Why does your shoulder hurt repeatedly? Watch for gout

Produced by: Science Popularization China

Author: Mai Bo, Hu Yingyi, Sun Qianbing

Producer: Guangdong Provincial Association for Science and Technology

Mr. Chen, 62, has been diagnosed with diabetes for five years, with generally controlled blood sugar levels. About a month ago, while doing household chores, he suddenly experienced pain in his right shoulder. Mistakenly believing it was just a flare-up of shoulder arthritis, he chose to rest and did not give it much thought. However, a week later, the pain returned. After several days of physiotherapy without improvement, the pain worsened to the point where lifting his arm became difficult. Realizing the seriousness of his situation and fearing potential joint damage from diabetes, he promptly consulted the endocrinology department at the Red Cross Hospital in Guangzhou.

The attending physician quickly ordered relevant examinations, including biochemical tests and shoulder joint X-rays. Blood test results indicated that Mr. Chen's uric acid level was as high as 509 umol/L, and the X-ray revealed a high-density shadow in the shoulder joint. Over-the-counter painkillers provided little relief from the shoulder pain. Drawing on years of clinical experience in treating gout, the attending physician decided it was essential to rule out gouty arthritis and ordered a highly specific examination—dual-energy CT. This test revealed the cause of Mr. Chen's pain: uric acid crystals concealed deep within the joint! Following an adjustment in his gout medication, Mr. Chen's condition was soon brought under control.

Gout has increasingly become a modern disease that can affect any joint.

Dr. Chen Guangshu, an attending physician in the Endocrinology Department at Guangzhou Red Cross Hospital, noted that the diversification of diets and a lack of physical exercise have led to rising blood uric acid levels during health screenings. Recent studies indicate that the prevalence of hyperuricemia in China is as high as 13.3%, with approximately one-third of individuals with elevated uric acid likely to experience gout attacks. The most common site for gouty arthritis is typically the big toe, though it can also affect the dorsum of the foot, ankle, and knee joints.

The experience of a gout attack is quite memorable. In the early stages of gout, the pain may not be particularly severe, but over time, the accumulation of uric acid crystals in the joints can lead to various degrees of deformity. The pain associated with gout attacks may become progressively worse. Literature indicates that joints such as the shoulders, hips, and spine—characterized by rich blood supply and a higher alkalinity in joint fluid—are less likely to accumulate uric acid crystals and thus less frequently experience gout. However, the growing number of potential gout patients has led to an increasing range of joints affected by gouty arthritis. Reports of gout in these areas are relatively uncommon, largely because physicians from different specializations may not fully recognize gout, and the limited availability of dual-energy CT scanning may result in significant misdiagnoses and improper treatments.

Many individuals suffer from both hyperuricemia and shoulder-neck pain, yet the likelihood of gouty arthritis affecting the shoulder joint may be underestimated. Literature describes the deposition of uric acid crystals in the shoulder joint, potentially leading to secondary ligament injuries or calcification, which complicates treatment and can result in poorer outcomes. Therefore, early identification and timely, effective treatment are particularly crucial.

Gout management is advancing, and it warrants attention.

To enhance the diagnosis, differentiation, and management of gout patients, the Department of Endocrinology and Metabolic Diseases at Guangzhou Red Cross Hospital has collaborated with the Radiology Department to implement dual-source CT joint gout spectroscopy analysis technology. Dual-energy CT imaging offers a non-invasive means to detect and clearly visualize gout nodules, making it an optimal first-line screening tool for investigating shoulder pain related to hyperuricemia. Naturally, it is also essential to distinguish pain due to gout in the shoulder from other conditions, such as frozen shoulder, rheumatoid arthritis, and ligament injuries.

Dr. Chen Guangshu stresses that if blood uric acid levels remain persistently high accompanied by severe pain in one shoulder or other joints, it is important to consult an endocrinology and gout specialist to avoid missing a diagnosis of gouty arthritis.

Five Misconceptions About Gout Treatment

Myth 1: Gout is trivial since many people have it; simply taking some painkillers will suffice.

Research indicates that hyperuricemia often accompanies other metabolic diseases like diabetes and hypertension. A significant concern is the potential development of urate nephropathy. Chronic use of painkillers can contribute to deteriorating kidney function, which may worsen gout attacks and create a vicious cycle.

Misconception 2: Medications for lowering uric acid can harm the liver and kidneys, so they should be avoided or taken minimally.

Chronic hyperuricemia and gouty stones can lead to kidney damage. While uric acid-lowering medications carry some risk of liver dysfunction, this probability is low. With careful monitoring, any adverse reactions can be promptly managed, alleviating excessive concerns.

Misconception 3: Avoiding seafood will prevent gouty arthritis.

The primary cause of hyperuricemia lies in insufficient liver enzymatic activity or reduced kidney excretion of uric acid, which leads to its buildup in the blood. Dietary factors contribute less than 20% to hyperuricemia, making it difficult to significantly lower elevated uric acid levels solely by diet control.

Misconception 4: Febuxostat is a miracle drug that will certainly control gout attacks.

Some individuals remain hyperuricemic even after taking febuxostat, possibly due to genetic variants affecting renal uric acid transport proteins, which cause excessive reabsorption of uric acid by the renal tubules. If febuxostat proves ineffective, it may be beneficial to investigate genetic risks for gout/hyperuricemia to seek targeted treatment for gout.

Myth 5: Gout does not require prolonged medication; lowering uric acid levels is enough.

Standardized diagnosis and treatment of gout is crucial. Discontinuing medication independently can easily lead to recurrent arthritis, kidney damage, and other complications that are not worth the risks.

Five Precautions for Gout Patients in Daily Life

1. Gout Advisory – Minimize Gatherings:

Avoid or minimize seafood, beer, and barbecue, as these can trigger gout.

2. Limit red meat and organ meats.

Animal purines can raise uric acid levels more readily than plant purines. It is advisable to restrict the intake of red meat, offal, and related processed products to no more than twice a week while consuming foods such as mushrooms, cauliflower, and spinach in moderation.

3. Regular exercise for weight management is essential:

Consistent aerobic exercise can effectively control weight and diminish the frequency of gout attacks.

4. Limit consumption of fructose-containing beverages.

Reduce intake of sweetened drinks and beer while also limiting rich soups.

5. Incorporating milk and coffee can be beneficial:

Consuming 250 milliliters of milk daily can decrease the risk of gout in men by 50%. Low-fat milk, yogurt, and coffee can also help reduce uric acid levels.

Content from: Guangdong Provincial Association for Science and Technology

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