Home Tophaceous Gout and Rheumatoid Arthritis Awareness
Article Open Access

Tophaceous Gout and Rheumatoid Arthritis Awareness

  • CPT Paul J. Shogan and COL Les R. Folio
Published/Copyright: July 1, 2008
Download Article (PDF)
Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 108 Issue 7

To the Editor:

With respect to the case report by Damon L. Baker, DO, and colleagues1 in the December 2007 issue of JAOA—The Journal of the American Osteopathic Association about tophaceous gout in a patient with rheumatoid arthritis, the authors eloquently discuss the salient radiographic findings of rheumatoid arthritis. They also correctly assert that the radiographic findings of tophaceous gout are generally in contradistinction to rheumatoid arthritis.2

The hallmark radiographic findings of tophaceous gout are tophi, normal mineralization, late joint space destruction, erosions of adjacent bone, an overhanging edge of cortex, and asymmetric polyarticular distribution—most commonly affecting the first metatarsophalangeal joint.3 The concomitant radiographic finding of both gout and rheumatoid arthritis is indeed rare, though its incidence is increasing.4

Typically, men are affected more than women, with gout being the initial disease and rheumatoid arthritis developing years later.4 Interestingly, in 1976, Rappoport et al5 described 16 patients with rheumatoid arthritis who exhibited goutlike changes of well-defined marginal erosions, diaphyseal erosions, and hypertrophic bone formation.

Unfortunately, the radiographic images published in the case report by Baker et al1 demonstrate an inverted grayscale, such that the findings of rheumatoid arthritis described in the case report and figure captions are obscured. Furthermore, the radiographic images of the patient's left hand and right foot, supporting the discussion of symmetric bilateral findings, have been excluded from the case report. Thus, it is difficult for the readers to fully appreciate the radiographic change as described—underscoring the importance of correlating laboratory and histologic findings to arrive at the proper diagnosis. It is interesting to note that, on the radiographic image of the right hand, in Figure 2,1 and on the mislabeled oblique and lateral radiographic images of the left foot, in Figure 3,1 the patient does not exhibit gouty tophi and is without evidence of joint destruction.

We encourage readers to visit the Uniformed Services University of the Health Sciences' MedPix database for a radiographic education exhibit of two patients, one with tophaceous gout3 and the other with rheumatoid arthritis.6

  1. Editor's Note: The views expressed in this letter are those of the authors and do not reflect the official policy or position of the Department of the Army, the Uniformed Services University of the Health Sciences, the Department of the US Air Force, the US Department of Defense, the US government, or any of the institutional affiliations listed.

1 Baker DL, Stroup JS, Gilstrap CA. Tophaceous gout in a patient with rheumatoid arthritis [case report]. JAm Osteopath Assoc. 2007;107:554-556. Available at: http://www.jaoa.org/cgi/content/full/107/12/554. Accessed July 3, 2008.Search in Google Scholar

2 Sommer OJ, Kladosek A, Weiler V, Czembirek H, Boeck M, Stiskal M. Rheumatoid arthritis: a practical guide to state-of-the-art imaging, image interpretation, and clinical implications. Radiographics. 2005;25:381-398. Available at: http://radiographics.rsnajnls.org/cgi/content/full/25/2/381. Accessed July 3, 2008.Search in Google Scholar

3 Travis MD. Tophaceous gout. MedPix Topic ID: 6028 [database online]. Bethesda, Md: Uniformed Services University of the Health Sciences; 2004. Modified December 7, 2004. Available at: http://rad.usuhs.mil/medpix/topic_display.html?recnum=6028#top. Accessed July 3, 2008.Search in Google Scholar

4 Resnick D. Diagnosis of Bone and Joint Disorders. 4th ed. Philadelphia, Pa: WB Saunders Co;2002 : 955.Search in Google Scholar

5 Rappoport AS, Sosman JL,Weissman BN. Lesions resembling gout in patients with rheumatoid arthritis. AJR Am J Roentgenol. 1976;126:41-45. Available at: http://www.ajronline.org/cgi/reprint/126/1/41. Accessed July 3, 2008.Search in Google Scholar

6 Vangeertruyden P. Rheumatoid arthritis. MedPix Topic ID: 6816 [database online]. Bethesda, Md: Uniformed Services University of the Health Sciences; 2005. Modified November 2, 2005. Available at: http://rad.usuhs.mil/medpix/topic_display.html?recnum=6816#top. Accessed July 3, 2008.Search in Google Scholar
Published Online: 2008-07-01
Published in Print: 2008-07-01

The American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Articles in the same Issue

  1. LETTERS
  2. DOs Need to Define Value of Osteopathic Medicine
  3. AOA is Strong Advocate for Debt Relief and Primary Care
  4. THE SOMATIC CONNECTION
  5. The Somatic Connection
  6. ORIGINAL CONTRIBUTIONS
  7. Inpatient Osteopathic Structural Examinations: Is “Red Tape” Getting in the Way of Personalized Patient Care?
  8. REVIEW ARTICLES
  9. Alpha-Adrenergic Receptor Antagonists in Older Patients With Benign Prostatic Hyperplasia: Issues and Potential Complications
  10. SPECIAL COMMUNICATIONS
  11. Current Regulations and Modest Proposals Regarding Disposal of Unused Opioids and Other Controlled Substances
  12. CASE REPORTS
  13. Pulmonary Embolism Mimicking Anteroseptal Acute Myocardial Infarction
  14. LETTERS
  15. Something Wrong With This Picture
  16. Questionable Diagnosis of Hemolytic Anemia?
  17. Tophaceous Gout and Rheumatoid Arthritis Awareness
  18. Culture Drives Research Funding
  19. Living in Fast Forward
https://doi.org/10.7556/jaoa.2008.108.7.352
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. LETTERS
  2. DOs Need to Define Value of Osteopathic Medicine
  3. AOA is Strong Advocate for Debt Relief and Primary Care
  4. THE SOMATIC CONNECTION
  5. The Somatic Connection
  6. ORIGINAL CONTRIBUTIONS
  7. Inpatient Osteopathic Structural Examinations: Is “Red Tape” Getting in the Way of Personalized Patient Care?
  8. REVIEW ARTICLES
  9. Alpha-Adrenergic Receptor Antagonists in Older Patients With Benign Prostatic Hyperplasia: Issues and Potential Complications
  10. SPECIAL COMMUNICATIONS
  11. Current Regulations and Modest Proposals Regarding Disposal of Unused Opioids and Other Controlled Substances
  12. CASE REPORTS
  13. Pulmonary Embolism Mimicking Anteroseptal Acute Myocardial Infarction
  14. LETTERS
  15. Something Wrong With This Picture
  16. Questionable Diagnosis of Hemolytic Anemia?
  17. Tophaceous Gout and Rheumatoid Arthritis Awareness
  18. Culture Drives Research Funding
  19. Living in Fast Forward
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 28.9.2025 from https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2008.108.7.352/html
Scroll to top button