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

J Korean Rheum Assoc. 2009 Dec;16(4):318-322. Korean.
Published online December 31, 2009.  https://doi.org/10.4078/jkra.2009.16.4.318
Copyright © 2009 The Korean Rheumatism Association
A Case of the Lumbar Spine Involvement and Sacroiliitis in a Patient with Gout
So-Young Bang,1 Jong Heon Jeong,1 Kyung Bin Joo,2 Jae-Bum Jun,1 and 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.

Corresponding author (Email: sungyk@hanyang.ac.kr )
Received June 08, 2009; Revised August 18, 2009; Accepted August 21, 2009.

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

Figures


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).
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Fig. 2
The CT scan shows bony erosions in the right L5-S1 facet joint on two consecutive images (A, B).
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Fig. 3
The gadolinium enhanced T1-weighted MRI shows heterogenous enhancement of the right sacrum, SI joint and ilium.
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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).
Click for larger image

References
1. Grahame R, Scott JT. Clinical survey of 354 patients with gout. Ann Rheum Dis 1970;29:461–468.
2. Perkins P, Jones AC. Gout. Ann Rheum Dis 1999;58:611–617.
3. Schumacher HR. Crystal-induced arthritis: an overview. Am J Med 1996;100:S46–S52.
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;10:411–414.
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;150:151–154.
7. Riddell CM, Elliott M, Cairns AP. An unusual "gouty" case of back pain and fever. J Rheumatol 2008;35:2076–2077.
8. Mantle B, Gross P, Lopez-Ben R, Alarcon GS. Hip pain as the presenting manifestation of acute gouty sacroiliitis. J Clin Rheumatol 2001;7:112–114.
9. Schlesinger N, Baker DG, Schumacher HR Jr. Serum urate during bouts of acute gouty arthritis. J Rheumatol 1997;24:2265–2266.
10. Konatalapalli RM, Demarco PJ, Jelinek JS, Murphey M, Gibson M, Jennings B, et al. Gout in the axial skeleton. J Rheumatol 2009;36:609–613.
11. Gerster JC, Landry M, Rappoport G, Rivier G, Duvoisin B, Schnyder P. Enthesopathy and tendinopathy in gout: computed tomographic assessment. Ann Rheum Dis 1996;55:921–923.
12. Gerster JC, Landry M, Rivier G. Computed tomographic imaging of subcutaneous gouty tophi. Clin Rheumatol 1998;17:62–64.
13. Oaks J, Quarfordt SD, Metcalfe JK. MR features of vertebral tophaceous gout. AJR Am J Roentgenol 2006;187:W658–W659.
14. Hsu CY, Shih TT, Huang KM, Chen PQ, Sheu JJ, Li YW. Tophaceous gout of the spine: MR imaging features. Clin Radiol 2002;57:919–925.
15. King JC, Nicholas C. Gouty arthropathy of the lumbar spine: a case report and review of the literature. Spine 1997;22:2309–2312.