Gouty arthritis mimicking rheumatoid arthritis

We describe the case of a 62-year-old African-American man with an alleged 30-yr history of rheumatoid arthritis (RA), who was misdiagnosed and subsequently found to have had polyarticular gout. The patient presented to us with acute monoarticular arthritis of the right wrist from which joint aspiration monosodium urate crystals were identified. Culture of the synovial fluid also grew methicillin sensitive Staphylococcus aureus causing acute septic arthritis. Our patient emphasizes the persistence of the diagnostic dilemma between RA and gout. Gouty arthritis and rheumatoid arthritis are usually distinguishable based on clinical and radiographic criteria, but overlapping features still present a diagnostic challenge. The presence of asymmetric polyarthritis, without 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.