Elsevier

Joint Bone Spine

Volume 80, Issue 6, December 2013, Pages 656-659
Joint Bone Spine

Case report
When gout involves the spine: Five patients including two inaugural cases

https://doi.org/10.1016/j.jbspin.2013.06.002Get rights and content

Abstract

Spinal involvement is uncommon during gout and may raise diagnostic challenges. We describe five cases seen at a single center.

Methods

We retrospectively reviewed the medical charts of the five patients with spinal gout seen over a 3-year period.

Results

There were four men and one woman with an age range of 52 to 87 years. One patient presented with acute neck pain and visualization by imaging studies of a discovertebral tophus, another had febrile arthritis of a lumbar facet joint, and a third presented with a synovial cyst in a lumbar facet joint. The remaining two patients had acute febrile discitis confirmed by magnetic resonance imaging, at the cervical spine and lumbar spine, respectively. Laboratory tests showed systemic inflammation in four patients and marked serum uric acid elevation in two patients. Only three patients reported a previous history of peripheral acute gout attacks. Specimens of the spinal lesions were obtained in three patients and consistently showed monosodium urate crystals with tissue inflammation or a tophus. The outcome was rapidly favorable, either with colchicine therapy alone in four patients or after surgical resection of a facet joint cyst (during surgery to stabilize the lumbar spine) in the remaining patient. The patient with neck pain due to a tophus experienced nerve root pain at the acute phase. No other neurological manifestations were recorded.

Conclusion

These case reports illustrate the diagnostic challenges raised by spinal involvement due to gout. The spinal lesions can be inaugural, as seen in two of our five patients.

Introduction

Gout remains a topical issue. This multifaceted disease [1], [2] continues to raise diagnostic problems [3]. Although involvement of the spine is considered rare, lesions of the disks and vertebral bodies or facet joints have been reported, as well as neurological complications related to tophi [4], [5], [6]. Here, we describe findings in five patients with spinal gout seen at a single center. In two of these patients, the spinal lesions were inaugural.

Section snippets

Methods

All five cases of spinal gout were diagnosed at a single center over a 3-year period. The diagnostic relied on EULAR criteria [3] in three patients and on converging evidence including at least a history of acute gout attacks that responded well to colchicine in the two remaining patients. We collected the following data for each patient: age, gender, medical history, co-morbidities, presenting symptoms, imaging study findings, laboratory test results, treatment, and outcome. For the three

Results

Table 1 reports the main data for the five patients. There were four men and one woman aged 51 to 87 years. Three patients had a previous history of acute gout attacks. Co-morbidities were present in all five patients and consisted of hypertension (n = 3), heart failure (n = 2), chronic kidney failure (n = 1), hypercholesterolemia (n = 1), and polychondritis (n = 1). The patients presented with inflammatory pain in the cervical (n = 2) or lumbar (n = 3) spine, with an acute onset in four of five cases. One

Discussion

Spinal involvement with gout has chiefly been described as anecdotal case reports. Our case-series of five patients illustrates various types of spinal lesions due to gout: discitis, discovertebral tophus, and facet joint deposits.

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

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