Gout in the spine and sacro-iliac joints: Radiological manifestations

Abstract

It is well known that deposits of urates in soft tissues occur commonly in gout, particularly in para-articular areas and in articular cartilages of the limbs. Involvement of the spine and sacro-iliac joints by such deposits, however, has been regarded as being relatively unusual and has attracted little attention in the literature. As we were impressed by the frequency of episodes of acute back pain in our patients with gouty arthritis, established definitely on clinical and biochemical grounds, we undertook a radiological investigation of the spine and sacro-iliac joints in a series of 54 subjects. It was suspected that their episodes of pain were clinical manifestations of gout, and 12 of the group had suffered one or more attacks. Of these 12 subjects, eight were found to have radiological abnormalities. In six subjects, evidence of sacro-iliitis was demonstrated, which is comparable to the report of Resnick and Reinke [8], and in two patients vertebral lesions corresponded to those describe by Jaffe [5]. Hyperostotic spondylosis was present in no fewer than 29 of the series. Although lacking histological confirmation of the lesions demonstrated radiologically, we believe that our suspicions have been confirmed.

Spinal and sacroiliac gouty arthritis: report of a case and review of the literature

“…Radiographic analyses have shown a prevalence of sacroiliac gouty arthropathy in the range of 13–17% ( 1 , 7 ), with a recent publication showing that axial involvement in gout could be as high as 35% with CT scan evaluation ( 8 ), although a bias of patient selection could, at least in part, explain these results.…”

“…Gouty arthritis is usually monoarticular, more frequently found in men, and usually affects peripheral joints ( 1 ). Although axial involvement of gout is generally considered to be rare or unusual ( 2 – 6 ), recent publications, mostly in the rheumatologic literature, have pointed out that axial gouty arthropathy may be, in fact, much more common than initially perceived ( 6 – 9 ). With that in mind, we report an “uncommon” case of a 69-year-old woman, with spinal and sacroiliac involvement of gout, thoroughly evaluated with conventional radiography, computed tomography (CT) scan, magnetic resonance imaging (MRI), bone scintigraphy, and PET-CT.…”

A clinical picture of chronic polyarticular tophaceous gout

“…In gout, urate deposits in soft tissues (namely the so-called "tophi") are well recognized [1] and since they frequently come out after several years of gout attacks, they represent the chronic phase of the disease process [2]. Among the inflammatory arthritis group, gout is one of the most successfully treatable form but nevertheless, 5% of patients may not respond to medical management, and some of these may evolve to the tophaceous stage [3].…”

Percutaneous endoscopic treatment for cervical ligamentum flavum gouty tophus

“…Less frequently, the condition could also involve the spine, with the possible incidence of 14% to 22%. [3,4] Open surgery, usually in the form of laminectomy, seems to be the main course of treatment, particularly in patients with neurological deficits. Percutaneous endoscopic technique is routinely performed for disc herniation and spinal canal stenosis at our department.…”