Tophaceous hip gouty arthritis revealing asymptomatic axial gout

Abstract

BackgroundHip and axial involvement is uncommon during gout and may raise diagnostic challenges. We describe a rare case of tophaceous hip gout which lead to the diagnosis of asymptomatic axial tophaceous gout at a single rheumatology center. Case presentationA 35-year-old man, diagnosed with tophaceous polyarticular gout 14 years before presentation, consulted for a gout attack with reduced hip range‐of‐motion on physical examination and an increased serum uric acid level (655 µmol/L). He had been regularly taking colchicine, allopurinol (300 mg/j), and occasionally non-steroidal antiinflammatory drugs. Plain Radiography of the hips revealed bilateral circumferential joint space narrowing, subchondral erosions of the right acetabular, a calcified soft tissue tophus of the left hip and bilateral sacroiliitis grade IV. Computed tomography (CT) showed total ankylosis of the upper segments of both sacroiliac joints and bilateral hip joint space narrowing, subchondral geode eroding the right acetabulum. Moreover, CT revealed soft-tissue tophi involving the major trochanter of the left acetabulum, the right coxofemoral joint and lowest two levels of lumbar facet joints (L4-L5; L5-S1). A spinal and plevis magnetic resonance imaging (MRI) concluded on a gouty tophi, locolized bilaterally intraarticularly in the coxofemoral joints, gluteus medius bursae, lumbar facet joints (L4-L5; L5-S1), and cofirmed bilateral sacroiliitis. ConclusionThe axial and hip gouty arthritis are exceptionnel localisation. Radiographic imaging tools, mainly CT and MRI, may show the monosodium urate crystals and tophi that can contribute to bone and joint lesions of gout. They also allow the exclusion of other possible etiologies such as spondylodiscitis, infection, and neoplasia.