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Query: UMLS:C0018099 (gout)
 5,192 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gout, like diabetes mellitus, is a common metabolic disorder. Typically affecting the distal joint of the appendicular skeleton, its occurrence in the spine is rare. We report the case of a 68-year-old male with a long history of diabetes mellitus and hyperuricemic gout. Neck pain developed over two weeks with subsequent quadriparesis, with concomitant subcutaneous deposition of gouty tophi in the right elbow. Magnetic resonance image of the cervical spine revealed multiple segmental narrowing of the thecal sac at the C3-6 levels due to hypertrophic spurs and bulging discs. Anterior discectomies of C3-4 and C4-5 were performed, with a chalky-white, granular material noted in the C4-5 disc space. Histological examination of the surgical specimen revealed deposits of needle-like crystals surrounded by histiocytes and multinucleated giant cells, with the appearance compatible with gout. The patient was ambulatory with the assistance of a walking frame six months after the operation. We emphasize that gouty tophi can be deposited in the spine over a relatively short time, subsequently precipitating a variety of symptoms, from pain to cord compression. The regular administration of antihyperuricemia drug treatment for hyperuricemic gout is necessary to prevent this deposition. If neurological defects are found, surgical decompression can provide satisfactory results.
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PMID:Cervical myelopathy due to gouty tophi in the intervertebral disc space. 1186 23

Anterior Cervical Hypertrophic Osteophytosis (ACHO) is a clinical entity caused by degenerative changes of the cervical spine. ACHO may also be found in Diffuse Idiopathic Skeletal Hyperostosis (DISH)1-3, Ankylosing Spondylitis and Post-traumatic Osteophytogenesis. In a minority of cases it may lead to oesophagical manifestations and less commonly, to respiratory complaints. The authors report the case of a 75-year-old male with a personal history of chronic tophaceous gout and chronic obstructive lung disease. The patient presented with a history of progressive worsening of dyspnoea and dysphagia (for solid food) as well as foreign body sensation at the cervical level. On general examination, the patient presented with slightly diminished breath sounds and an increased expiratory time. On rheumatologic examination, the patient had moderate limitation of all cervical movements, crepitating knees and multiple gout tophi in both hands. Cervical plain radiographs showed large anterior osteophytes at the level of C4 and C5. Flexible videobronchoscopy was also performed, showing an angle of distortion in the upper third of the tracheal wall, caused by extrinsic compression. These changes were confirmed by cervical CT scan which also documented an anterior sliding of the oesophagus due to large anterior cervical osteophytes. Videofluoroscopic swallow study revealed the presence of paradoxal contraction of the cricopharyngeal muscle. The patient was treated with a non-steroidal anti-inflammatory drug (NSAID) and a skeletal muscle relaxant. Dysphagia improved but not the respiratory symptoms. Although there was indication for surgical removal of the hypertrophic osteophytes, the patient refused surgery and continues to be followed-up regularly at our outpatient clinic.
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PMID:[Tracheal stenosis by extrinsic compression: a case of anterior cervical hypertrophic osteophytosis]. 2097 45

Tophaceous gout has classically been described as an affliction of the extremities. It has however been reported as early as 1947 to involve the spinal column. We report a 63-year-old male, previously scheduled for Anterior Cervical Discectomy and Fusion to correct an existing cervical myelopathy at the C3-C4 spinal level, who presented to the emergency room with progressive weakness of the lower extremities and inability to ambulate for three days. Physical examination suggested a possible worsening of his cervical myelopathy but magnetic resonance imaging (MRI) findings remained unchanged from comparison studies. On the day of surgery, he became febrile and complained of excruciating back pain and we therefore initiated an infectious etiology workup and obtained a lumbar spine MRI. Results of imaging suggested a lumbar epidural abscess with effacement of the thecal sac. Emergent L4-L5 decompression led to an evacuation of a "chalky" substance, which was sent for pathology evaluation. This patient was diagnosed with tophaceous gout of the lumbar spine upon final pathological review. We aim to present the management of this case and review the literature associated with this diagnosis with the goal of improving the approach taken to diagnose and treat this pathology.
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PMID:Tophaceous Gout of the Lumbar Spine: Case Report and Review of the Literature. 2661 49