. Was RF high, was there Anti-CCP. And what was the evidence of RA compared to gout alone.
Posted by: shakaib on Jan 2006
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