Uric Acid Back Pain: The Heavy Load Of Gout

Uric Acid Back Pain ImageA 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[1]. 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. Following comment(s) below, this page is now under review. If you have ideas for improving this page, please add a reply to Improving Uric Acid Back Pain Page.


Uric Acid Back Pain References

  1. 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.

Uric Acid Back Pain: Document History

Date Revision
Jul 22, 2010 (first archive). First Published.
May 05, 2015 (archive). Added notes about other causes of gout-related back pain. Also, added links to gout forum.
Oct 10, 2016 (archive). Flagged for review after comment from Joanne. If you have ideas about improving this page, please add your replies to Improving Uric Acid Back Pain Page.

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Doctor, do I have gout?

It’s been my sad duty today to tell someone that they have got gout.

First his doctor suspected gout but wasn’t sure. He ran the usual blood test for uric acid. The doctor didn’t understand the results, and suggested it was unlikely to be gout.

Like 3 in 4 doctors, he got confused between facts about laboratory reference ranges for uric acid, and facts about medical uric acid safety.

Our patient is left worrying what is wrong with him, and wondering what to do next. Someone had to step up and help this poor guy. That someone turned out to be me.

This is an ongoing story, fresh from the gout forum. As I write, I do not know how the story will end. Will our gout sufferer get the right diagnosis? Will he get the right treatment? Can he ever get the right lifestyle improvement advice if his gout is undiagnosed? You can find out by joining the gout forum link below.

Here are the simple gout facts we have learned so far.

Continue reading Doctor, do I have gout?

Bismuth Subsalicylate and Gout

Bismuth subsalicylate is the active ingredient of many anti-diarrhea products. You should avoid it if you have gout.

Most products that contain bismuth subsalicylate carry warnings about gout. Salicylates are found in many plants, where they give beneficial protection against pests. Most famously, salicylates from willow was used to develop aspirin, though it is produced artificially now.

I mentioned salicylates in Beware Gout Cures You Do Not Need. That article lists many medicines that can cause gout, or make it worse.

Continue reading Bismuth Subsalicylate and Gout

Finger Lost To Gout

This finger tophi review looks at a case study of advanced tophaceous gout causing loss of a finger through amputation.

Tophi are deposits of uric acid crystals that frequently occur under the skin, but can spread throughout the body. Unfortunately, tophi can grow and spread without the usual painful gouty arthritis most commonly associated with uric acid crystals. This often results in gout not being diagnosed properly.

Gouty Fingers Case Study

This is a layman’s review of:

Title:
Erosive polyarticular tophaceous gout: an unusually deforming and destructive presentation.
Authors:
Redmond CE, Babiker A, Redmond PL, O’Rourke KP.
Published:
BMJ Case Rep. 2013 Dec 10;2013.

Polyarticular means occurring in multiple joints.
Tophaceous gout is where gout has progressed to the stage where tophi are visible.

The case study contains a description, learning points, and references. It contains a photograph and an x-ray image. For clarity, I have omitted the gout x-ray from this review, though it does show some significant bone erosion, particularly around the joints. The authors claim this to be more extensive than previous cases.[1-3]

Gouty Fingers Case Description

An 87 year old male suffered from painful, swollen and deformed fingers. He had longstanding gout, which led to amputation of the middle finger of his left hand. The report mentions suboptimal treatment of gout, but offers no further explanation.

The patient’s right index finger was swollen with multiple tophi. There was severe loss of movement in the joints of the fingers. There was almost complete destruction of the middle and end finger joints in both hands.

Gouty Fingers PhotoBlood tests revealed normal uric acid levels. However, we know from other research, that “normal uric acid levels” are meaningless in the clinical context of gout management. Analysis of a sample from the right index finger confirmed the presence of uric acid crystals.

Treatment was longterm colchicine at 1mg per day, and 600mg allopurinol per day.

Gouty Fingers Case Learning Points

The report lists 3 learning points, though it is not clear who needs to learn from them, as all 3 are well-documented prior to the date of this report.

  • Advanced tophaceous gout can result from longterm untreated acute gout.
  • Severe gouty tophi in many joints can occur even with normal uric acid and inflammation blood tests. If in doubt, joint fluid should be examined for uric acid crystals.
  • Uric acid crystal deposits can lead to severe bone destruction, which may require amputation in rare cases.

Gouty Fingers: Next Steps

Though this case study does not reveal new information about gout, and how to manage it, it does emphasize the destructive nature of gout.

If you suspect gout, you really must take steps to get uric acid safe. Safe means 5mg/dL, or lower, and you need to take responsibility for it, as many medical practitioners are unaware of the dangers. Never settle for a normal uric acid test result. This gouty fingers case study confirms that if uric acid is not made safe, then bone destruction will happen.

Leave Finger Lost To Gout to browse other Finger Tophi pictures.


