Peripheral arthrocentesis in the work-up of acute low back pain

Involvement of the axial skeleton in acute gouty arthritis has rarely been reported. Without the presence of peripheral tophi or history of gout, this diagnosis is often not considered. A patient is described with acute low back pain and for whom a diagnosis of acute axial gout was suggested after arthrocentesis of an asymptomatic peripheral joint yielded monosodium urate crystals. Treatment with colchicine led to prompt resolution of the gouty flare. Demonstration of urate crystals in this manner may encourage the clinician to attempt a trial therapy for acute gout, or at least to add gout to the differential diagnosis of acute back pain.