Nervous system involvement in tophaceous gout is rare. Case reports of median nerve compression by tophi have been published (1). To date, compression of the spinal cord by tophi has been described only once before (2). We report a patient with spinal cord compression by tophaceous masses and evidence of median nerve entrapment and cervical radiculopathy on a similar basis.
Case Report. A 50-year-old white postmenopausal woman was admitted for evaluation of back pain and lower extremity numbness and weakness of 3 weeks' duration. At age 1 1, she had a 3-week episode of left elbow arthritis. She was asymptomatic until approximately age 21, when she had the onset of severe intermittent bilateral ankle pain. By age 26, the wrists, knees, temperomandibular joints, and toes were involved. Rheumatoid arthritis (RA) was diagnosed, and the patient was treated with antimalarials, injections of gold salts, aspirin, and several nonsteroidal antiinflammatory drugs. Steroids were used intermittently for 25 years and continuously for 8 years before admission. She is currently taking prednisone 15-20 mg orally per day.
In the year before her admission, flexion contractures of multiple digits developed, and punctate white lesions appeared on her elbows, forearms, buttocks, and chest. Two months before admission, she