Gout in back?

[Grendall]

Hi all,

I have seen a few posts recently regarding Gout. My query is a recent CT scan to check for kidney stones showed Degenerative disc disease as I have had 3 recent episodes (still ongoing) with severe nerve pain generating from my spine in my lower back.

I have also read someone had said it could be due to raised ‘Uric acid’ levels. I have my next hospital appointment next week and was wondering if to ask the Heam doc if my levels have been raised over the last few blood tests.

I am currently on weekly 65mg interferon injection.

I would appreciate any guidance or advice on this please, no idea if I am just clutching at straws at this stage

[hunter5582]

I don't know anything about spinal gout other than it it is rare. Sorry to hear about the degenerative disk disease. Unfortunately, the back can wear out. I also have spinal degeneration in the cervical, thoracic and lumbar regions. It can be painful at times. Recently, I have been experiencing what is either paresthetica meralgia or IT Band Syndrome. Nerves going from the spine to the thigh being impinged. I have found some things that really help with the back issues.

Massage Therapy by a skilled therapist is critical to relieving pain, increasing flexibility and maintaining function. I am very fortunate to have found someone very skilled. Physical Therapy can also be very helpful. I also practice Qigong, which also helps with flexibility and balance.

I would think you can get a clear diagnosis of the spinal issues from a proper assessment by a spinal specialist. It is correct that raised uric acid levels can lead to the deposit of crystals into joints. This can be properly assessed. I would be more suspicious of the spinal deterioration, but this is an issue to figure out with your care team. We can only guess.

I know form my own experience just how debilitating back pain can be. Wishing you success in figuring out what is going on and finding a viable solution.

[Grendall in reply to hunter5582]

thank you very much Hunter, I am just trying to reach out for possible answers but I agree I will get the correct referral to specialists first

[PhysAssist]

Hi Grendall,

Uric acid levels are usually only elevated transiently in gout- most often as a precursor to an acute flare in an affected joint.

I don't ever recall having seen any literature about gout affecting the spine, which doesn't mean that it's not possible, just that it would be rather rare.

OTOH, I don't think gout could really be called rare in general, it just doesn't seem as common as it used to be. It does seem to be a relatively rare complication of MPN's though.

It is most often a genetic disorder where certain proteins [which contain a lot of an amino acid called purine] are poorly metabolized leading to a buildup of uric acid in the blood, which can be concentrated in joint spaces- most often in distal ones [think extremities] toes, knees, and hands.

See here:

mayoclinic.org/diseases-con...

OTOH again, spinal arthritis [i.e., degenerative joint/disk disease] is a very common finding, especially after the age of 30.

see here:

arthritis.org/health-wellne...

versusarthritis.org/about-a...

I hope this is at least somewhat helpful.

Best,

PA

[Grendall in reply to PhysAssist]

thank you so much for the info I will have a read, my GP is just trying to get to what is going on with my back x

[PhysAssist in reply to Grendall]

Hi Grendall,

The pain you described does sound more like it might be from the degenerative process, rather than from gouty arthritis, which would more likely be localized to the individual joint being affected.

I do agree with Hunter regarding non-surgical care being the best initial treatment option- in my case physical therapy resolved a months-long set of nerve symptoms emanating from my cervical [neck] spine to my hand, for which I thought I was going to need surgery.

I did have surgery to remove a calcified disk fragment from where it was compressing the nerve[s] to my hand about 16 years ago, but that was only after PT failed and my symptoms indicated that surgery was the only option- i.e., muscle atrophy due to the near-complete lack of innervation.

Local therapies with ice, heat, massage, and even a topical anti-inflammatory [Voltaren/diclofenac gel] can also be helpful, because nothing is really curative per se- it's a process that continually evolves.

Best,

PA

[Grendall in reply to PhysAssist]

I am inclined to agree, although at the minute I am past all medicines that I have tried, Diclafenic, Codeine, Naproxin etc.

Per my GP, apparently they have to have confirmed from a physio (appointment next week) that it is muscular skeletal to attempt sending for an MRI without waiting for a referral for months to the hospital under the NHS… will keep you posted x

[PhysAssist in reply to Grendall]

Hi Grendall,

Delay of any kind really sucks when you're dealing with these kinds of things. Ironically, musculoskeletal pretty much describes anything that isn't psychosomatic, although it sort of leaves out the neurological component of the problem.

May I suggest that you ask your GP to consider an EMG/NCV study? The results of which are usually unequivocal and can often define not only what nerves are being affected, but also at what level they are being compromised. [EMG- Electromyography, NCV- Nerve conduction velocities].

spineuniverse.com/exams-tes...

Just a thought, because while I love my PT's and it has been helpful in treating my disk-related issues at certain times, it's still not an exact science and it is very operator dependent . This leads to the fact that some PT's are excellent at physiatry and are skilled diagnosticians, while other lack significant insight and basically practice 'cookbook' therapy.

Best,

PA

[AnBee]

hi Grendall. I am an Acupuncturist in practice for 35 years and 50% of my patients in that time have for back pain and sciatica. I can absolutely assure you that acupuncture in the hands of a properly trained acupuncturist is the number one treatment for acute and chronic pain regardless of the source ie neurological or muscular or joint The main thing is to find a properly trained acupuncturist who knows how to treat pain. Not someone who tacks it on to another profession. Someone who does it only day in and day out. Hope this helps.

[Grendall in reply to AnBee]

thank you for your advice, I am taking everything on board going forward, thanks