Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
A Prospective Study of Correlates of Axial Gout.
Konatalapalli4, Rukmini M., Lumezanu3, Elena, Jelinek3, James, Murphey1, Mark, Carter2, Elizabeth, Weinstein3, Arthur
Axial gout is considered to be a rare manifestation of gouty arthritis. In our earlier retrospective study we found prevalence of axial gout to be 14%. This prospective study was done to determine the prevalence of axial gout in a population of patients with established gouty arthritis and to analyze potential clinical, laboratory and radiological correlates.
Forty eight subjects with a history of gouty arthritis (ACR criteria) for 3 or more years and who had an attack of acute gouty arthritis or had hyperuricemia in the previous year, were included. Subjects were questioned about back pain, examined clinically for arthritis, joint deformities and subcutaneous tophi, and had radiographs of the hands and feet, as well as computerized tomographic (CT) scan without contrast (the preferred imaging modality to detect gouty erosive disease in the spine) of the cervical spine, lumbar spine and sacroiliac joints (SIJs), serum uric acid level and serum creatinine. CT scans were read by one of three radiologists who were blinded to results of the radiographs and the radiographs were read by an experienced rheumatologist (AW) who had no knowledge of CT scan results. Patients with characteristic erosions and/or tophi in the spine or SIJs were considered to have axial or spinal gout. For statistical analysis Fisher's exact test and Wilcoxon Two-Sample tests were used.
Seventeen patients (35%) had CT scan evidence of spinal gout-erosions and/or tophi. Tophi in the axial skeleton were identified in 7 of the 48 subjects (14.6%). In the entire studied population the mean age was 61years, mean duration of gout was over 10years in 26 (54%) and less than 10years in 22 (46%), mean serum uric acid level was 7.7mg/dl and 22 (46%) had clinical tophi. Thirty five (73%) were men and 42 (87%) were African American. No correlations were found with these variables and spinal gout nor was there any correlation with the presence of back pain which occurred in 24 (50%) patients. The location of the characteristic CT changes of axial gout was 7 (42%) cervical, 16 (94%) lumbar and 1 (6%) SIJs. Fourteen patients (82%) had axial gout in more than one location. Abnormal hands and feet radiographs were found in 21 (44%) patients and strongly correlated with CT scan evidence of axial gout (p< 0.0005). All patients with tophi in the spine had abnormal hand and/or feet radiographs (p<0.005).
Axial gout may be a common feature of gouty arthritis, at least in our predominantly African American population with poorly controlled gouty arthritis. The lack of correlation with clinical back pain, the use of magnetic resonance imaging rather than CT imaging in patients with back pain and the lack of recognition of the problem of spinal gout by physicians, suggest that this diagnosis is often missed.
To cite this abstract, please use the following information:
Konatalapalli, Rukmini M., Lumezanu, Elena, Jelinek, James, Murphey, Mark, Carter, Elizabeth, Weinstein, Arthur; A Prospective Study of Correlates of Axial Gout. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :869