Ulnar deviation of the fingers in gout simulating rheumatoid arthritis

Two cases of gout with marked ulnar deviation (UD) are reported. Both cases were previously diagnosed rheumatoid arthritis (RA) at referral, but gout was clinically suspected because of atypical features of RA, and subsequently confirmed by demonstration of monosodium urate crystals under the polarized microscope. No definitive evidence of associated RA was present in either case. Although UD in gout is distinctly rare, it is important to recognize this deformity in gout in order to avoid inappropriate therapy. Mechanical factors might have contributed to the hand deformities in both cases.