Академический Документы
Профессиональный Документы
Культура Документы
discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/8367255
CITATIONS READS
14 99
6 authors, including:
Atul Gogia
Sir Ganga Ram Hospital
70 PUBLICATIONS 134 CITATIONS
SEE PROFILE
Some of the authors of this publication are also working on these related projects:
Unusual complication of prolonged indwelling urinary catheter ‑ iatrogenic hypospadias View project
All content following this page was uploaded by Atul Gogia on 02 June 2014.
Indian J Med Sci Vol. 58 No. 8, August 2004 Indian J Med Sci Vol. 58 No. 8, August 2004
CONCOMITANT GOUT AND RHEUMATOID ARTHRITIS 351 352 INDIAN JOURNAL OF MEDICAL SCIENCES
monosodium urate crystals with birefringence. and the high titer of RF (1:2560) support the started.
Patient underwent arthroscopy of the right diagnosis of RA beyond doubt. Unusual feature
knee and synovial biopsy was taken. observed in our patient was bilateral sacroilitis. REFERENCES
Ar throscopic finding revealed synovial This is an uncommon finding, seen in
1. Spector AK, Christman RA. Arthritis. Journal of
hypertrophy with gouty crystals embedded and rheumatoid arthritis.7 There is no clear data on
the America Podiatric Medical Association
spread everywhere in the joint. Synovial biopsy Sacroilitis in gout but cases showing sacroilitis
1989;79:552-8.
was compatible with gouty tophi in synovium in gout have been reported (Reference: Talbott
2. Atdjian, Fernandez-Madrid F. Coexistence of
along with rheumatoid nodule like structure JH, Altman RD, Yu TF. Gouty ar thritis chronic Tophaceous Gout and Rheumatoid
(Figure 3). Diagnosis of chronic tophaceous masquerading as Rheumatoid ar thritis. Arthritis. J Rheumatol 1981;8:989-92.
gout with rheumatoid arthritis was made and Seminars in Arthritis and Rheumatism 1978; 3. Martinez-Cordero E, Bessudo-Babani A, Perez
the patient was star ted on colchicine, Figure 3: Synovial biopsy showing gouty crystals along 8(2): 100-101. SCT, Guillermo-Grajales E. Concomitant Gout
with rheumatoid nodule like structure.
allopurinol and methotrexate. and Rheumatoid Ar thritis. J Rheumatol
We agree with Atdijian and Fernandez and 1988;15:1307-11.
DISCUSSION gradually progressive.) or vice versa. In all Rizzoli et al2,6 that diagnosis of this coexistence 4. Wallace DJ, Klinenberg JR, Morhaim D,
cases in which gout and RA were associated can be made with certainty by finding the Berlanstein B, Biren PC, Callis G. Coexistent
The co-existence of gout and RA may be no difficulty was encountered in establishing histological evidence of rheumatoid nodules Gout and Rheumatoid Arthritis. Arthritis and
supported by both clinical and laboratory the diagnosis of gout.2 Papers in the literature and monosodium urate crystal deposition. Rheumatism. 1979;22:81-6.
clearly document the presence of gout but rely 5. Talbott JH, Altman RD, Yu TF: Gout arthritis
criteria.3 Synovial biopsy from right knee in our patient
on the presence of mor ning stiffness, masquerading as rheumatoid arthritis or vice
had changes of gout and rheumatoid arthritis.
Our patient had recurrent gouty attacks symmetrical synovitis and positive RF with low versa. Semin Arthritis Rheum 1978;8:77-114.
The fixation of biopsy materials in alcohol is
or high titer for the diagnosis of RA.2 Morning 6. Rizzoli AJ, Trujeque L, Bankhurst AD. The
superimposed by rheumatoid arthritis. He had important since granulomas with histologic coexistence of gout and rheumatoid arthritis:
high serum uric acid; monosodium urate stiffness and fusiform swelling of PIP and MCP features resembling rheumatoid nodules or Case reports and a Review of Literature. Journal
deposit in subcutaneous nodules, high titer of joints, though suggestive of RA, are misleading rheumatoid synovitis may show crystals of of Rheumatology 1980;7:316-24.
RF, radiographic changes of gout and erosive since these findings can occur in polyarticular MSU when examined under contrast polarizing 7. De Carvalho A, Graudal H. Sacroiliac joint
RA and histological evidence of a rheumatoid tophaceous gout. It has been reported that light microscope.2 After a confirmed diagnosis, involvement in classical or definite rheumatoid
arthritis. These manifestations have been chronic synovitis in gout may also simulate RA treatment with Disease modifying drugs along ar thritis. Acta Radiol Diagn (Stockh)
proposed as the criteria for the coexistence of when studied by means of arthrography.2 The with hypouricemic therapy can be safely 1980;21:417-23.
both diseases.4 A literature review revealed 17 presence of lymphocytic infiltration with
patients with concomitant gout and RA.3,5 The germinal centers and the absence of crystals
difficulty of reaching a diagnosis of coexistence in the chronic synovitis support the diagnosis
of both diseases may be due to the fact that it of RA.2 and a high incidence of positive test
takes time to establish definite evidence of for RF has been reported in gout without
gout clinically as chronic tophaceous gout clinical evidence of RA. Kozin and McCarty1
mimics rheumatoid arthritis, so a clinician does found 30% of patient with chronic topahceous
not suspect the condition. RA or their gout and 10% of patients with acute gout to
concurrence. Many features of gout during the have rheumatoid factor present in low titers
evolution of the disease may mimic RA (We (<1:320). Other researchers also found positive
would like to tell that we are not talking about titers of RF, but in a smaller percentage of
Indian J Med Sci Vol. 58 No. 8, August 2004 Indian J Med Sci Vol. 58 No. 8, August 2004