Rheumatoid Arthritis and Gout

Case Posted 1/21/2003

Diagnosis

Rheumatoid Nodule Co-existing with Gouty Tophus.

Discussion

This is an extremely rare association of two relatively common diseases. Upon further discussion with the patient's rheumatologist, it was noted that the patient had a history of gout with a documented elevated serum uric acid level. However, he also had an elevated serum rheumatoid factor (RF). Physical examination revealed no other stigmata of rheumatoid arthritis such as small joint swelling or a rash. Ideally, the tissue should be fixed in alcohol or a non-aqueous fixative to better preserve the water soluble uric acid crystals. Polarization revealed weakly birefringent crystals, consistent with uric acid. Polarization was negative within the necrobiotic granulomas. In addition, special stains for acid-fast bacilli and PAS for fungus were negative. In the handful of cases reported, nearly all patients have been male with the gout presenting years before the onset of the rheumatoid arthritis.

References

Gout

Rheumatoid Arthritis

Coexistent gout and rheumatoid arthritis. Case report and literature review. Wallace DJ, Klinenberg JR, Morham D, Berlanstein B, Biren PC, Callis G. Arthritis Rheum 1979 Jan;22(1):81-6.

The coexistence of gout and rheumatoid arthritis: case reports and a review of the literature. Rizzoli AJ, Trujeque L, Bankhurst AD. J Rheumatol 1980 May-Jun;7(3):316-24.

Coexistence of chronic tophaceous gout and rheumatoid arthritis. Atdjian M, Fernandez-Madrid F. J Rheumatol 1981 Nov-Dec;8(6):989-92.

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Last Updated 1/21/2003