Trauma & Orthopaedics, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
Trauma & Orthopaedics, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK.
BMJ Case Rep. 2021 May 31;14(5):e236166. doi: 10.1136/bcr-2020-236166.
Gout is a common crystal-induced arthropathy affecting mainly the joints of the appendicular skeleton; however, rarely this condition affects the axial skeleton as well. Spinal gout can cause radiculopathy, cord compression, canal stenosis and discitis. We describe a case of a 71-year-old woman where the initial presentation of destructive arthropathy and spinal masses secondary to axial gout was mistaken for a metastatic malignancy. Despite chronic polyarthropathy and bilateral subcutaneous gouty tophi, spinal gout was not considered a differential diagnosis during initial assessment.The patient was managed conservatively with pharmacological treatment resulting in improvement of her upper limb radiculopathy and systemic joint pain, although little improvement in mobility. Such extensive involvement is rare and the masses can mimic an underlying metastatic disease. Careful history and clinical examination recognising polyarthropathy and subcutaneous tophi can aid the clinician to make the right diagnosis and institute correct treatment. Delay in recognising gout as a differential diagnosis can lead to marked morbidity as illustrated in our case.
痛风是一种常见的晶体诱导性关节病，主要影响四肢骨骼的关节；然而，这种情况很少也会影响到脊柱骨骼。脊柱痛风可引起神经根病、脊髓压迫、椎管狭窄和椎间盘炎。我们描述了一例 71 岁女性的病例，其初始表现为破坏性关节炎和脊柱肿块，继发于轴向痛风，误诊为转移性恶性肿瘤。尽管存在慢性多关节炎和双侧皮下痛风石，但在初始评估时并未将脊柱痛风视为鉴别诊断。患者接受了药物治疗的保守治疗，导致上肢神经根病和全身关节痛得到改善，尽管活动度改善不大。如此广泛的受累是罕见的，并且这些肿块可能类似于潜在的转移性疾病。仔细的病史和临床检查，识别多关节炎和皮下痛风石，可以帮助临床医生做出正确的诊断并采取正确的治疗。如我们的病例所示，延迟识别痛风作为鉴别诊断可能会导致明显的发病率。
