GOUTY-ARTHRITIS MIMICKING RHEUMATOID-ARTHRITIS

We describe the case of a 62-year-old African-American man with an all eged 30-yr history of rheumatoid arthritis (RA), who was misdiagnosed and subsequently found to have had polyarticular gout. The patient pre sented to us with acute monoarticular arthritis of the right wrist fro m which joint aspiration monosodium urate crystals were identified. Cu lture of the synovial fluid also grew methicillin sensitive Staphyloco ccus aureus causing acute septic arthritis. Our patient emphasizes the persistence of the diagnostic dilemma between RA and gout. Gouty arth ritis and rheumatoid arthritis are usually distinguishable based on cl inical and radiographic criteria, but overlapping features still prese nt a diagnostic challenge. The presence of asymmetric polyarthritis, w ithout radiologic evidence of osteopenia and/or joint space narrowing, especially in the presence of any features suggestive of gout, should favor continued investigation for a diagnosis of gouty arthritis.