Letter

Abstract

d e Mello FM, et al 1 reported that axial gout was not rare, and the incidence in their study of patients with gout was up to 29%. The proportion of axial gout in patients with gout would be really so high? We think that the answer might not be particularly determined.First, although several previous studies have confi rmed that computed tomography was useful in preliminary diagnosis of spinal gout, the "gold standard" remains histopathological examination. 2-5 Second, the mean age of patients enrolled in their study was 62.7 (SD = 11.1) years. And in this age group, degenerative endplate changes were not uncommon, part of which were similar to the gout-suggestive features presented by de Mello et al , 1 such as intervertebral disc abnormal bony neoformation. However, in the study by de Mello et al , axial gout was defi ned when "any" of the gout-suggestive features on the computed tomography were present in the axial skeleton. So, the standard might be "overly sensitive," and there might be some "false-positive" results. Moreover, the patients included in the study were with obvious clinical symptoms, but they concluded that axial involvement in gout was not related to clinical symptoms of the spine. How to exclude the impact of spinal degeneration on their results?In summary, we think that the true incidence of axial gout is still unclear and needs more studies with a larger sample size, a more precise assessment to investigate.

The Frequency of Axial Deposition in Korean Patients With Gout at a Tertiary Spine Center

“…Although the demonstration of MSU crystals in tissue samples is the gold standard for diagnosing gout, previous studies suggested that CT is a useful imaging modality in the initial diagnosis of axial gout ( 5 , 7 – 10 , 18 ). Hongli et al raised a question on whether the gout-suggestive features on CT are specific for axial gout or gouty arthritis, especially for abnormal bony neoformations of the facet joints and intervertebral disk ( 22 ). Thus, these abnormal bony neoformations were not considered as being a suggestive feature of axial gout in the CT in the present study.…”