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SUMMARY The infrequent occurrence of gout in patients with sickle cell anaemia contrasts with the high incidence of hyperuricaemia and impaired renal function. This report records the third case of synovial membrane uric acid deposition and the first case of tophaceous deposits in haemoglobin SS patients. The limitations of a diagnosis of gout on the basis of hyperuricaemia and arthritis are confirmed. Analysis of reported cases suggests the existence of 2 forms of arthritis associated with sickle cell anaemia-noninflammatory and inflammatory. Paradoxically, gout appears to be associated with the former, in which the pathophysiological changes probably prevent or diminish the acute inflammatory response.