Spinal involvement in gout simulating spondyloarthritis (clinical case)
https://doi.org/10.14412/1996-7012-2024-1-90-94
Abstract
The article presents a case of the lumbar spine involvement in a 37-year-old patient with gout who was observed for several years with a diagnosis of spondyloarthritis. Spinal involvement in the context of gout was confirmed by dual-energy computed tomography. This is a relatively new method for the diagnosis of microcrystalline arthritis, which makes it possible to detect urate deposits in the atypical course of the disease, especially when the axial skeleton is affected. We demonstrate the advantages of the modern gout treatment strategy of achieving and maintaining target uric acid levels by prescribing appropriate doses of xanthine oxidase inhibitors (febuxostat at a dose of 120 mg/day) while preventing arthritis flares (low-dose colchicine).
About the Authors
Y. I. Kuzmina
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
34A, Kashirskoye Shosse, Moscow, 115522
M. S. Eliseev
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
Russian Federation
34A, Kashirskoye Shosse, Moscow, 115522
References
1. Nasonova VA, Barskova VG. Early diagnostic and treatment of gout – is scientifically based reguirements for improvement of labour and living prognosis of patients. Nauchno-prakticheskaya revmatologiya. 2004;42(1):5-7. (In Russ.).
2. Eliseev MS. Algorithm for the diagnosis and treatment of gout. Russkii meditsinskii zhurnal. 2015;(7):410-4. (in Russ.).
3. Barskova VG, Mukagova MV, Severinova MV, et al. Diagnosis of gout. Sibirskii meditsinskii zhurnal (Irkutsk). 2012;112(5):132-135. (In Russ.).
4. Hasegawa EM, de Mello FM, GoldensteinSchainberg C, Fuller R. Gout in the spine. Rev Bras Reumatol. 2013 May-Jun;53(3): 296-302. doi.org/10.1590/S0482-50042013000300008
5. Eliseev MS, Mukagova MV, Smirnov AV, et al. Atypical gout: spinal tophaceous injury. Nauchno-prakticheskaya revmatologiya. 2013; (5):586–589. (In Russ.).
6. Zheng ZF, Shi HL, Xing Y, et al. Thoracic cord compression due to ligamentum flavum gouty tophus: a case report and literature review. Spinal Cord. 2015 Dec;53(12):881-6. doi:10.1038/sc.2015.93
7. Wolsko PM, Eisenberg DM, Davis RB, et al. Patterns and perceptions of care for treatment of back and neck pain: results of a national survey. Spine (Phila Pa 1976). 2003 Feb; 28(3):292–7. doi: 10.1097/01.BRS.0000042225.88095.7C.
8. Taylor W, Gladman D, Helliwell P, et al. CASPAR Study Group. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006 Aug;54(8):2665-73. doi: 10.1002/ art.21972.
9. Levshakova AV, Bochkova AG, Bunchuk NV, et al. Magnetic resonance imaging in the diagnosis of inflammatory changes of the spine in patients with ankylosing spondylitis. Meditsinskaya vizualizatsiya. 2010;(6):96-105. (In Russ.).
10. Canella C, Schau B, Ribeiro E, et al. MRI in seronegative spondyloarthritis: imaging features and differential diagnosis in the spine and sacroiliac joints. AJR Am J Roentgenol. 2013 Jan;200(1):149-57. doi: 10.2214/AJR.12.8858.
11. Yu JS, Chung C, Recht M, et al. MR imaging of tophaceous gout. Am J Roentgenol. 1997 Feb;168(2):523-7. doi: 10.2214/ajr.168.2.9016240.
12. Chen CK, Chung CB, Yeh L, et al. Carpal tunnel syndrome caused by tophaceous gout: CT and MR imaging features in 20 patients. AJR Am J Roentgenol. 2000 Sep;175(3):655-9. doi: 10.2214/ajr.175.3.1750655.
13. Chan AT, Leung JL, Sy AN, et al. Thoracic spinal gout mimicking metastasis. Hong Kong Med J. 2009 Apr;15(2):143-5.
14. Sorotskaya VN, Eliseev MS. Gout with tophus mimicking a tuumor of the thoracic spine. Nauchno-prakticheskaya revmatologiya. 2018; 56(1):113-116. (In Russ.).
15. Bonaldi VM, Duong H, Starr MR, et al. Tophaceous gout of the lumbar spine mimicking an epidural abscess: MR features. AJNR Am J Neuroradiol. 1996 Nov-Dec;17(10): 1949-52.
16. Kersley GD, Mandel L, Jeffrey MR. Gout; an unusual case with softening and subluxation of the first cervical vertebra and splenomegaly. Ann Rheum Dis. 1950 Dec;9(4): 282-304. doi: 10.1136/ard.9.4.282.
17. Koskoff YD, Morris LE, Lubic LG. Paraplegia as a complication of gout. J Am Med Assoc. 1953 May 2;152(1):37-8. doi: 10.1001/jama.1953.63690010013007h.
18. Konatalapalli RM, Lumezanu E, Jelinek JS, et al. Correlates of axial gout: a cross-sectional study. J Rheumatol. 2012 Jul;39(7):1445-9. doi: 10.3899/jrheum.111517.
19. King JC, Nicholas C. Gouty arthropathy of the lumbar spine: a case report and review of the literature. Spine (Phila Pa 1976). 1997 Oct 1;22(19):2309-12. doi: 10.1097/00007632-199710010-00023.
20. Ogdie A, Taylor WJ, Weatherall M, et al. Imaging modalities for the classification of gout: Systematic literature review and metaanalysis. Ann Rheum Dis. 2015 Oct;74(10): 1868-74. doi: 10.1136/annrheumdis-2014-205431.
21. Bongartz T, Glazebrook KN, Kavros SJ, et al. Dual-energy CT for the diagnosis of gout: An accuracy and diagnostic yield study. Ann Rheum Dis. 2015 Jun;74(6):1072-7. doi: 10.1136/annrheumdis-2013-205095.
22. Baer AN, Kurano T, Thakur UJ, et al. Dual-energy computed tomography has limited sensitivity for non-tophaceous gout: A comparison study with tophaceous gout. BMC Musculoskelet Disord. 2016 Feb;17(1): 1-9. doi: 10.1186/s12891-016-0943-9.
23. Chikina MN, Eliseev MS, Zhelyabina OV. Practical application of national clinical guidelines for the management of gout (preliminary data). Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2020;14(2):97- 103. (In Russ.). doi: 10/14412/1996-7012-2020-2-97-103.
24. Eliseev MS, Shayakhmetova RU. Experience with febuxostat in a patient with severe disabling gout. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2017;11(3):81-84. (In Russ.). doi: 10.14412/1996-7012-2017-3-81-84.
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For citations:
Kuzmina YI, Eliseev MS. Spinal involvement in gout simulating spondyloarthritis (clinical case). Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2024;18(1):90-94. (In Russ.) https://doi.org/10.14412/1996-7012-2024-1-90-94
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