A Case of the Lumbar Spine Involvement and Sacroiliitis in a Patient with Gout

So-Young Bang; Jong Heon Jeong; Kyung Bin Joo; Jae-Bum Jun; Yoon-Kyoung Sung

doi:10.4078/jkra.2009.16.4.318

Journal List > J Korean Rheum Assoc > v.16(4) > 1003692

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Bang, Jeong, Joo, Jun, and Sung: A Case of the Lumbar Spine Involvement and Sacroiliitis in a Patient with Gout

Original Article

J Korean Rheum Assoc 2009;16(4):318-322.

Published online: 20 January 2009

DOI: https://doi.org/10.4078/jkra.2009.16.4.318

A Case of the Lumbar Spine Involvement and Sacroiliitis in a Patient with Gout

So-Young Bang¹, Jong Heon Jeong¹, Kyung Bin Joo², Jae-Bum Jun¹, Yoon-Kyoung Sung¹

¹Department of Rheumatology, Hospital for Rheumatic Disease, Hanyang University College of Medicine, Seoul, Korea

²Department of Radiology, Hanyang University College of Medicine, Seoul, Korea

Received 8 June 2009 Revised 18 August 2009 Accepted 21 August 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Although gout often initially affects the peripheral joints, gout may also involve the axial joints. The radiologic changes of axial gout are more common than are clinically recognized. According to a recent report, when the spine CT images of peripheral gout were reviewed for features of axial gout, there was about a 14% frequency of suspected axial gout. The vertebral level and the finding with the most common spinal gouty changes were L4 and lumbar facet joint erosions. We describe here the case of a 36-year-old gout patient with low back and right buttock pain and his lesions were unexpectedly diagnostic of lumbar facet joint arthritis and right sacroiliitis.

Keywords: Gout, Spine, Sacroiliac joint, Computed tomography, Magnetic resonance imaging

References

1. Grahame R, Scott JT. Clinical survey of 354 patients with gout. Ann Rheum Dis. 1970; 29:461–8.

2. Perkins P, Jones AC. Gout. Ann Rheum Dis. 1999; 58:611–7.

3. Schumacher HR. Crystal-induced arthritis: an overview. Am J Med. 1996; 100:S46–52.

4. 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; 9:282–304.

5. Kaye PV, Dreyer MD. Spinal gout: an unusual clinical and cytological presentation. Cytopathology. 1999; 10:411–4.

6. van den Berge M, Vrugt B, Holt C, Smit CJ, Hoogenberg K. Gout as an unusual cause of pelvic pain. Ned Tijdschr Geneeskd. 2006; 150:151–4.

7. Riddell CM, Elliott M, Cairns AP. An unusual "gouty" case of back pain and fever. J Rheumatol. 2008; 35:2076–7.

8. Mantle B, Gross P, Lopez-Ben R, Alarcon GS. Hip pain as the presenting manifestation of acute gouty sacroiliitis. J Clin Rheumatol. 2001; 7:112–4.

9. Schlesinger N, Baker DG, Schumacher HR Jr. Serum urate during bouts of acute gouty arthritis. J Rheumatol. 1997; 24:2265–6.

10. Konatalapalli RM, Demarco PJ, Jelinek JS, Murphey M, Gibson M, Jennings B, et al. Gout in the axial skeleton. J Rheumatol. 2009; 36:609–13.

11. Gerster JC, Landry M, Rappoport G, Rivier G, Du-voisin B, Schnyder P. Enthesopathy and tendinopathy in gout: computed tomographic assessment. Ann Rheum Dis. 1996; 55:921–3.

12. Gerster JC, Landry M, Rivier G. Computed tomographic imaging of subcutaneous gouty tophi. Clin Rheumatol. 1998; 17:62–4.

13. Oaks J, Quarfordt SD, Metcalfe JK. MR features of vertebral tophaceous gout. AJR Am J Roentgenol. 2006; 187:W658–9.

14. Hsu CY, Shih TT, Huang KM, Chen PQ, Sheu JJ, Li YW. Tophaceous gout of the spine: MR imaging features. Clin Radiol. 2002; 57:919–25.

15. King JC, Nicholas C. Gouty arthropathy of the lumbar spine: a case report and review of the literature. Spine. 1997; 22:2309–12.

Fig. 1.

The T1-weighted MRI shows low signal intensity on the right L5-S1 facet joint, bone, and soft tissue (A). T2-weighted MRI shows intermediate to high signal intensity on the right L5-S1 facet joint, bone, and soft tissue (B). The gadolinium enhanced T1-weighted MRI shows heterogenous enhancement of the right L5-S1 facet joint, bone, and soft tissue (C).

Fig. 2.

The CT scan shows bony erosions in the right L5-S1 facet joint on two consecutive images (A, B).

Fig. 3.

The gadolinium enhanced T1-weighted MRI shows heterogenous enhancement of the right sacrum, SI joint and ilium.

Fig. 4.

The coronal reformatted CT image of the SI joints show multiple, well-marginated erosions along the articular surfaces of the right SI joint (A, B).

TOOLS

Similar articles