title: Gout initially mimicking rheumatoid arthritis and later cervical spine involvement.
abstract: Gout is clinically characterized by episodes of monoarthritis, but if not treated properly, it can lead to a chronic polyarthritis, which may eventually mimic rheumatoid arthritis (RA). We present the case of a 59-year-old man, with a history of symmetrical polyarthritis of the large and small joints with later development of subcutaneous nodules, which was initially misdiagnosed as RA, being treated with prednisone and methotrexate for a long period of time. He complained of occipital pain and paresthesia in his left upper limb, and computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of an expansive formation in the cervical spine with compression of the medulla. He was admitted for spinal decompressive surgery and the biopsy specimen demonstrated a gouty tophus. Chronic gout can mimic RA and rarely involves the axial skeleton, and thus its correct diagnosis and the implementation of adequate therapy can halt the development of such damaging complications.
authors.affiliation: Department of Rheumatology, Santa Izabel Hospital, Praça Almeida Couto 500, 40050-410 Salvador, BA, Brazil.
authors.forename: Eduardo Araújo Santana
authors.initials: EA
authors.lastname: Nunes
authors.affiliation: Department of Neurosurgery, Santa Izabel Hospital, Praça Almeida Couto 500, 40050-410 Salvador, BA, Brazil.
authors.forename: Adroaldo Guimarães
authors.initials: AG
authors.lastname: Rosseti
authors.affiliation: Department of Radiology and Image Memorial Radiology Service, Santa Izabel Hospital, Praça Almeida Couto 500, 40050-410 Salvador, BA, Brazil ; Serviços Especializados em Reumatologia da Bahia, Rua Conde Filho 117, Graça, 40150-150 Salvador, BA, Brazil.
authors.forename: Daniel Sá
authors.initials: DS
authors.lastname: Ribeiro
authors.affiliation: Department of Rheumatology, Santa Izabel Hospital, Praça Almeida Couto 500, 40050-410 Salvador, BA, Brazil ; Serviços Especializados em Reumatologia da Bahia, Rua Conde Filho 117, Graça, 40150-150 Salvador, BA, Brazil.
authors.forename: Mittermayer
authors.initials: M
authors.lastname: Santiago