Spinal gout: Back pain & high uric acid

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Recent studies suggest that axial gout may be more prevalent than suspected.

Traditionally gout thought of as a rare problem characterized by a sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe. Spinal gout can affect the facet joint, laminae, ligamentum flavum, as well as the epidural spaces.

 

Mechanism

Although no studies have been able to conclude the exact mechanism for axial involvement in gout, the likely theory is, as gout usually involves joint spaces, facet joint may be the initial deposition location for MSU crystals.

 

Presentation

Back or neck pain

Suspect when have gout as comorbid, no history of fall

 

Investigation

Uric acid : high

X ray: normal

MRI: hypointense signal on the T1-weighted MRI and heterointense signals on the T2-weighted MRI

if MRI positive:  surgical sampling for pathological confirmation of negatively birefringent monosodium urate crystals.

 

 

Treatment

Acute:

NSAIDS

Colcichine (Colchicine in Gouty Athritis: Low Dosage is effective)

 

Long term:

control of uric acid via diet and Allopurinol.

Follow up.

 

Ref:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112347/

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