hyperuricemia – Journal of Clinical Orthopaedics

Abstract

Spinal gout is an uncommon form of gout that is distinguished by the deposition of monosodium urate (MSU) crystals in the spine, resulting in severe pain and potential neurological impairments. Despite its rarity, spinal gout can be difficult to diagnose because of its vague symptoms and similarities to other spinal illnesses. This study delves into the epidemiology, clinical aspects, and diagnostic problems of spinal gout, focusing on the Indian setting. Diagnostic methods such as X-ray, computed tomography (CT), and magnetic resonance imaging are investigated, with a focus on dual-energy CT for identifying MSU deposits. The treatment options vary from conservative maintenance with non-steroidal anti-inflammatory drugs and urate-lowering medication to surgical intervention in situations of neurological damage.
Keywords: Spinal gout, tophaceous gout, lumbar spine, diagnostic challenges, hyperuricemia.

References

1. Richette P, Bardin T. Gout. Lancet 2010;375:318-28.
2. Zhang W, Doherty M, Pascual E, Bardin T, Barskova V, Conaghan P, et al. EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006;65:1301-11.
3. Kuo CF, Grainge MJ, See LC, Yu KH, Luo SF, Zhang W, et al. Epidemiology and management of gout in Taiwan: A nationwide population study. Arthritis Res Ther 2015;17:13.
4. Misra DP, Sharma A, Dharmanand BG, Chandrashekara S. The epidemiology of rheumatic diseases in India. Indian J Rheumatol 2024;19:54-61.
5. Singh JA. Racial and gender disparities among patients with gout. Curr Rheumatol Rep 2013;15:307.
6. Singh JA, Reddy SG, Kundukulam J. Risk factors for gout and prevention: A systematic review of the literature. Curr Opin Rheumatol 2011;23:192-202.
7. Choi HK, Stone JH. Epidemiology of gout. In: A Clinician’s Pearls & Myths in Rheumatology. Cham: Springer International Publishing; 2023. p. 513-7.
8. Schlesinger N. Diagnosis of gout. Minerva Med 2007;98:759-67.
9. Khanna I, Pietro R, Ali Y. What has dual energy CT taught us about gout? Curr Rheumatol Rep 2021;23:71.
10. Saag KG, Choi H. Epidemiology, risk factors, and lifestyle modifications for gout. Arthritis Res Ther 2006;8 Suppl 1:S2.
11. van Durme CM, Wechalekar MD, Landewé RB, Pardo Pardo J, Cyril S, van der Heijde D, et al. Non-steroidal anti-inflammatory drugs for acute gout. Cochrane Database Syst Rev 2021;12:CD010120.
12. Nazwar TA, Bal’afif F, Wardhana DW, Panjaitan C. Understanding spinal gout: A comprehensive study of 88 cases and their clinical implications. J Craniovertebr Junction Spine 2024;15:133-40.

How to Cite this article: Kale S, Vatkar A, Dhar S, Bhor P, Phadnis A, Samant P, Mehra S. Spinal Gout: A Comprehensive Review of Clinical Features, Diagnostic Challenges, and Management Strategies in Spinal Gout. Journal of Clinical Orthopaedics July-December 2024;9(2):35-37.

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.666

Open Access License: CC BY-NC 4.0

Submitted Date: 05 Aug 2024, Review Date: 25 Aug 2024, Accepted Date: 11 Oct 2024 & Published Date: 10 Dec 2024

Author: Shivam Mehra [1], Nindiya Kapoor Mehra [1], Arvind J. Vatkar [2], Kamal Mehra [1], Bharat Veer Manchanda [3], Sachin Kale [4]

[1] Mehra Hospital and Research Institute, Lucknow, Uttar Pradesh, India,
[2] MGM Medical College, Nerul, Navi Mumbai, Maharashtra, India,
[3] Arthritis and Breast Care Centre, Kurukshetra, Haryana, India,
[4] Department of Orthopaedics, Dr D Y Patil School of Medicine, Nerul, Navi Mumbai, India

Address of Correspondence

Dr. Shivam Mehra,
Mehra Hospital and Research Institute, Lucknow – 226012, Uttar Pradesh, India.
E-mail: drshivammehra@gmail.com

