Ask the Doctors February 2014 Issue

Ask The Doctors: February 2014

Having rheumatoid arthritis and gout at the same time...Vertebral compression fracture treatment

Q. I was diagnosed with rheumatoid arthritis (RA) in my hands several years ago. Now, my doctor thinks I may also have gout in my big toe as well. Could I have both conditions at once?

A. Both gout and rheumatoid arthritis (RA) are inflammatory conditions. Gout develops when uric acid builds up in joints, bones and tissue causing inflammation in the joints, and presents most often in the big toe, although any joint can be affected. Rheumatoid arthritis (RA) affects the joints, surrounding tissues and sometimes the body’s internal organs.

In its early stages, gout is distinct from RA due to it presenting with a very sudden onset in one or a few joints, and a length of seven to 10 days. In later stages, if gout is not treated it may become “polyarticular,” which means it may be in many joints and resemble RA.

If untreated, gout can also be associated with a positive rheumatoid factor, an antibody often detected in the blood of people with RA. Buildups of sodium urate can form lumps under the skin, which often resemble the nodules fairly common in RA.

While it’s generally thought that having both gout and RA is rare, a study published in the International Journal of Clinical Rheumatology (Aug. 2013) showed the two could occur simultaneously. Among a review of 813 patients with RA between 1980 and 2007, six were diagnosed with gout prior to RA and 22 patients developed gout over the study period, most often in the big toe. The 25-year cumulative prevalence of gout for those in the study with RA was 5.3 percent. Risk factors included being overweight and being male.

With the knowledge that gout may occur in patients with RA, although at a lower rate than the general population, it’s important to discuss any symptoms you may have with your doctor to ensure the best treatment for both conditions.

Q. My doctor has found a vertebral compression fracture on a recent magnetic resonance imaging (MRI) test. What is a vertebral compression fracture, and how is it typically treated?

A. A vertebral compression fracture (VCF) occurs when the bones of the spine become compressed, causing the spine to shorten and curve forward. More than 700,000 VCFs occur each year in the United States due to thinning of bones or osteoporosis. Symptoms of the condition include back pain from simple tasks as well as shortness of breath, depression, and, in the case of a complete collapse of the vertebral body, severe neurological damage.

Early treatment is vital to improving the long-term diagnosis of VCF. Patients with fractures have osteoporosis, resulting in a need for an evaluation for secondary causes of low bone mass and therapy with medication. In patients with vertebral fractures an anabolic agent such as teriparatide (Forteo®) may be indicated. While back pain from VCF may fade over time, about 42 percent of patients continue to experience pain and diminished quality of life months after the initial fracture.

The two surgical techniques kyphoplasty/vertebroplasty have shown to provide pain relief and improve mobility if used within 12 weeks after fracture. During kyphoplasty/vertebroplasty, a hollow needle called a trocar is inserted through the skin and into the vertebra. A type of X-ray, called fluoroscopy, is used to guide the trocar into proper position. After placement of the trocar, cement is inserted into the vertebra through the needle. This stabilizes the vertebra in addition to restoring height by straightening out the spinal curve. The minimally invasive technique usually provides pain relief and improved mobility within 48 hours. For some patients, pain relief is immediate after undergoing the procedure.