Gouty Fingers Case References

  1. Bloch C, Hermann G, Yu TF. A radiologic reevaluation of gout: a study of 2,000 patients. AJR Am J Roentgenol 1980;134:781–7.
  2. Samaras N, Rossi C. Images in clinical medicine. Tophaceous gout. N Engl J Med 2012;366:e6.
  3. Monu JUV, Pope TLJ. Gout: a clinical and radiologic review. Radiol Clin NA 2004;42:169–84.

Why do I have Gout?

You’re in agony, and you don’t know why. You get the tests, and your doctor laughs and says “it’s gout!”

Why me?

Then the garbage hits you. Everyone has an opinion. You’re too fat. You eat the wrong things. You enjoy too much rich living. You’re just like your grandad.

That’s it! The last one. 99 people will tell you trash about gout caused by your lousy eating habits. One person will tell you that gout is genetic. Bad diet is never a good thing. It shortens your life, but it is rarely the cause of gout. If you have a bad diet, it is good to try and make it right, but that is unlikely to stop gout.

Gout is caused by years of high uric acid. It probably started in your 30s, but you never noticed it. The doctors call it asymptomatic hyperuricemia, which simply means high uric acid that does not trouble you. It does not trouble you at first. After a few years, it bites so hard you wonder if someone just ripped your toe off.

So why is your uric acid high?

For most people, it’s like short-sightedness, or the color of your hair. It’s inherited, and you have to accept it.

Sometimes, high uric acid is caused by drugs for other health problems. Usually, there is an alternative treatment that won’t give you gout.

Sometimes, you really are eating too much of the wrong things. If your diet is so bad that it causes gout, other health problems such as heart disease and diabetes are just waiting to happen. Gout is your wake up call to start eating healthy. I can help you do that without stopping your enjoyment of food.

Most times, gout is an hereditary condition. Most times, your kidneys have a genetic defect that prevents excess uric acid passing out of your body. Sometimes, your body produces too much uric acid.

Why Gout Causes Matter Image
Do you know why gout causes matter?

Whatever the reason for your gout, you cannot ignore it. Gout flares come and go, but gout is with you every day. Even when you are not in pain, uric acid crystals are growing and spreading. Your joints are being destroyed, and crystals spread into soft tissues, damaging skin, kidneys, heart and all other organs.

If, like me, you are overweight, read my Gout Diet guidelines, and let me help you fight the fat. Getting down to a healthy weight is not only good for gout, but it will also save you from many other diseases that can ruin your life.

Whatever the reason for your gout, you need to master the pain, and also stop it returning. I have all the information you need in my Gout Treatment guidelines. Learn to stop gout pain, and stop it returning by getting safe uric acid levels.

If your gout is caused by drugs for other health problems, or environmental factors such as toxins, we call this secondary gout. You can learn more in my Gout Symptoms and Causes guidelines.

Whatever the reason for your gout, I am here to help you understand it and control it. Why do you think you have gout?

Leave Why do I have Gout? to browse the Gout Symptoms, Causes, and Diagnosis guidelines

Pseudogout

Pseudogout means false gout.

It is similar to gout, but is caused by calcium crystals, not urate crystals.

Why Care About Pseudogout?

Gout sufferers without a clear diagnosis need to watch out for pseudogout. The symptoms are similar, though pseudogout tends to affect larger joints such as knees and shoulders whereas regular gout can affect any joint.

If suspected gout does not respond to urate lowering therapy after one year of safe uric acid levels, then joints should be inspected for pseudogout.

Note that gout and pseudogout can co-exist.

Do You Suspect Pseudogout?

To confirm pseudogout, joints must be inspected for calcium crystals. This investigation should be carried out by a crystal arthritis specialist using joint fluid analysis. If available, the new non-invasive DECT procedure will also differentiate between gout and pseudogout.

Pseudogout Causes

Though we know that pseudogout is caused by a buildup of calcium joints, we do not know all the reasons for this buildup.

Risks increase with age. 3% of people in their 60s get it, rising to 50% in their 90s. Pseudogout affects men and women equally. In general, their may be a hereditary risk factor. Dietary calcium does not appear to affect calcium deposits.

Specific factors that can trigger pseudogout are:

  • Excessive calcium in the blood (hypercalcemia)
  • Excess iron storage (hemochromatosis)
  • low magnesium levels in blood
  • overactive parathyroid gland
  • severely underactive thyroid (hypothyroidism)

Pseudogout Treatments

I have said that there are no known treatments for pseudogout, other than pain relief. The pain relief options are similar to those listed on my gout gout treatment pages. However, if pseudogout is caused by one of the underlying conditions I listed above, then treating that can slow down the development of pseudogout. For example, some readers have reported benefits from magnesium supplementation. One reader also pointed out that magnesium levels are very hard to determine, so it might be a case of simply trying supplements to see if they derive benefits – you should, of course, consult your doctor about this.

