DEAR DR. GOTT: Does gout ever affect anything other than joints? My brother thinks he has gout in his middle back. Thank you.
DEAR READER: Not to my knowledge. Gout is a complex form of arthritis that attacks joints – primarily those of the great toe. It occurs when urate crystals form in a joint because of high levels of uric acid in the blood. The body naturally produces uric acid during the breakdown of purines, a large group of nitrogen compounds that may be products of protein digestion in the diet, from some drugs and even from caffeine. Those foods high in purines that should be avoided include legumes, organ meats, anchovies, sardines and more. The healthy individual’s uric acid dissolves in the blood, passes to the kidneys and is excreted through urine. When the system fails and the body either produces too much uric acid or the kidneys excrete too little uric acid, there can be a build-up of the needle-like urate crystals in or around joints. The result is extreme pain, swelling and inflammation.
Those individuals at an increased risk for developing gout include those who drink excessive amounts of alcohol, have a family history, take low-dose aspirin or thiazide diuretics often prescribed for hypertension and being male.
Middle back pain occurs anywhere from the base of the neck to the lower end of the rib cage and can have many causes to include a herniated disc, sciatica and rheumatoid arthritis to name a few. You don’t mention whether the pain is between the shoulder blades that can occur from twisting too hard in one direction, lifting an object incorrectly, having bad posture for extended periods of time, or from trauma such as an automobile accident or from a contact sport such as a football game.
I’ve learned never to say never but it is very unlikely the pain your brother has is associated with gout. I recommend you take a few minutes and attempt to review the possibilities. Did he twist at work a few days prior, get too physical when stacking wood, or carry an overload of books to the attic? Perhaps he fell and one of his vertebral bodies collapsed unknowingly. In essence, could he have injured himself without realizing it at the time? Does he drive for extended periods of time with a wallet in his back pocket? Has your brother attempted to rest his back, taken over-the-counter pain relievers, or asked for something stronger in the form of prescription medication? The problem could be arthritis but if so, he will likely experience pain in other joints of his body as well. If he can pinpoint the cause, he can take steps to prevent the problem from happening again. If not, he should ask his physician if a referral to an orthopedic specialist is appropriate. Perhaps simple X-rays, an MRI or CT scan are required to determine if there is something else going on.
Your brother owes it to himself to take rapid steps to get to the bottom of the issue in order to determine if he has a condition that can be remedied with OTC or prescription medication, proper exercise, yoga, tai chi, physical therapy, or through other methods. Help is available but the cause must be found before it can be fixed.
Readers who are interested in related information can order my Health Report “Gout” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
