Coexistent rheumatoid arthritis and tophaceous gout: a case report.

Abstract

SUMMARY Rheumatoid arthritis and gout are both common rheumatic diseases, but their coincidence is rare. We report the case of a 67-year-old Caucasian woman with rheumatoid arthritis who later developed tophaceous gout. The tophi disappeared with remarkable rapidity on treatment with allopurinol.Case report A married woman aged 67 was first referred to our department in May 1972 with a history of pain in many of her joints with increasing morning stiffness in her hands. General examination and systemic review were normal. Both ulnar styloids were

Nonarticular gout: hyperuricemia and tophus formation without gouty arthritis

“…It has been estimated, for example, that there should be 1680 patients in the United States with coexisting gout and rheumatoid arthritis (3), yet there are only 4 previous unequivocal case reports (4-6). Tophi are occasionally reported to be present at the time of the first attack of gout (7), but interestingly, one recent report of tophi without acute gout concerned a patient who also had rheumatoid arthritis (6). The infrequency of acute gout in chronic renal failure (8), where hyperuricemia is common, is surprising; one explanation suggested is that the duration of untreated renal impairment may be insufficient for the miscible pool to reach the critical level (9).…”

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“…The presence of chronic hyperuricemia is usually a prerequisite for the occurrence of a tophus; however, occasionally a tophus occurs without a previous attack of acute gouty arthritis. This rare phenomenon has been described in patients with rheumatoid arthritis 7,8 . We were unable to find references regarding the occurrence of tophi with normal serum uric acid levels.…”

“…Tophaceous gout is commonly present on the helix or antihelix of the ear, and on the fingers, toes, hands, feet, elbows, and knees. Occasionally, the overlying skin breaks down and a thick creamy material composed of urate crystals drains 3,4,6,8 …”