Could Your Back Pain Be Gout?

By Carolyn Sayre | Updated June 2, 2023

If you’ve ever had back pain, you know how  hard it can be to pinpoint the cause. From bone spurs to overworked muscles to slipped discs, there’s no shortage of ailments that can wreak havoc on your lower back.

And now, you can add one more to the list. Over the last 10 years, rheumatologists have documented more cases of gout appearing in the spine. So if you are one of the 9 million Americans with this inflammatory form of arthritis — and you have unexplained back or neck pain, tingling sensations down your arm or leg, or numbness — there’s a small chance the culprit could be g­­out.

How Common is Spinal Gout?

Gout in the spine is rare. As of 2016, only 131 cases had been described in medical journals. But experts like Theodore Fields, MD, a rheumatologist at Hospital for Special Surgery in New York City, say spinal gout may be more common than we think.

“Some early studies suggest there is more gout in the spine than we previously thought. Most doctors just aren’t looking for it,” he says. “Patients with spinal gout usually have a history of gout in other places.”

Gout typically affects the big toe joint and other extremities first, including the knees and tips of the fingers. But Dr. Fields says it’s possible someone could present with back pain as an initial symptom.

“Gout can travel to almost any joint over time,” he notes. “If someone has untreated gout for 10 to 20 years, it is not rare to get it in their fingers, wrists, cervical and lumbar joints, and even occasionally the elbows. The only place it is really rare to get gout is in the hip.” Still, he says, doctors are more likely to attribute back pain to a herniated disc or osteoarthritis — and in many cases, they would be right.

How Gout Can Affect the Spine  

Symptoms of spinal gout can vary. It can cause back or neck pain and may be due to elevated uric acid levels. Some people also have classic neuropathy, including pinched nerve pain down the arm.

But Brian Mandell, MD, PhD, a rheumatologist at Cleveland Clinic in Ohio and board member of The Gout & Uric Acid Education Society, cautions that most people with spinal gout don’t have symptoms.

Historically, he says, doctors thought of spinal gout as affecting transplant patients taking organ-rejection drugs like cyclosporine, which are known to send uric acid levels through the roof. Then researchers began looking at CT scans of the spine and found gout in places they never expected.

“With the new dual energy CT scans we have today, you will actually be able to see clumps of uric acid colored green along the spine. You can see a definitive collection in the area where the symptoms are and predict which nerves would be involved,” Dr. Mandell says.

In the most severe cases, large tophi — dense masses of uric acid — may invade the spine and reach into the spinal canal, sometimes damaging the spinal cord.

Dr. Mandell cautions, however, that uric acid deposits don’t always cause gout attacks and that spinal gout — though more prevalent than once thought and likely undertreated — is still uncommon.  

It may be worth talking with your doctor if you have back pain and a history of gout. You should be even more suspicious if you use diuretics, have high blood pressure or are obese. Early diagnosis and treatment with uric acid-lowering drugs may prevent the need for surgery to relieve pressure on the spine.