Axial Gout Frequently Missed in Chronic Gouty Arthritis

Axial gout may be a common feature of chronic gouty arthritis, but the diagnosis often is missed. Reasons include a lack of correlation with back pain, infrequent use of CT for patients with back pain, and a lack of recognition of spinal involvement in gouty arthritis.

Konatalapalli and associates studied 48 patients who had a history of gouty arthritis for 3 years or longer. Patients underwent a history; physical examination; laboratory testing; and imaging studies, including hand and foot radiography and cervical and lumbar spine and sacroiliac joint CT.

CT showed evidence of spinal erosions or tophi or both in 17 patients (35%); tophi were identified in 7 patients (15%). The spinal location of axial gout was cervical in 7 patients, lumbar in 16 patients, and in the sacroiliac joints in 1 patient; there was more than 1 location in 14 patients. The duration of gout, presence of back pain, and serum uric acid levels did not correlate with axial gout. Extremity radiographic findings characteristic of gouty arthropathy in 21 patients (45%) were strongly correlated with CT evidence of axial gout. The results of hand or feet radiographs were abnormal for all patients who had tophi in the spine.