Gout is a type of inflammatory arthritis that affects more than 8 million people in the United States.

It’s caused by the buildup of a substance called uric acid in your joints. The most common place for gout to develop is your big toe. Other common places are your other toes, ankles, or knees.

If gout is left untreated, uric acid crystals may start to build up in other areas, such as your spine, rib cage, or skull.

Spinal gout is considered rare. From 2000 to 2014, only 68 case reports were published in medical literature. However, it’s hard to know exactly how common it is because its symptoms are nonspecific, and it’s thought to often go undiagnosed. Some studies estimate that it may affect up to 22 to 35 percent of people with gout.

Keep reading as we take a deeper look at spinal gout, including symptoms, causes, and treatment.

Symptoms of spinal gout are nonspecific and can mimic many other conditions.

Potential symptoms include:

Gout symptoms alternate between flare-ups and periods with no symptoms.

In a 2016 study, researchers found that 69.1 percent of 68 people with spinal gout experienced back or neck pain. The lower spine was the most common place gout developed and the upper spine was the least common area.

Gout is caused by a build-up of uric acid in your body. This condition is called hyperuricemia. However, not everybody with hyperuricemia develops gout.

Your body produces uric acid when it breaks down chemicals called purines found in some foods. Too much uric acid creates crystals that build up in your joints, fluids, and tissues. If left untreated, masses of these crystals called tophi can form outside of your joints in places such as your spinal column.

Some people are more likely to develop hyperuricemia and gout. Risk factors include:

Spinal gout is managed with a combination of medications and home management strategies. The same medications are used to treat spinal gout and gout that affects your joints.

A doctor or healthcare professional can recommend the best way to manage your disease. Common treatment options include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as naproxen, ibuprofen, or indomethacin, are commonly used to treat pain and inflammation during flare-ups.
  • Colchicine. Colchicine is an alternative to NSAIDs for people with NSAID allergies, chronic kidney disease, or other conditions that make them ineligible for NSAIDs.
  • Lifestyle changes to prevent future flare-ups. Lifestyle changes, such as eating a balanced diet, limiting alcohol and high purine foods, and keeping a moderate weight, can help prevent future flare-ups.
  • Preventive therapy. Doctors may recommend drugs, such as allopurinol, febuxostat, or pegloticase, for preventing tophi and kidney stones.

Flare-ups should be treated in the first 24 hours to reduce their severity and duration. Gout flare-ups generally last 5 to 7 days. If left untreated, spinal gout can cause permanent spinal cord damage.

It’s important to see a doctor if you have unidentified back pain or other potentially concerning symptoms, such as muscle numbness and weakness.

The British National Health Service recommends looking for urgent attention if you have symptoms that could indicate an infection, such as:

  • you feel sick and can’t eat
  • you have a high fever
  • your pain is getting worse

Diagnosing spinal gout can be difficult because it doesn’t cause any specific symptoms.

A doctor called a rheumatologist, who specializes in arthritis and diseases of joints, bones, and muscles, can diagnose gout.

Gout can only be diagnosed during flare-ups when lab tests can find uric acid crystals.

A doctor may measure your uric acid levels with a blood test. Uric acid levels above 7 milligrams per deciliter are indicative of hyperuricemia.

A doctor may order imaging tests, such as an MRI scan, CT scan, or X-ray, to look for signs of spinal compression or other abnormalities.

A biopsy or surgical sampling of uric acid crystals is needed to confirm a diagnosis. Another imaging test, dual-energy computed tomography, specifically finds uric acid deposits. A doctor may recommend this scan if a biopsy is unsuccessful.

In a 2020 study, researchers estimated that 77 percent of gout cases may have been preventable in a group of 44,654 men followed over 26 years. They estimated that gout could’ve been prevented had all men:

  • kept a healthy weight
  • avoided alcohol
  • avoided diuretics
  • followed a diet similar to the DASH diet (diet based on dietary approaches to stop hypertension), developed to prevent high blood pressure

A doctor can give you specific strategies to prevent future gout flare-ups. Some changes you can make include:

  • eating a balanced diet
  • minimizing your intake of purines
  • limiting alcohol
  • getting or staying physically active
  • keeping a healthy weight if you’re a person who’s overweight or a person with obesity
  • taking care to prevent joint injuries

Foods that are high or moderately high in purines that you may want to avoid include:

  • red meat
  • organ meat
  • game meat
  • some fish and seafood, such as:
    • tuna
    • trout
    • mussels
    • sardines
    • mackerel
    • anchovies
    • haddock
    • herring
    • crab
    • shrimp
    • roe

Read more about the best diet for gout.

Gout is a type of inflammatory arthritis caused by the buildup of uric acid. The most common place for gout to develop is in your big toe. Spinal gout is considered rare, but it’s thought that it’s underdiagnosed because it doesn’t cause any specific symptoms.

It’s important to see a doctor as soon as possible if you think you’re having a gout flare-up. Prompt treatment can minimize the severity and duration of your symptoms.