Inflammatory sciatica due to spinal tophaceous gout.

A 73-year-old woman with chronic tophaceous gout presented with acute right-sided sciatica. Conventional radiology and CT scan of the lumbar spine revealed severe degenerative changes at the level of L3/4 and L4/5 disc and tophaceous deposits around the facet joints bilaterally. Investigations revealed a raised acute phase response (C reactive protein 97 mg/l, erythrocyte sedimentation rate >100 mm/h), leucocytosis and thrombocytosis. Because of non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity and intolerance to colchicine, a local steroid infiltration of the L4-5 facet joint was administered with a partial response. The patient was treated with anakinra 100 mg daily administered for 3 days. The treatment led to rapid clinical improvement of sciatica as well as normalisation of the acute phase response. She was subsequently maintained on anakinra 100 mg three times weekly with total resolution of sciatic pain.