Facet Joint Gouty Arthropathy: An Uncommon Cause of Chronic Lumbar Pain

Gout is a well-recognised metabolic disorder typically affecting peripheral joints; however, axial involvement remains underdiagnosed and poorly understood. Facet joint gouty tophi, although rare, represent an important manifestation of gout that can significantly impact patient outcomes. This case report details a 27-year-old gentleman who presented with left-sided lower back pain for the past three years on a background of poorly controlled gout and obesity. A contrast-enhanced MRI revealed T1-weighted contrast enhancement at the L4-L5 facet joint area and a possible punched-out erosion, suggestive of facet joint gouty arthropathy and tophaceous changes, given his history of poorly controlled gout. This case report discusses the prevalence, presentation, imaging and management of facet joint gout arthropathy as an uncommon cause of chronic lower back pain.