Rheumatology Advance Access originally published online on March 29, 2008
Rheumatology 2008 47(5):608; doi:10.1093/rheumatology/ken025
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Tophaceous pseudogout—an unusual cause of nodulosis in rheumatoid arthritis
Department of Rheumatology, Nottingham University Hospitals NHS Trust, City Campus, Hucknall Road, Nottingham.
Correspondence to: I. Pande, Department of Rheumatology Nottingham University Hospitals NHS Trust, Nottingham NG7, 2UH, UK. E-mail: Ira.Pande{at}nuh.nhs.uk
A 56-yr-old woman with long-standing seropositive, erosive RA developed two enlarging circumscribed whitish-yellow non-tender cystic nodules over the right ring and little finger DIP joints (Fig. 1) over a 1-yr period. These differed in appearance to the long-standing rubbery rheumatoid nodules at the right second MCP joint and both elbows. She had been intolerant to multiple DMARDs including methotrexate 7.5 mg weekly, which was taken for 2 months in 1997 but discontinued because of impaired liver function. For the preceding 4 yrs her RA was quiescent on prednisolone 5 mg daily. Purulent fluid aspirated from the little finger swelling demonstrated CPPD crystals under compensated polarized light microscopy. Radiographs revealed erosive changes throughout the wrist and hand consistent with RA, along with DIP joint OA and a soft tissue swelling on the ulnar aspect of the right little finger DIP joint.
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This is the first reported case of CPPD crystal deposition presenting as tophaceous pseudogout in RA. Since rheumatoid nodulosis is a poor prognostic factor and may prompt more aggressive treatment, recognition of tophaceous pseudogout as a potential cause of nodular swellings in RA may avoid unnecessary escalation of treatment.
Disclosure statement: The authors have declared no conflicts of interest.
Accepted 10 January 2008
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