Mixed gout and rheumatoid arthritis of the foot

Case contributed by Mohamed Mahmoud Elthokapy
Diagnosis possible


Underlying rheumatoid arthritis. Swelling and pain in the medial aspect of the right foot for a few months. No history of trauma or fever.

Patient Data

Age: 55 years
Gender: Male

Multiple scattered erosive changes are seen involving the bones of the foot including tarsal bones, metatarsal, tarsometatarsal, and big toe articulations with overlying denudation and irregularity as well as variable subchondral degenerative sclerotic (low signal on all pulses), pseudocysts (low T1, intermediate to higher FAT SAT images) along the fore-mentioned articulations.

Rather well-defined oval-shaped subchondral/sub-cutaneous nodular/mass-like lesions eliciting low T1, heterogeneous intermediate PD signals are seen around the big toe more along dorsal and medial surfaces , likely degenerative geode /pannus formation.

Normal peri-articular musculature.

Case Discussion

A patient with known rheumatoid arthritis several years ago, but not on regular treatment presented with the appearance of multifocal erosive arthritis, however, big toe swelling with subchondral and subcutaneous nodules raised the possibility of co-existing gouty arthritis with tophus.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.