Background/Purpose:

According to the current rheumatology literature, the simultaneous occurrence of rheumatoid arthritis (RA) and gout is rare and only a few cases have been reported to date (1). However, clinical practice suggests otherwise. The goal of this study was to investigate the coexistence of RA and gout in patients with known RA and identify prognostic factors that could lead to the development of gout in these patients.

Methods:

Patients who fulfilled ACR criteria for RA and had a serum uric acid (SUA) level above 6 mg/dl were included. The presence of uric acid deposits in joints was confirmed by means of a dual energy computed tomography (DECT). DECT is a new imaging tool which uses x-ray beams of two different energies to differentiate monosodium urate (MSU) deposits from connective tissues and from calcium containing structures by their absorption properties (2). The following baseline parameters were assessed: gender, age, BMI, duration of disease, DAS 28, current RA therapy, use of medications that interfere with SUA, ESR, CRP, SUA  and presence of metabolic syndrome. DECT of patients’ feet was performed.

Results:

100 patients (45 females, 55 males) were recruited. 55 patients were seropositive and 45 seronegative. Mean ± SD age was 63.05 ±11.15 years, mean ± SD duration of disease was 8.76 ± 11.15 years, mean ± SD DAS 28 was 3,28 ±1,58. DECT was positive in 16.3% of all scanned patients (9% in seropositive and 24% in seronegative patients). Regarding those, the mean ± SD SUA level was 7,82 ±2,18 mg/dl, mean ± SD age was 63.44 ± 11.71 years, and mean ±SD BMI was 28.06 ±3.45. 88% were male, 20% had a metabolic syndrome and 69% were taking medications that could elevate SUA. According to a logistic regression model analysis, the following parameters showed significance for the presence of uric acid deposits: male gender (Wald x² = 3.897, Exp B =5.678, 95% CI= 1.013 – 31.844, p=0.048) and seronegativity (Wald x²= 4.973, Exp B = 0.171, 95% CI= 0.036 – 0.807, p=0.026). Interestingly, SUA was not statistically significant.

Conclusion:

Our study showed that a considerable number of patients with a diagnosis of RA and elevated SUA level present MSU deposits in typical locations. Male gender and seronegative status are independent variables related to positive findings. Based on this study it is always necessary to think of gout as an additional diagnosis in patients with RA and hyperuricemia.

References:

1. Kuo CF, Tsai WP, Liou LB. Rare copresent rheumatoid arthritis and gout: comparison with pure rheumatoid arthritis and a literature review. Clin Rheumatol. 2008 Feb; 27(2):231-5.
2. Manger B, Lell M, Wacker J, Schett G, Rech J. Detection of periarticular urate deposits with dual energy CT in patients with acute gouty arthritis. Ann Rheum Dis. 2012 Mar;71(3):470-2.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/gout-and-ra-not-such-a-rare-coexistence-after-all/