Coexistence of chronic tophaceous gout and rheumatoid arthritis

The coexistence of chronic tophaceous gout and rheumatoid arthritis (RA) in the same patient is extremely rare. Only 6 cases, considered genuine, including ours, have been reported. With 1 exception, all the reported cases, including our own, were males and gout was the initial disease followed years later by the development of RA. We are proposing modified criteria for the definite diagnosis of RA and gout in the same patient to avoid the inclusion of many patients with chronic topaceous gout, who would otherwise fulfill the American Rheumatism Association criteria for RA. We stress the importance of fixation of biopsy material in formalin and alcohol to avoid diagnostic errors, since granuloma with histologic features resembling a rheumatoid nodule or rheumatoid synovitis may show the presence of crystals of monosodium urate when examined with compensated polarized light microscopy.