Gout. If you have had gout, you
know how uncomfortable it is. You may also know how tough
it was to diagnose, particularly if it
was in the spine. Back pain or leg pain may have been your first
symptom. Your Richmond chiropractor at Johnson Chiropractic understands
spinal gout, its similarities with other conditions’ symptoms,
and the latest recommended assessments to diagnose it
sooner than later to help you get the (appropriate!)
care you need.
PREVALENCE OF SPINAL GOUT
Arthritis is an inflammatory condition affecting
people around the world - 47.8 million US sufferers, 8 million UK sufferers,
108 million European sufferers - with osteoarthritis being the most common
affecting joints in the knee, hands, etc. Gout is just
such an inflammatory cause of pain in similar areas, making it difficult to diagnose and differentiate
from other inflammatory issues. (1) A new narrative review stated
that 94% of spinal gout patients had back or neck
pain, 86% showed neurological symptoms, 72% had a
history of gout, 80% tested for elevated levels of serum
uric acid, and 76% underwent surgery. Though an infrequent
cause of spine pain, gout’s inflammatory arthritis results from
monosodium urate crystals in synovial fluid and other joint tissues (ankle,
foot, hands, wrists, elbows, knees, hips, and spine). (2) An early, suitable
diagnosis of spinal gout can better direct treatment and improve
clinical outcomes.
DIAGNOSIS OF SPINAL GOUT
Researchers have explored a
variety of ways to safely and accurately diagnose gout in
people who have never had gout. They have reviewed
studies from as far back as 1945! They found that synovial
fluid monosodium urate crystal analysis and imaging were superior to a clinical algorithm of signs and symptoms only for diagnosis and
treatment planning. (3) Facet joint disorders, osteoarthritis, synovial cysts,
etc., can complicate the diagnostic process for spinal
gout. Fortunately, dual energy computed tomography (DECT)
illustrates the crystals. However, healthcare providers must be
aware of the possibility of gout to order
the right test. (4) A narrative review of published studies on
spinal gout that was undertaken by two chiropractors concurred.
To improve the quality of life of spinal gout
sufferers as well as the diagnosis, treatment planning and prevention of
surgery, a combination of clinical symptoms, lab tests, and DECT may be
the key. (2) Johnson Chiropractic
notes that cases of spinal gout are emerging in
the medical literature.
CASES OF SPINAL GOUT and TREATMENT
One case of a 48-year-old man with sudden, severe, sharp low
back pain that limited his mobility and with no history of gout ended
up with a diagnosis of spinal gout after an MRI showed a mass in
his right erector spinae muscles which lead to a biopsy that divulgedspinal
gout. 29% of
patients with gout have spinal gout, too,
which didn’t help in this case of a patient without gout but is a
noteworthy stat to consider in the next case. (5) A 41-year-old
male who did have a 7-year history of gout came for help with
severe back pain, fevers, and radiculopathy. After a biopsy, spinal gout was
diagnosed invalidating an initial diagnosis of vertebral
osteomyelitis. Primary treatment often involves
symptom management with colchicine, steroids, urate reducing
therapy, and NSAIDS. (6) If spinal gout is speculated,
Johnson Chiropractic will get the right tests ordered.
CONTACT Johnson Chiropractic
Listen to this PODCAST
with Dr. Joseph Beissel on The
Back Doctors Podcast with Dr. Michael Johnson as he
illustrates the relief with The Cox® Technic System of Spinal
Pain Management for chronic back pain.
Schedule your Richmond chiropractic
appointment soon. Your Richmond chiropractor will do
a complete examination to determine the best course
to appropriately diagnose, treat, and attain the best relief of
spinal gout.