Mixed gout and rheumatoid arthritis of the foot
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At the time the case was submitted for publication Mohamed Mahmoud Elthokapy had no financial relationships to ineligible companies to disclose.View Mohamed Mahmoud Elthokapy's current disclosures
Underlying rheumatoid arthritis. Swelling and pain in the medial aspect of the right foot for a few months. No history of trauma or fever.
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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.
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.