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      A Case of Tophaceous Gout in the Lumbar Spine: A Review of the Literature and Treatment Recommendations

      case-report

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          Abstract

          Study Design Case report.

          Objective The objective of this study is to report the occurrence of tophaceous gout in the lumbar spine.

          Methods Using a case report to illustrate the key points of gout in the spine, we provide a brief review of gout in the literature as it relates to its orthopedic and spinal manifestations as well as guidelines for management.

          Results This case report details the occurrence of a large and clinically significant finding of tophaceous gout in the lumbar spine in a 24-year-old man with a known history of gout and a 3-year history of progressive back pain.

          Conclusion A high index of suspicion can assist in diagnosis of patients presenting with back pain or neurologic findings with a history of gout. A previous history of gout (especially the presence of tophi), hyperuricemia, and the radiological characteristics presented here should aid the clinician in making the diagnosis of spinal gout. Early diagnosis has the potential to prevent the need for surgical intervention.

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          Most cited references11

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          Clinical practice. Gout.

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            Correlates of axial gout: a cross-sectional study.

            A cross-sectional study was undertaken to determine the prevalence of axial gout in patients with established gouty arthritis and to analyze clinical, laboratory, and radiological correlations. Forty-eight subjects with a history of gouty arthritis (American College of Rheumatology criteria) for ≥ 3 years under poor control were included. Subjects underwent history, physical examination, laboratory testing, and imaging studies, including radiographs of the hands and feet and computerized tomography (CT) of the cervical and lumbar spines and sacroiliac joints (SIJ). Patients with characteristic erosions and/or tophi in the spine or SIJ were considered to have axial or spinal gout. Seventeen patients (35%) had CT evidence of spinal erosions and/or tophi, with tophi identified in 7 of the 48 subjects (15%). The spinal location of axial gout was cervical in 7 patients (15%), lumbar in 16 (94%), SIJ in 1 (6%), and more than 1 location in 14 (82%). Duration of gout, presence of back pain, and serum uric acid levels did not correlate with axial gout. Extremity radiographs characteristic of gouty arthropathy found in 21 patients (45%) were strongly correlated with CT evidence of axial gout (p < 0.001). All patients with tophi in the spine had abnormal hand or feet radiographs (p = 0.005). Axial gout may be a common feature of chronic gouty arthritis. The lack of correlation with back pain, the infrequent use of CT imaging in patients with back pain, and the lack of recognition of the problem of spinal involvement in gouty arthritis suggest that this diagnosis is often missed.
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              Gout in the axial skeleton.

              Gout typically affects the peripheral joints of the appendicular skeleton and rarely involves the axial joints. The literature on axial gout is limited to case reports and case series. This preliminary study was conducted to identify the frequency and characteristics of axial gout.
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                Author and article information

                Journal
                Evid Based Spine Care J
                Evid Based Spine Care J
                10.1055/s-00000165
                Evidence-Based Spine-Care Journal
                Georg Thieme Verlag KG (Stuttgart · New York )
                1663-7976
                1869-4136
                April 2014
                : 5
                : 1
                : 52-56
                Affiliations
                [1 ]Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, United States
                [2 ]Department of Radiology, University of Washington, Seattle, United States
                Author notes
                Address for correspondence Mithulan Jegapragasan, MD Department of Orthopaedics and Sports Medicine, University of Washington 1959 NE Pacific Street, Box 356500, Seattle, WA 98195-650United States mithulan@ 123456uw.edu
                Article
                1300029cr
                10.1055/s-0034-1366979
                3969431
                24715872
                25fd02cb-52d3-4bcd-8bd6-3888ae928d29
                © Thieme Medical Publishers
                History
                : 09 July 2013
                : 02 December 2013
                Categories
                Article

                gout,hyperuricemia,radiculopathy,lower back pain
                gout, hyperuricemia, radiculopathy, lower back pain

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