Can You Get Gout in the Neck?



neck pain and gout

Uric acid crystals in the neck tissues can cause symptoms of gouty arthritis - but is neck surgery really necessary?

Neck pain has many causes but those with gouty arthritis might wish to talk to their physician about the possible connection between neck pain and gout. Gout can affect the head and neck at any stage of the disease but is usually a symptom in patients who have had gout for a long time.

Primary manifestations of gout in the neck are tophi and cricoarytenoid arthritis and many sufferers notice pain originating from behind the ear, in the jaw, or even deep in the neck causing both pain and altered speech or hoarseness. Where neck pain and gout are connected an MRI can often reveal the location of uric acid deposits, which may require surgical removal.

Signs of Gout in the Neck

Tophi are aggregates of elongated needle-shaped crystals formed by the body due to an inability to eliminate uric acid. On an MRI tophi may look like bundles of wheat and the body surrounds these with foreign body giant cells, histiocytes, and dense fibrous connective tissue, creating swelling and inflammation, as well as structural deformity. Spotting uric acid crystal deposits in the cervical spine or tissue of the neck can be more difficult than detecting them in other joints such as in the hands or feet. Gout in the big toe is particularly common, whereas there are many more reasons for pain in the neck, such as degenerative disc disease and osteoarthritis. Gout in the temporomandibular joint (jaw) is very rare but neck and jaw pain referred from gouty arthritis in the neck may occur in some cases.

Gout Symptoms in the Neck

Symptoms of gout in the neck may include acute progressive neck pain, sensory dysfunction in the arms and hands, weakness of the hands and even problems walking if the spinal cord itself is compressed along with cervical spinal nerves. Problems with speech (dysphonia), and swallowing (dysphagia), may also occur and some patients may have hoarseness and neck pain, difficulty swallowing, excess or reduced oral secretions, and even aspiration pneumonia if the gout in the neck is pronounced and goes untreated. Neck pain from gout may occur as a result of crystal deposits in the spine itself or from uric acid tophi in the soft palate, uvula, glossoepiglottic fold, hyoid bone, thyroid cartilage, and even the tongue and trachea, amongst other tissues in the neck and head.


Treating Gout in the Neck

Treatments for gout and neck pain may include injections of Teflon to address vocal cord paralysis, improve speech and reduce difficulties with oral and respiratory tract secretions. General gout treatments include medications such as colchicine, allopurinol, probenecid, corticosteroids, and nonsteroidal, anti-inflammatory agents (NSAIDs) in order to lower the levels of urate in the system and/or interrupt the inflammatory pathways. Treating gout and neck pain early in the course of the disease can help dissolve tophi but some patients may have persistent deformity of the joints and resultant pain and neurological symptoms if the aggregates are large and longstanding.

Cervical Spine Surgery for Gout

Some patients suffering from gout and neck pain will need neck surgery to remove the offending accumulations of uric acid crystals. Luckily, most cases of gout are diagnosed early in the disease and medications to treat gout prevent tophi developing to such a severe degree. Antihyperuricemic therapy can also prevent disabling joint problems that may result from gout and reduce the possibility of renal failure that can also occur in the disease. Those who have gout and arthritis, or some other degenerative joint issue affecting the cervical spine are more likely to need arthroplastic procedures to correct deformities and restore mobility and function.

Neck Gout

Gout is a common metabolic disorder that may be the cause of neck pain and recurrent arthritis symptoms. Axial skeleton involvement is, however, rare but does occur; there does not appear to be any higher proportion of cases of gout in the neck than in the thoracic or lumbar spine but symptoms may arise more slowly in less mobile spinal regions that incur fewer degenerative changes due to wear and tear. Sharp turning of the neck may produce acute neck pain from gout, as can awkward spinal posture when sitting at a desk, in a car, or when holding a phone for long periods of time.

Gout, Neck Pain and Diet

Gout sufferers may experience acute neck pain several days after drinking beer and/or eating high purine foods such as shellfish or meats, although the effect of diet on uric acid levels and gout symptoms is not thought as pronounced as it once was. Gout and neck pain may be connected in some patients and MRI scans and tests of urate levels can help diagnose the condition. Where neck pain is caused by gout there are numerous medications and treatments for gout that can help with neck pain relief and, for most patients, neck surgery for gout is unnecessary.

References

Barnes, L., Surgical Pathology of the Head and Neck, Volume 2, Marcel Dekker, Inc., New York, Basel, 2001.

Pankhania, A.C., Patankar, T., Du Plessis, D., (2006), Neck pain: an unusual presentation of a common disease, The British Journal of Radiology, 7), 537–539.

Duprez TP, et al. Gout in the cervical spine: MR pattern mimicking disk vertebral infection. AJNR Am J Neuroradiol, 1996;17:151–3.

Kaye PV, Dreyer MD. Spinal gout: an unusual clinical and cytological presentation. Cytopathology 1999;10:411–4.

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