As with gout, it is important to consult a rheumatologist if you have, or suspect pseudogout. You can find a local rheumatologist on the College of Rheumatology website. Their listing of rheumatologists covers the USA and most other countries.

Pseudogout: Next Steps

My help and advice is here to support gout sufferers, and most of this site is not relevant to pseudogout sufferers. If you have been diagnosed with pseudogout, then all the gout pain relief information is relevant, but uric acid information is not relevant.

My gout diet information may also help pseudogout sufferers to a certain extent, though any parts that relate to purines or the uric acid lowering effects of certain foods are not relevant.

If you are certain that you have pseudogout, the best action is to follow the advice of your doctor, or seek advice from a rheumatologist who specializes in calcium crystal diseases. I do not cover this topic in depth, but I may occasionally publish information if it seems relevant or interesting to gout sufferers. You can find these articles in the pseudogout archive.

False Gout Spellings

Pseudogout is a fairly awkward word to spell correctly. The following list shows all the spelling options I am aware of. All of these mean the same thing, so whenever you see them, always refer to pseudogout.

Falsegout

Best alternative. False gout best describes what pseudogout really is – something that is similar to gout, but is actually something else. Occasionally hyphenated as false-gout.

Fauxgout

Most pretentious, and fortunately rare, from the French for false. Also faux gout or faux-gout.

Pseudogout

Pseudogout is the correct spelling of false gout. It frequently gets split (pseudo gout), or hyphenated (pseudo-gout).

Psudogout

Missing ‘e’. Also psudo gout or psudo-gout.

Psuedogout

Transposed ‘e’ and ‘u’. Also psuedo gout or psuedo-gout.

Sudogout

Phonetic spelling. Also sudo gout or sudo-gout.

If you are aware of other alternative spellings, please share them on the gout forum.

If you believe you are more likely to have gout than pseudogout, you can find more relevant information in the gout symptoms guidelines, which also explains gout causes and diagnosis.

Leave Pseudogout to browse Gout Symptoms guidelines

Symptoms Of Gout

The main symptoms of gout are usually considered to be a red, swollen, extremely painful big toe.

Other gout sufferers and I have even had a gout diagnosis turned down because we did not present these common symptoms.

Yes, a swollen big toe is a common symptom of gout, but as we will see, it only affects just over half of gout sufferers.

Symptoms Of Gout Survey

Gout Symptoms Survey 2007-2010 Population Map
Please click for full-size image
Between January 2007, and July 2012, I collected data from over 4,000 visitors to GoutPal. Though predominantly Americans, respondents live all around the world.

The survey was in two parts: one question on types of gout symptoms, and the other on joints affected.

Types of Gout Symptoms Survey

I will publish the symptoms of gout survey for types of gout symptoms soon.

Joints Affected by Gout Survey

Symptoms Of Gout: Joints Affected Chart

We can see from the total number of joints affected by gout, compared to the total number of people who recorded their symptoms, that on average, gout sufferers have two affected joints. I have not segmented the analysis to show how many people has 1, 2, 3 etc joints affected. If you want to see that breakdown, please discuss this in the gout forums.

The actual data for the chart is:

Joint Affected by Gout Count Percent
Other part of Foot / Ankle 2422 57%
Big Toe 2184 51%
Knee 1133 27%
Other part of Hand / Wrist 1102 26%
Elbow 527 12%
Index Finger 503 12%
Shoulder 417 10%
Back 376 9%

The table is in count order, but questions were asked in a different sequence. Thus: Other part of Foot / Ankle means other than the Big Toe, and Other part of Hand / Wrist means other than the Index Finger.

Of course, the joint of the big toe that is normally affected by gout, is on the side of the foot, so people may have inadvertently described it incorrectly. Nevertheless, the other joints are significant, and for anyone who understands gout, this is to be expected.

Firstly, uric acid crystals form more readily in the extremities, where temperatures are lower, but this is equally a risk factor in the hands for most people. More significantly, untreated gout will spread to all joints, and beyond. Many gout patients do not get told the all important fact, as determined by professional rheumatologists. If you have ever had a gout attack, uric acid should never be allowed to rise above 5mg/dL (0.30mmol/L).

You will see in the Gout Treatment pages that there are many ways to control uric acid, but you can only do this if you know your number, and check it at least once per year. Good diagnosis of your symptoms of gout is your first step to Gout Freedom. Whenever you see your doctor about gout, be certain to get your blood tested for uric acid, and be certain to learn the exact number. Do not be fobbed off with phrases like “normal” or “not too high”.

If you have experienced different symptoms of gout, please share your story in your gout symptoms discussion.

Leave Symptoms of Gout to browse other Gout Symptoms pages