What is the prevalence of gout in the shoulder joint?

Prevalence of Gout in the Shoulder Joint

Gout in the shoulder joint is exceedingly rare, with the shoulder being one of the least common locations for gouty arthritis to develop. 1

Epidemiology and Distribution of Gout

Gout is one of the most common rheumatic diseases of adulthood, with a self-reported prevalence in the USA estimated at 3.9% of adults (approximately 8.3 million people), and more recent data suggesting a prevalence of 5.1% (affecting 12.1 million adults). 2, 3

However, the distribution of gout in different joints is not uniform:

• First metatarsophalangeal joint (podagra) is involved in approximately 50% of initial attacks 4
• Lower extremity joints are most commonly affected 1
• Small joints of the hands, wrists, and elbows may also be involved 1
• Shoulder, hip, sacroiliac joints, and spine involvement is rare 1

Documented Cases of Shoulder Gout

The literature contains very few documented cases of gout affecting the shoulder joint:

• Case reports of shoulder gout are sparse, highlighting its rarity 5, 6
• When gout does affect the shoulder, it can lead to severe complications such as:
  • Erosive lesions of the glenoid 5
  • Osteolytic destruction 5
  • Humeral head subluxation 5

Diagnostic Challenges for Shoulder Gout

The rarity of shoulder gout creates diagnostic challenges:

• It may be misdiagnosed as other conditions due to its unusual location
• Definitive diagnosis requires:
  • Identification of monosodium urate (MSU) crystals through synovial fluid aspiration 4
  • Examination under polarized light microscopy (gold standard) 4

Clinical Presentation of Shoulder Gout

When gout does affect the shoulder, it may present with:

• Severe pain, often worse at night 6
• Episodes that may initially resolve spontaneously 6
• Progressive worsening if left untreated 6
• Potential for severe joint destruction in chronic cases 5

Implications for Clinical Practice

For clinicians evaluating shoulder pain:

• Consider gout in the differential diagnosis, especially in patients with:
  • Known history of gout in other joints
  • Hyperuricemia
  • Risk factors for gout (obesity, renal impairment, hypertension, etc.) 4
• Joint aspiration is recommended when possible to confirm diagnosis 2
• When severe erosion is present in the shoulder, physicians should consider gouty arthritis based on medical history and clinical manifestations 5, 6

Conclusion

While gout is a common inflammatory arthritis overall, its presentation in the shoulder joint is exceptionally uncommon. The rarity of shoulder gout makes it important to maintain clinical suspicion in patients with risk factors and to pursue definitive diagnosis through synovial fluid analysis when possible.