Cases of Spinal Gout Increasing in Recent Decades

Cases of spinal gout have surged in recent decades, with a similar patient characteristic profile of those with systemic gout, according to a study published in European Spine Journal.¹ These findings may help to improve treatment outcomes, guide the management of this condition, and increase the clinical understanding of spinal gout.

Netanja I Harlianto, MD

Credit: ResearchGate

“The first presentation is usually a gout flare, presenting as an inflammatory arthritis in the lower extremities,” wrote Netanja I Harlianto, MD, associated with the Department of Orthopedic Surgery at the University Medical Center Utrecht & Utrecht University, in the Netherlands, and colleagues. “Frequent gouty depositions include the feet, ankles, and wrists, but nonarticular sites such as olecranon bursae, ears, and tendons of hands and feet may also be affected. Gouty presentation at the level of the spine, however, is a relatively uncommon location site.”

Common treatment for gout includes urate lowering therapy for patients with tophus gout with concurrent anti-inflammatory prophylaxis. However, for those with spinal gout, a condition first reported in 1950, surgical treatment may be necessary. Since its discovery, investigators have reported various cases in literature, including literature reviews.²

Investigators conducted a systematic literature search of Medline and EMBASE from inception until April 2023 to investigate all studies on spinal gout with a focus on treatment, location demographics, patient characteristics, and outcomes. Afterwards, 2 investigators performed a quality assessment regarding these areas of interest.

In total, 214 articles, comprised of 204 case reports and 10 case series, were included in the analysis, with 315 subjects with spinal gout. Case reports were defined as those with 1 or 2 patients with spinal gout, while case series included ≥3 patients with the condition. Overall, 81% were male and the mean age was 58.1 years, although most (36%) of cases were aged between 60 – 69 years.

An increase in both publications and cases from 1950 to the present were observed, with most patients from Asia (37.8%, n = 119), North America (30.5%, n = 96), Europe (n = 63), and South America (n = 22). The most commonly reported symptoms, observed in 267 patients, were back pain (75%, n = 200), radiating pain to the extremities (27.3%, n = 73), weakness in the legs (n = 58), weakness in the arms (n = 12), fever (n = 32), and sensory dysfunction (n = 31). Severe symptoms reported were incontinence (n = 12), paraplegia (n = 9), and quadriplegia (n = 5).

The area most affected was the lumbar spine. Of the treatments prescribed, 34.2% of patients received pharmacological interventions.

Approximately half (46.3%, n = 146) of patients required surgery and 4.8% had postoperative complications. Additionally, a small proportion of patients (2%, n = 3) had secondary surgery for recurrence, indicating good clinical outcome. This may be beneficial for patients with either a progression of symptoms or those who have inadequate management of their condition.

Investigators emphasized reporting bias could not be completely determined as some studies had missing outcome and population information. Additionally, systemic reviews are inherently limited by the inability to assess publication bias and incomplete validity assessments. However, they noted the current analysis reviewed and summarized the largest population of patients with spinal gout and used an expert literature search without language restrictions. Investigators also attempted to exclude bias with their selection protocol.

“Published cases of spinal gout have increased over the last decades, yet, the prevalence of spinal gout remains underestimated,” investigators concluded. “Patient characteristics of spinal gout were similar to findings in systemic gout, most commonly affecting men, at an earlier stage compared to women.”

References

1. ^{Harlianto NI, Harlianto ZN. Patient characteristics, surgical treatment, and outcomes in spinal gout: a systematic review of 315 cases [published online ahead of print, 2023 Sep 14]. Eur Spine J. 2023;10.1007/s00586-023-07942-8. doi:10.1007/s00586-023-07942-8}
2. ^{Hou LC, Hsu AR, Veeravagu A, Boakye M (2007) Spinal gout in a renal transplant patient: a case report and literature review. Surg Neurol 67:65–73}