Axial Gout Is Frequently Associated With the Presence of Current Tophi, Although Not With Spinal Symptoms

Mello, Filipe Martins de; Helito, Paulo Victor Partezani; Bordalo-Rodrigues, Marcelo; Fuller, Ricardo; Halpern, Ari Stiel Radu

doi:10.1097/brs.0000000000000633

Cited by 36 publications

(19 citation statements)

References 20 publications

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“…Tophi are a common manifestation of gout, but spinal manifestations are considered rare. Recent research by de Mello et al[1], however, suggests that tophi in the axial skeleton may be more prevalent than first suspected.…”

Section: Discussionmentioning

confidence: 99%

“…If untreated, nodular masses of MSU crystals called tophi may eventually deposit in extraarticular locations, such as, the axial skeleton. Although traditionally thought of as a rare complication, recent study suggests that axial gout may be more prevalent than suspected[1]. Gout affecting the spinal column will typically present with neurological compromise, localized pain, and lytic vertebral lesions[2,3].…”

Section: Introductionmentioning

confidence: 99%

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Spinal gout: A review with case illustration

Elgafy¹,

Liu²,

Herron³

2016

WJO

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AIMTo summarize clinical presentations and treatment options of spinal gout in the literature from 2000 to 2014, and present theories for possible mechanism of spinal gout formation.METHODSThe authors reviewed 68 published cases of spinal gout, which were collected by searching “spinal gout” on PubMed from 2000 to 2014. The data were analyzed for clinical features, anatomical location of spinal gout, laboratory studies, imaging studies, and treatment choices.RESULTSOf the 68 patients reviewed, the most common clinical presentation was back or neck pain in 69.1% of patients. The most common laboratory study was elevated uric acid levels in 66.2% of patients. The most common diagnostic image finding was hypointense lesion of the gout tophi on the T1-weighted magnetic resonance imaging scan. The most common surgical treatment performed was a laminectomy in 51.5% and non-surgical treatment was performed in 29.4% of patients.CONCLUSIONSpinal gout most commonly present as back or neck pain with majority of reported patients with elevated uric acid. The diagnosis of spinal gout is confirmed with the presence of negatively birefringent monosodium urate crystals in tissue. Treatment for spinal gout involves medication for the reduction of uric acid level and surgery if patient symptoms failed to respond to medical treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spinal gout: A review with case illustration

Elgafy¹,

Liu²,

Herron³

2016

WJO

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“…Characteristically, gout results in arthritic pain as aggregates of monosodium urate crystals, or tophi, deposited in joints [2,4,19]. Up to approximately one-third of patients with chronic gout have tophaceous involvement of the spinal column [1,2,4,8,26], with 80% of these lesions confined to the lumbar spine, followed by the thoracic spine [1,4,8]. Bonaldi et al and Hou et al have postulated that spinal inflammation as a result of motion-related degeneration provides an ideal environment for urate crystallization and deposition in the lumbar spine [1,27].…”

Section: Discussionmentioning

confidence: 99%

Intradural Tophaceous Gout of the Cavernous Sinus and Spine: Case Report and Review of Literature

Ka¹,

Mm²,

Hm³

et al. 2015

J Neurol Disord

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IntroductionWith a worldwide incidence of 0.4% [1], gout is a prevalent metabolic disorder that results from the inappropriate metabolism of uric acid and deposition of monosodium urate crystals in tissues [2]. While gout is typically associated with an inflammatory arthritis of the peripheral joints, gouty involvement of the axial spine is a well-known and underreported source of back pain, radiculopathy, myelopathy, and even paraplegia [1][2][3][4]. Since Koskoff et al. described the first case of extradural gout causing paraplegia [5], the radiographic prevalence of axial spine gout has been estimated to be between 14% and 35% in patients with poorly controlled hyperuricemia [2,[6][7][8].Though spinal gout can involve any portion of the spine, the preponderance of lesions occur in the lumbar spine [1,2,4,7,8], and more than 80% of patients with gout may harbor multiple gouty lesions [2,4]. The clinical diagnosis of spinal gout remains a challenge because the common presenting findings such as fever, leukocytosis, and elevated systemic inflammatory markers such as sedimentation rate more commonly suggest infection [9][10][11][12]. Fortunately, characteristic findings on magnetic resonance imaging (MRI) [13,14], computed tomography (CT) [15,16], or ultrasound [17] serve as useful adjuncts for proper diagnosis of spinal gout. Successful medical and surgical management of spinal gout has been previously described in the literature [1,4,[18][19][20].Whereas tophaceous gout of the calvarium [21], infratemporal fossa [22], middle ear [22,23], and cervicomedullary junction with involvement of lower cranial nerves [24] have been reported in the past, to our knowledge, intradural tophaceous gout has not been described. We present the first case of an individual with gouty tophi involving the cavernous sinus and the intradural spinal compartment. Case PresentationA 61-year-old, African-American male with stage 1 chronic kidney disease, hypertension, and gout (uric acid levels <7.0 mg/dL maintained on allopurinol) presented to the outpatient neurosurgery clinic with headaches, diplopia, masticatory difficulty, and neuralgia along the third division of the left trigeminal nerve. On examination, he was found to have left abducens palsy, weakness of the left masseter, and trismus. MRI of the brain revealed a large lesion in the lateral wall of the left cavernous sinus and Meckel's cave as well as an incidental lipoma. The lesion appeared hypointense on T1-and T2-weighted images and demonstrated contrast enhancement. The soft tissue mass extended into the infratemporal and pterygopalatine fossae via the foramina ovale and rotundum, respectively ( Figure 1A-1C). Marked denervation atrophy of the masticator and pterygoid muscles was also noted. Follow-up MRI of the brain demonstrated further extension of the mass into the left superior orbital fissure. Surgical resection via a trans-Sylvian corridor was undertaken to prevent permanent ophthalmoplegia and blindness. Intra-operatively the cavernous sinus dura appeared thickened...

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“…Involvement of the axial skeleton by gouty tophi has been described in the literature in around 100 cases [ 4 ] and may be associated with compression of the spinal cord. However, a recently published paper revealed the presence of spinal gout, as identified by CT, in 12 out of 42 (29%) gouty patients, mainly in lumbar and none in cervical spine and there was no association between symptoms and axial gout [ 5 ]. Patients may present with a variety of symptoms, such as isolated lumbar or cervical pain or various other neurological syndromes, depending on the level of tophi deposition in the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Gout Initially Mimicking Rheumatoid Arthritis and Later Cervical Spine Involvement

Nunes

Rosseti

Ribeiro

et al. 2014

Case Reports in Rheumatology

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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.

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Axial Gout Is Frequently Associated With the Presence of Current Tophi, Although Not With Spinal Symptoms

Abstract: 3.

Cited by 36 publications

References 20 publications

Spinal gout: A review with case illustration

Spinal gout: A review with case illustration

Intradural Tophaceous Gout of the Cavernous Sinus and Spine: Case Report and Review of Literature

Gout Initially Mimicking Rheumatoid Arthritis and Later Cervical Spine Involvement

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