title: Tophaceous gout causing atlanto-axial subluxation mimicking rheumatoid arthritis: a case report.
abstract: This is a case report of an extremely rare condition of atlanto-axial subluxation secondary to gouty arthritis, which mimicked rheumatoid arthritis at presentation. Gouty arthritis involving the spine is a rare condition. We highlight a case of gouty arthritis involving the atlanto-axial joint resulting in joint instability, subluxation, and neurological deficit. A 66-year-old obese woman who had a polyarticular disease for the previous 3 years presented with neck pain and progressive neurology. A 2-stage procedure was performed: posterior decompression and occipitocervical fusion followed by further anterior trans-oral decompression. However, after an initial neurological improvement, she succumbed to aspirational pneumonia and septicaemia. Atlanto-axial subluxation caused by gouty arthritis can present in the same way as rheumatoid arthritis. Therefore, the possibility of this as a differential diagnosis should be kept in mind.
authors.affiliation: Department of Orthopaedic surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia. naveed@imu.edu.my
authors.forename: N N
authors.initials: NN
authors.lastname: Wazir
authors.forename: V
authors.initials: V
authors.lastname: Moorthy
authors.forename: A
authors.initials: A
authors.lastname: Amalourde
authors.forename: H H
authors.initials: HH
authors.lastname: Lim
mesh_terms: D000368:Aged; D015210:Arthritis, Gouty / Q000150:complications* / Q000175:diagnosis*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D001268:Atlanto-Axial Joint; D001707:Biopsy, Needle; D003131:Combined Modality Therapy; D019299:Decompression, Surgical / Q000379:methods; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D004204:Joint Dislocations / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D009765:Obesity / Q000503:physiopathology; D018570:Risk Assessment; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome