Gout in Spial Vertebrae Mimicking Rheumatoid Arthritis

Title: Tophaceous gout causing atlanto-axial subluxation mimicking rheumatoid arthritis: A case report.
Wazir NN et al.
Publication: J Orthop Surg (Hong Kong). 2005 Aug;13(2):203-6.

The authors reported an extremely rare condition of gout found at the joints between the vertebrae of the spine, causing a dislocation at that joint that looks just like rheumatoid arthritis.

The authors highlighted a case of gouty arthritis (or also commonly known as gout) at the joint between the C1 (atlas) and C2 (axis) vertebrae of the spinal cord. This resulted in joint instability, dislocation of the joint, and impairment of nerve function (Editor's note: the exact problem is not disclosed, although it is most likely caused by pinched nerves or neural impingement). A 66-year old obese woman who had a joint disease, which affects multiple of her joints, for the previous 3 years came with neck pain and nerve function problems.

She was then treated with spinal decompression surgery and occipitocervical (back of the skull and the neck) spinal fusion.

After the initial improvement after the treatment, however, the patient developed complications, namely aspiration pneumonia or inflammation of the lungs caused by inhalation of gastric contents, and septicemia or blood poisoning caused by infection by microorganisms.

The authors concluded that since joint dislocation due to gout can be very similar to that caused by rheumatoid arthritis, doctors should keep this possibility in mind.

Editor’s note: in spinal decompression surgery, a small portion of the bone over the nerve root or disc material under the nerve is removed to relieve the pressure on the nerve and to give it more space. It is often combined with a spine fusion surgery to provide more stability to the joint where the bone has been removed.

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