Spondylodiscitis and Achilles tendonitis due to gout

Area of Science:

• Rheumatology
• Orthopedics
• Internal Medicine

Background:

• Gout, a form of inflammatory arthritis, typically affects joints like the big toe, but can manifest in rarer locations.
• Hyperuricemia, elevated uric acid levels, is a primary risk factor for gout development.
• Patient presented with symptoms suggestive of systemic inflammation and musculoskeletal involvement.

Observation:

• A 62-year-old male with a history of hyperuricemia and heavy alcohol consumption presented with severe neck pain, Achilles enthesopathy, and polyarthralgia.
• Biochemical tests revealed elevated C-reactive protein (CRP), uric acid (UA), and creatinine.
• Imaging studies (bone scintigraphy, CT, MRI, ultrasonography) confirmed polyarthritis, spondylodiscitis (C5-C6), and Achilles tendonitis with enthesitis.

Findings:

• Needle aspiration of the affected joint revealed urate crystals, confirming the diagnosis of gouty arthritis.
• The patient was diagnosed with gouty arthritis complicated by spondylodiscitis and Achilles tendonitis.
• Treatment with allopurinol, colchicine, and prednisolone led to symptom improvement and normalization of CRP and UA levels.

Implications:

• This case highlights the importance of considering gouty arthritis in the differential diagnosis of spondylodiscitis and enthesitis, even in rare locations.
• Cervical spine and Achilles tendon involvement in gout are uncommon but significant, necessitating thorough diagnostic evaluation.
• Prompt recognition and management of atypical gout presentations are essential for preventing complications and improving patient outcomes.