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Review
. 2021 Feb 15;15(1):74.
doi: 10.1186/s13256-020-02638-9.

Tophaceous gout of the atlantoaxial joint: a case report

Andrew Benjamin Romero  1   2 , Evan Paul Johnson  3 , John S Kirkpatrick  4   3
Affiliations
Review

Tophaceous gout of the atlantoaxial joint: a case report

Andrew Benjamin Romero et al. J Med Case Rep. .

Abstract

Background: To report the occurrence of tophaceous gout in the cervical spine and to review the literature on spinal gout.

Case presentation: This report details the occurrence of a large and clinically significant finding of tophaceous gout in the atlantoaxial joint of the cervical spine in an 82-year-old Caucasian man with a 40-year history of crystal-proven gout and a 3-month history of new-onset progressive myelopathy. The patient's American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria score was 15.0.

Conclusion: Spinal gout is more common than previously thought, and it should be considered in patients who present with symptoms of myelopathy. Diagnosis can be made without a tissue sample of the affected joint(s) with tools like the ACR/EULAR criteria and the use of the "diagnostic clinical rule" for determining the likelihood of gout. Early conservative management with neck immobilization and medical management can avoid the need for surgical intervention.

Keywords: Atlantoaxial joint; Cervical spine; Gout; Neck pain; Radiculopathy; Spine; Tophaceous.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Sagittal computed tomography of cervical spine revealing a large, retrodental calcific mass following the contour of the transverse ligament of atlas, causing severe spinal canal stenosis. The radiographic finding is highlighted by the arrow
Fig. 2
Fig. 2
Transverse computed tomography of atlantoaxial joint with noticeable involvement of the odontoid process of axis (a), the lateral masses of atlas (b), the tubercles of atlas (c) for the transverse ligament, and the transverse ligament itself
See this image and copyright information in PMC

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