Rare Association between Chronic Tophaceous Gout and Rheumatoid Arthritis in a Black African Subject: A Case Report

Rheumatoid arthritis (RA) and gout are common diseases, but their coexistence is rare. We describe the case of a 76-year-old man with hypertension who had been treated for gout for 20 years on allopurinol and colchicine. He was seen in consultation for deforming polyarthritis of the small and large joints, which had been evolving for about 2 years. The acute episode occurred 10 days earlier with the onset of bilateral and symmetrical polyarthritis affecting the large and small joints. The physical examination revealed a peripheral joint syndrome with ulnar gale force deformities of the hands and several buttonhole deformities of the fingers. In addition, there were nodules, some of which were fistulised, giving rise to a chalky slurry. The biology revealed an inflammatory syndrome in addition to rheumatoid factors and ACPA, which were elevated. Biological analysis of the nodular fluid revealed clusters of sodium urate crystals and ultrasound scans of the joints revealed a double-contour appearance in several joints. The diagnosis of RA was made using the 2010 ACR/EULAR criteria. The patient was treated as an outpatient with corticosteroids before being put on methotrexate. It is important to understand that these two conditions can occur at the same time, so it is important to consider them when treating patients with gout or RA.