Unusual Clinical Presentations of Gout

Tony C. Ning; Robert T. Keenan


Curr Opin Rheumatol. 2010;22(2):181 

In This Article

Axial Gout

As previously discussed, gout usually presents in the peripheral joints. Axial gouty arthropathy can occur, mimicking spinal metastases, spinal stenosis, and infection.[37–39] Patients can present with back pain, neck pain, radicular pain, or even paraplegia. Axial gout involvement may also present in patients with organ transplants.[40] A recent report and review of the literature of axial gouty arthropathy found the most commonly involved site is the lumbar spine, followed by the sacroiliac joints.[41•] There have been an increasing number of reported cases of axial gout involving the cervical spine (Fig. 1). One report described a 66-year-old woman who presented with progressive neck pain and weakness.[42] Imaging was performed and a soft-tissue lesion was noted at the atlanto-axial joint, suspicious of rheumatoid arthritis. Subluxation was also noted at this joint, as was an erosion of the odontoid peg. The patient was taken to surgery and the histological findings were consistent with gout.


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