title: Gout in the axial skeleton.
abstract: OBJECTIVE
  Gout typically affects the peripheral joints of the appendicular skeleton and rarely involves the axial joints. The literature on axial gout is limited to case reports and case series. This preliminary study was conducted to identify the frequency and characteristics of axial gout.
  
  
  METHODS
  Six hundred thirty medical records with ICD codes 274.0, 274.82, and 274.9 for peripheral gout were reviewed. Ninety-two patients had clinical or crystal-proven gout, of which 64 had prior computed tomography (CT) images of the spine performed for various medical reasons. These CT images were reviewed for features of axial gout, which include vertebral erosions mainly at the discovertebral junction and the facet joints, deposits of tophi, and erosions in the vertebral body, epidural space, ligamentum flavum and pars interarticularis.
  
  
  RESULTS
  Nine of the 64 patients had radiographic changes suggestive of axial gout. Lumbar vertebrae were most commonly involved, with facet joint erosions being the most common finding. Isolated involvement of the sacroiliac joints was seen in 2 patients. Axial gout had been diagnosed clinically in only one patient.
  
  
  CONCLUSIONS
  Radiologic changes of axial gout were more common than recognized clinically, with a frequency of 14%. Since not all patients had CT images, it is possible that the frequency of axial involvement was even greater. A prospective study is needed to further define this process.
authors.affiliation: Department of Rheumatology, Washington Hospital Center, Washington, DC 20010, USA.
authors.forename: Rukmini M
authors.initials: RM
authors.lastname: Konatalapalli
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Demarco
authors.forename: James S
authors.initials: JS
authors.lastname: Jelinek
authors.forename: Mark
authors.initials: M
authors.lastname: Murphey
authors.forename: Michael
authors.initials: M
authors.lastname: Gibson
authors.forename: Bryan
authors.initials: B
authors.lastname: Jennings
authors.forename: Arthur
authors.initials: A
authors.lastname: Weinstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D006073:Gout / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013131:Spine / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed