1602 - Prevalence of Spinal Gout

Rukmini Bhandaru, Ravi Acharya, Rajkumari Bhagati MD, Bhagati, James S. Jelinek, Bryan Jennings, Michael Gibson, Paul J. DeMarco. Washington Hospital Center, Washington, DC
Presentation Number: 1602

INTRODUCTION: Though spinal gout is considered a rare complication; spinal gout is usually an incidental histologic finding at biopsy. The prevalence may be much higher than reported . The literature on spinal gout is limited to about 57 individual case reports. A case review to identify spinal gout is warranted.
METHODS: A retrospective medical record review of patients with gout seen at Washington Hospital Center (WHC) between the years 1998-2006 was performed. Records coded with ICD-9 codes 274.0, 274.82 and 274.9 were reviewed. Initial review included records with a synovial fluid crystal analysis documenting monosodium urate or the rheumatology consultant diagnosed gouty arthritis by radiographic review. Medical records with concomitant CT spinal imaging were included in the analysis; these were reviewed by three radiologists. Clinical parameters were reviewed.
RESULTS: A total of 630 medical records were reviewed. There were 64 patients with CT scans available for review; 67% were crystal proven while 32% were determined to have gouty arthritis by the consultant. A total of 6 CT neck/cervical, 28 CT chest/thoracic, 44 CT abdomen/lumbar, and 11 CT pelvis. Nine patients (17%) had radiographic changes suggestive of gout. None had cervical disease; 30% had thoracic disease. Lumbar disease was noted in 78%, and 22% had sacroiliac disease. Multiple vertebral levels were involved in 67%. The most common finding was lumbar spine facet joint erosions; 2 patients demonstrated lytic lesions in the sacroiliac joints. Only one gouty tophus was found. Clincal parameters are tabulated below:
VariableSpinal gout
(n of 9)
Non-spinal gout
(n of 55)
Mean age64.366.6 years
Mean Serum urate10.24 mmol/l8.49 mmol/l
Diabetes mellitus3 (30%)25 (45%)
Hypertension8 (89%)51 (92%)
Renal Insufficiency3 (30%)23 (42%)
ESRD2 (22%)9 (16%)
Diuretics5 (56%)27 (49%)
Aspirin4 (44%)22 (40%)

DISCUSSION: This is the largest case series in the literature. Record review noted only 33% of these cases were previously identified. Thoracic involvement only occurred when there was concomitant lumbar involvement. Multilevel involvement was common. Our study evaluated imaging already obtained on patients who presented with illness and significant comorbidity, and thus the prevalence may be higher than the general gout population
CONCLUSIONS: In this review of tertiary care patients, manifestations of spinal gout are more common than recognized; our study suggests a prevalence of 17%. Findings are frequently overlooked. Involvement of the lumbar facet joints with erosions is the most common manifestation. Clinical parameters did not predict spinal involvement; the number of spinal gout cases may have been too small to discern clinical characteristics. Prospective study is needed to further define this process.

 R. Bhandaru, None.