RESEARCH - Rare copresent RA and gout: comparison with pure RA and a literature review

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Clin Rheumatol. 2007 Dec 7 [Epub ahead of print]

Rare copresent rheumatoid arthritis and gout: comparison with pure

rheumatoid arthritis and a literature review.

Kuo CF, Tsai WP, Liou LB.

Division of Rheumatology, Allergy and Immunology, Chang-Gung Memorial

Hospital, No. 5, Fu-Shin Street, Kwei-san Hsiang, Tao-yuan County,

Taiwan, 333, b890121@....

Copresent rheumatoid arthritis (RA) and gout is seldom reported. This

study summarizes the findings of eight cases of copresent RA and gout

and compares them with 31 pure RA cases. Additional reported cases

were retrieved from the current literature by Medline search. Patients

with copresent RA and gout were older (p = 0.014) and predominantly

male (p < 0.01). Synovial fluid, positive for urate crystals, was

aspirated most frequently from the knee (five out of eight), followed

by the first metatarsophalangeal joint (three out of eight). Serum

creatinine and urate levels in the copresent group were significantly

higher (p < 0.01, both), and serum hemoglobin was lower (p = 0.04)

than those with pure RA. Copresent subjects had much lower percentage

of positive rheumatoid factor (RF) tests than patients with pure RA

(37.5 vs 80.6%). Only one copresent subject had both RF and

anti-cyclic citrullinated peptide antibody. Of copresent subjects, 75%

had gouty arthritis before diagnosis of RA, which is consistent with

earlier reports. Seven copresent subjects had gout attacks under

disease-modifying antirheumatic drug use. This study revealed that

polyarthritis negative for RF in a previously gouty patient may be RA

and vice versa. This combination occurs more frequently in males.

Moreover, anti-CCP antibody examination is not helpful for this

diagnosis. Therefore, physicians must obtain synovial fluid for

analysis in joints with intense swelling, especially in old RA

subjects with renal insufficiency or involvement of lower extremities.

Conversely, RA must be considered in gouty patients with polyarticular

involvement.

PMID: 18064397

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed & Cmd=ShowDetailView & TermToSear\

ch=18064397

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