Abstract

Introduction: Idiopathic retrocalcaneal pain is frequently linked to overuse injuries or inflammation around the Achilles tendon and surrounding bursae. However, systemic conditions such as gout, characterized by monosodium urate crystal deposition, can also present as retrocalcaneal pain. Gout commonly affects the first metatarsophalangeal joint, but atypical presentations like retrocalcaneal involvement are increasingly recognized. This study aims to assess the presentation, diagnosis, and treatment outcomes of gout in patients presenting with idiopathic retrocalcaneal pain.
Materials and Methods: This retrospective study analysed clinical data from 400 patients diagnosed with gout and presenting with idiopathic retrocalcaneal pain between 2019 and 2023 at a tertiary care centre. Diagnosis was based on clinical examination, serum uric acid levels, imaging, and in some cases, synovial fluid analysis. Patient demographics, diagnostic methods, and treatment outcomes, including pain (VAS) and functionality (FADI) scores, were evaluated.
Results: Of the 400 patients, 290 (72.5%) were male, and 110 (27.5%) were female, with a mean age of 56.8 ± 12.3 years. Pre-existing gout was present in 58% of patients, and serum uric acid levels were elevated in 75%. Synovial fluid analysis, performed in 65 patients, confirmed monosodium urate crystals in 92.3% of cases. Treatment resulted in significant reductions in pain (VAS: 7.8 ± 1.4 to 3.2 ± 1.1, p < 0.05) and improved functionality (FADI: 58.4 ± 5.7 to 85.7 ± 6.3). Recurrence of symptoms occurred in 25% of patients, particularly in those who did not adhere to urate-lowering therapy.
Conclusion: This study emphasizes the importance of considering gout in the differential diagnosis of idiopathic retrocalcaneal pain. Early diagnosis and appropriate management can lead to favourable outcomes and lower recurrence rates. Clinicians should remain vigilant for atypical presentations of gout to prevent prolonged discomfort and functional impairment.
Keywords: Idiopathic retrocalcaneal pain, gout, hyperuricemia, monosodium urate crystals, Achilles tendon, atypical gout, urate-lowering therapy

References

1. Duran E, Bilgin E, Ertenli Aİ, Kalyoncu U. The frequency of Achilles and plantar calcaneal spurs in gout patients. Turkish Journal of Medical Sciences. 2021;51(4):1841-8.
2. Sarkar D, Hoque TM. Association of High Serum Uric Acid with Retrocalcaneal Buristis. International Journal of Medical Science and Health Research. 2019;3(3):ISSN:2581-3366.
3. Yates B. The painful foot. Merriman’s Assessment of the Lower Limb. 3th. Ed. Edinburgh: Elsevier. 2009:469-98.
4. Aronow MS. Posterior heel pain (retrocalcaneal bursitis, insertional and noninsertional Achilles tendinopathy). Clinics in podiatric medicine and surgery. 2005;22(1):19-43
5. Pascual E, Sivera F. Time required for disappearance of urate crystals from synovial fluid after successful hypouricaemic treatment relates to the duration of gout. Annals of the rheumatic diseases. 2007 Aug 1;66(8):1056-8.
6. Sarkar¹ D, Hoque TM. Association of High Serum Uric Acid with Retrocalcaneal Buristis.

How to Cite this article: Mehra S, Mehra NK, Vatkar AJ, Mehra K, Manchanda BV, Kale S. Atypical Presentation of Gout: Idiopathic Retrocalcaneal Pain in 400 Patients. Journal of Clinical Orthopaedics July-December 2024;9(2):58-62.

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Spinal Gout: A Comprehensive Review of Clinical Features, Diagnostic Challenges, and Management Strategies in Spinal Gout

Author: Sachin Kale [1], Arvind Vatkar [2], Sanjay Dhar [1], Pramod Bhor [3], Ashish Phadnis [4], Prakash Samant [1], Shivam Mehra [5]

Abstract

References

Atypical Presentation of Gout: Idiopathic Retrocalcaneal Pain in 400 Patients

Author: Shivam Mehra [1], Nindiya Kapoor Mehra [1], Arvind J. Vatkar [2], Kamal Mehra [1], Bharat Veer Manchanda [3], Sachin Kale [4]

Abstract

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