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

Wendling, Daniel; Prati, Clément; Hoën, Bruno; Godard, J.; Vidon, Claire; Godfrin-Valnet, Marie; Guillot, Xavier

doi:10.1016/j.jbspin.2013.06.002

Cited by 34 publications

(21 citation statements)

References 25 publications

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“…In addition, there have been recent reports of unusual sites or presentations of tophaceous disease. This includes atypical musculoskeletal presentations causing spinal cord or nerve root compression [16][17][18] or involving the tarsal tunnel [19], the patellar tendon [20,21], the second metacarpal [22] and the os trigonum [23]. Additionally, non-skeletal presentations may rarely occur, including in the bronchus, causing airways obstruction [24], the mitral valve [25], the liver [26] and the breast [27].…”

Section: Clinical Presentation Of Tophaceous Goutmentioning

confidence: 99%

The Gouty Tophus: a Review

2015

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The tophus is the cardinal feature of advanced gout. This review summarises recent research into the biology, impact and treatment of tophaceous gout. Microscopically, tophi are chronic foreign body granuloma-like structures containing collections of monosodium urate (MSU) crystals surrounded by inflammatory cells and connective tissue. Extracellular trap formation mediated by neutrophil interactions with MSU crystals may be a central checkpoint in tophus formation. Gouty tophi impact on many aspects of health-related quality of life. Tophi are also implicated in the development of structural joint damage and increased mortality risk in people with gout. Effective treatment of tophaceous gout requires long-term urate-lowering therapy, ideally to achieve a serum urate concentration of <5 mg/dL (300 μmol/L). Recent advances in gout therapeutics have expanded urate-lowering therapy options for patients with severe tophaceous disease to allow faster regression of tophi, improved health-related quality of life and, potentially, improved structural outcomes.

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Section: Clinical Presentation Of Tophaceous Goutmentioning

confidence: 99%

The Gouty Tophus: a Review

2015

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“…8 Although MRI and computed tomography (CT) fi ndings have been useful in preliminary diagnosis of spinal gout, the gold standard remains histopathological examination where urate crystals can be demonstrated under polarized light. [8][9][10] Proper specimen collection avoiding formalin also needs highlighting in order not to miss the microscopic evidence of gout, as in our case. Once the diagnosis is reached, spinal gout can be controlled medically with the use of nonsteroidal anti-infl ammatory drugs (NSAIDs), allopurinol and colchicine, which have been shown to be effective in controlling symptoms as an alternative to defi nite surgical treatment.…”

Section: Discussionmentioning

confidence: 95%

“…Spinal involvement is relatively uncommon, although the frequency of axial involvement has been suggested to be as high as 14-35%. [5][6][7]9 The majority of these patients develop gout in the lumbar region, 6,7 and it can affect any part of the vertebral body, including the epidural space, ligamentum fl avum, pedicle or facet joint. 8 Some patients are asymptomatic; otherwise, presenting symptoms range from simple back pain to myelopathy and radiculopathy, which is the most common symptom, occurring up to 34.5% of cases (including this one).…”

Section: Discussionmentioning

confidence: 99%

“…Once the diagnosis is reached, spinal gout can be controlled medically with the use of nonsteroidal anti-infl ammatory drugs (NSAIDs), allopurinol and colchicine, which have been shown to be effective in controlling symptoms as an alternative to defi nite surgical treatment. [7][8][9] In summary, spinal gout can result in a varied clinical presentation and it should be considered in all patients with a known history of gout and presenting with new onset back pain or neurological compromise. 5,7,8,10 ■ …”

Section: Discussionmentioning

confidence: 99%

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Tophaceous gouty arthropathy of the lumbar spine

Saripalli¹,

Baskar

2014

Clinical Medicine

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Lesson of the month 1: Tophaceous gouty arthropathy of the lumbar spine Gout, classically affecting the fi rst metatarsal joints, knees, fi ngers and ears, is seldom thrown out as a differential when a patient complains of lower back pain. Symptoms presented by patients with spinal gout may be non-specifi c and varied; at times, the only clue being that the patient has a previous history of gout. Prompt treatment with anti-infl ammatory medication once diagnosis is reached helps to alleviate pain and improves the prognosis of the disease. Therefore, it is vital for the treating physician to keep an open mind and consider spinal gout as a diagnosis once other sinister causes such as osteomyelitis have been ruled out. This greatly reduces the morbidity associated with late treatment of spinal gout.

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“…[2][3][4][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.…”

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confidence: 99%

Letter

Wang

Jiang

2015

Spine

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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.

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

Cited by 34 publications

References 25 publications

The Gouty Tophus: a Review

The Gouty Tophus: a Review

Tophaceous gouty arthropathy of the lumbar spine

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