Axial gout may be more common than it appears

The frequency of axial gout may be much higher than previously known, and it may occur in the absence of back pain. Physicians often are unaware of the potential existence of axial involvement in patients with gout, and the diagnosis may be missed even when CT scanning is obtained.

Konatalapalli and associates reviewed 630 records of patients who had peripheral gout. Of the 92 patients who had their diagnosis confirmed based on clinical findings or crystals, 64 had undergone CT of the spine.

After reviewing these scans, the investigators found evidence of axial gout in 9 patients (14%), only 1 of whom had a clinical diagnosis of this condition. Seven patients (78%) had lumbar spine involvement and 3 patients (30%) had thoracic spine involvement. No cervical spine images showed changes suggestive of gout. Facet joint erosions were the most common clue to axial gout; 6 patients had vertebral involvement at several levels, and 2 had isolated involvement of the sacroiliac joint.

The authors noted that prospective studies are needed to determine the actual prevalence of spinal gout and whether clinical and laboratory features correlate with spinal involvement.