Spinal Gout: Causes, Symptoms, Diagnosis, Treatment

Gout is a type of inflammatory condition that occurs as a result of a build-up of uric acid. Spinal gout is a type of gout that affects the areas of the spine. Inability to remove excess uric acid and urate crystals can lead them to get collected around the joint causing pain and inflammation. In severe cases and when left untreated the uric acid crystals may collect under the skin, and these are known as tophi.

Spinal gout is a rare form of gout that mostly affects the lumbar spine.⁽¹⁾ It may affect 22-35% of people and many cases even go undiagnosed due to the lack of awareness and wide range of symptoms.

The symptoms of spinal gout include:

• Back pain
• Numbness
• Weakness
• Neck pain
• Reduced sensation in the legs, back, and buttocks

A condition in which excess uric acid collects in the body is known as hyperuricemia. Uric acid is a waste product of purine found in the body and certain foods. In some cases, hyperuricemia may lead to gout. High uric acid build-up forms crystals in the joints, tissues, and body fluids. This can lead to pain and inflammation.

There are certain factors that may increase the risk of high uric acid levels, which include:

• Obesity
• Heart failure
• Insulin resistance
• Being male
• High blood pressure
• Metabolic syndrome
• Poor kidney function
• Alcohol
• Diuretics
• High-fructose food and drinks
• A diet rich in purine may include red meat, organ meat, and seafood

If not treated, gout may spread to the spine mostly the joint spaces⁽²⁾ Research theorizes that a high uric acid level signals an increase in cerebrospinal fluid, which may lead to obstruction of the foramen or spinal canal.

Spinal gout is difficult to diagnose as it is a rare condition and has no definitive criteria. ⁽³⁾

Signs of spinal gout include:

• Pain in the axial skeleton
• High uric acid level
• Spinal cord compression
• Radiation of pain from spine to hips and legs along with numbness and weakness

Physical examination is done to check for nodules around the joints and tests are carried out to check muscle strength and reflexes.

A blood test is ordered to measure the uric acid level.

Medications used for the treatment of spinal gout are the same as those used for gout treatment and they include non-steroidal anti-inflammatory drugs.⁽²⁾

Non-steroidal anti-inflammatories are not used for people with chronic kidney and heart disease.

Medications are used for the long term to prevent the development of tophi and to lower uric acid levels. Also, taking colchicine twice a day can be successful to keep a person symptom-free.

Other treatments for gout include:

• Losing excess weight
• Limiting alcohol
• Reducing or avoiding foods rich in purines
• Avoiding medications that increase uric acid
• Staying physically active.

Sometimes a person may have to undergo surgery to treat the compression caused by spinal gout. This can help in giving a significant improvement in radiating pain.

Prompt diagnosis and treatment of spinal gout may help in giving relief from the symptoms and preventing the condition from spreading.