A new report on uric acid and back pain reminds me of the critical consequences of failure to manage gout properly.
Are you the type of person who wants to avoid daily uric acid treatment because you can stand the agony of a swollen big toe?
You might think again when your back is crippled and you can no longer stand upright.
I’m not one for scaremongering, but I do get frustrated by people who suffer years of gouty agony because they refuse to control uric acid. OK, so painkillers can mask the pain, but they cannot stop the inevitable invasive growth of uric acid deposits.
The big toe is the most common joint to get affected, but if left untreated, high uric acid levels will lead to urate deposits in every joint. This is more than a painful nuisance – these uric acid deposits known as tophi eat into bone, cartilage, and tendons causing permanent joint damage.
Most of us are lucky enough to live in a society where joint reconstruction surgery is a possibility, but why put yourself at that risk?
And I did mention every joint. Foot gout is a common problem because there are lots of joints in the foot. There are also lots of joints in the spine, and gout in the back, though fairly uncommon, is serious enough for you to be very afraid.
In gout management, there is too much emphasis on short term pain relief, and insufficient awareness of the consequences of allowing gout to reach the tophaceous stage. A single tophus (the name given to uric acid crystals when they form a lump in the body) often means severe joint movement restriction. This is quite common on the hands, where groups of tophi (the plural of tophus) tend to restrict finger movement. When this happens in the spine, back movement restriction becomes critical, and total incapacity from spine distortion is a real risk.
Samuels and colleagues reported a particularly bad case of spinal gout in the June issue of Bulletin of the NYU Hospital for Joint Diseases. The image above shows how tophi in and around the spine have severely distorted the patient’s back. The report reveals that this impaired the ability to stand long enough to take a shower.
Fortunately, the patient responded well to allopurinol, even though he required a dose of:
750 mg daily to achieve a target serum uric acid level less than 6.0 mg/dL.
As I mentioned, uric acid back pain in the form of tophaceous spinal gout is uncommon, but the Samuels report does manage to cite 7 other cases, and there will be many more that go unreported.
Uric Acid Back Pain: Other Causes
As well as tophi, uric acid can cause back pain in other ways.
I have experienced it from bad posture caused by limping. Whenever I had gout in my feet or knees, I often walked awkwardly to try and limit the pain. This is a common cause of back pain. It isn’t exactly gout in the back, but the cause is the same. Excess uric acid should be treated long before gout affects your back.
Another common cause of back pain is kidney stones. This is especially common with lower back pain. Again, early treatment is essential. Uric acid kidney stones can cause permanent damage and chronic kidney disease.
Uric Acid Back Pain: Next Steps
If you think your back pain might be uric acid related, what should you do next?
It really is not worth letting gout go untreated this long. Are you showing any symptoms of tophaceous gout, or indeed gout symptoms of any kind, such as swollen joints? If so, you need to get your uric acid level checked by your doctor, and controlled today.
If you are not sure what to say to your doctor, ask in the gout forum. You can also use the forum if you do not understand what your doctor tells you about uric acid back pain. If you have not used the gout forum before, please see how to log in to GoutPal, or click the orange Gout Support button.
Uric Acid Back Pain References
- Authors: Jonathan Samuels, M.D., Robert T. Keenan, M.D., M.P.H., Rena Yu, M.D., Michael H. Pillinger, M.D., and Tibor Bescke, M.D. Title: Erosive Spinal Tophus in a Patient with Gout and Back Pain. Published: June 2010.