Gout and the Sacroiliac Joint

Question: I have had episodes of gout…Can gout issues indicate other problems like sacroiliac joint dysfunction?

I have had episodes of gout for the last 8 years and recently also started getting back spasms/pain. MRI, CAT scan and x-rays all show nothing except a slightly bulged L4-L5 disc, but the doctors agree this is not likely the cause of my symptoms. Could my past gout issues indicate another joint problem like sacroiliac joint dysfunction? If yes, then what tests should I expect in order to confirm this? What sort of treatments would be recommended for the sacroiliac joint pain and will this make my gout worse? The gout has been very difficult for me to deal with and I really don’t want to add hip and leg pain on top of it.

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Doctor’s Response: Gout can be a generalized condition which can affect many joints, usually in the big toe but including the sacroiliac joint

Gout can be a generalized condition which can affect many joints. The classic joint is the metatarsophalangeal joint of the big toe. However, the sacroiliac joint could be affected as well. What would need to be done is, first of all, to treat as completely as possible the underlying condition of your gout. If that is being treated as well as can be, and the sacroiliac joint area is still hurting, then the sacroiliac joint needs to be injected, as that is the gold standard for determining whether the sacroiliac joint is indeed generating pain.

If gout is part of the condition, then, during the injection, the professional who is doing the injection under image injects not only an anesthetic to verify that this is a painful joint by giving it temporary relief, but also a steroid compound, which can actually help treat the gouty process. Because your MRI, CAT scan, and x-rays do not show any changes in the sacroiliac joint, I presume that the sacroiliac joint was indeed imaged with these tests; then, it is very unlikely that an inflammatory condition like gout is what is affecting your sacroiliac joint.

Also, the fact that you have a bulging disk at L4-5 becomes important, as all lumbar pathology must be ruled out before the sacroiliac joint can be incriminated. You could be suffering from discogenic pain at L4-5 and/or foraminal narrowing at L4-5, which could be masquerading as sacroiliac joint pain. Therefore, a good workup needs to be done by someone who does injections well, to determine whether your pain is coming from the L4-5 level or the sacroiliac joint.

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In Spine-health’s Doctor Advice section, physicians respond to frequently asked questions about back pain issues. These responses represent the opinion of one physician, and do not necessarily reflect the views of the broader medical community. The advice presented has not been peer reviewed by Spine-health’s medical advisory board.