Abstract
BackgroundInflammatory back pain is a condition characterized by inflammation of the sacroiliac joints and lower spine. It is frequently seen in patients with spondyloarthropathies like ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis and reactive arthritis. Inflammatory back pain can be caused by many other conditions like infection and crystal deposition such as gout. In this case, it is difficult to specifically identify gout as a cause by ordinary imaging like magnetic resonance imaging (MRI) or ultrasound.Case presentationThis case report describes a young man with severe psoriasis, presumptive psoriatic spondyloarthropathy and chronic extensive tophaceous gout which was difficult to treat because of non-compliance with medications and lifestyle. He presented with inflammatory type low back and buttocks pain with raised inflammatory markers. MRI of the lower back and sacroiliac joints showed features of active sacroiliitis. He was subsequently treated with a Tumor Necrosis Factor (TNF) alpha inhibitor for presumed axial psoriatic arthritis and had no significant benefit. Two attempts DECT of the lumbar spine was not executed correctly. CT lumbar spine and SIJs showed L2/3 endplate and left SIJ erosions mostly related to gout. Rasburicase was introduced. The tophi decreased in size peripherally with marginal improvement in back pain. From this study, we want to bring to the attention of physicians that gout can lead to back pain with inflammatory changes on MRI. We also want to address the importance of other imaging modalities if the cause of the back pain is not clear.ConclusionThis case is meant to highlight an important but overlooked cause of active sacroililitis and inflammatory type back pain in patients who have gout, and to bring to the attention that plain X-ray, MRI and ultrasound cannot differentiate between inflammatory sacroiliitis caused by seronegative arthritis versus gouty arthritis. CT scan can add more information but DECT is the preferred method for differentiation and identification of axial tophaceous gout.
Highlights
Inflammatory back pain is a condition characterized by inflammation of the sacroiliac joints and lower spine
This case is meant to highlight an important but overlooked cause of active sacroililitis and inflammatory type back pain in patients who have gout, and to bring to the attention that plain X-ray, magnetic resonance imaging (MRI) and ultrasound cannot differentiate between inflammatory sacroiliitis caused by seronegative arthritis versus gouty arthritis
CT scan can add more information but dual energy computerised tomography (DECT) is the preferred method for differentiation and identification of axial tophaceous gout
Summary
The aim of this case report is to highlight an important but overlooked cause of active sacroililitis and inflammatory type back pain in patients who have tophaceous gout, and to bring to the attention that plain X-ray, MRI and ultrasound cannot differentiate between inflammatory sacroiliitis caused by seronegative arthritis versus gouty arthritis. DECT is the preferred method for differentiation and identification of axial tophaceous gout. Funding We received no funding to work on or publish this case report. Authors’ contributions SQ and RV wrote the manuscript of this case report including the case report and discussion. JR and GM reviewed the manuscript and added to the discussion. Author details 1Royal College of Physicians of Ireland, Cork University Hospital, Cork, Ireland. Author details 1Royal College of Physicians of Ireland, Cork University Hospital, Cork, Ireland. 2Rheumatology Department, Cork University Hospital, Cork, Ireland. 3Radiology Department, Cork University Hospital, Cork, Ireland
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