Do I have gout or pseudo-gout?

[Yafeng Xu]

About 3 weeks ago, I felt pain (not very acute) in my left big toe so went to see GP, who told me that it’s very likely gout. I was so sad to hear that because (1) I am not overweight (2) I am a 45 year old woman (3) I exercise regularly (4) I don’t drink alchol at all (5) generally I believe I am in a very good diet.

GP didn’t ask me to take any medicine but advise more water and Vitamin C, as the toe was not swollen or red and I could walk like normal (though a bit pain).

About 10 days later, my pain didn’t go away and I also felt pain on the (front) back of my foot, though not worsen much compared before. So I went to see another GP, who told me that it may not be gout because (1) the toe (and surrounding area) was not reddish, not swollen (though might be a little bit); (2) I could stand and walk without much pain. Therefore, this GP sent me for X-ray which I will have the result next week.

During these 2 weeks I also bought USure test kit to measure my uric acid level a few times (a few days apart each). Here are the results (3.8, 4.1, 3.2, 5.3, 5.1). I also started talking Cherry supplement one week ago.

Anyone here may advise me my situation? thanks a lot.

Yafeng

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Discuss if you have gout. Or, a different type of arthritis.

[nobody]

Best get your uric acid tested professionally. If the result agrees with your own test kit, great. But I wouldn’t recommend simply assuming these results are accurate.
If the results are accurate, I guess gout is unlikely. It’s not impossible to have gout with such results but your symptoms aren’t typical either. Maybe they’ll become more recognizable later though.

If you symptoms persist but diagnosis proves difficult, consider seeing a rheumatologist.

[Yafeng Xu]

Thank you very much, ‘nobody’, for your advice. Yes I will ask GP for blood test next week and report results here. Do you think the X-ray result may tell whether it’s gout or not?

[nobody]

Gout does damage bones and X-rays are a diagnosis tool. But it’s not the best way to diagnose gout. My understanding is that gout damage will only show in severe cases, when gout has been allowed to fester.
X-rays could reveal something other than gout though. That would make gout even less likely.

Whatever the X-rays show, your blood test results should be revealing.
I recommend testing yourself before the profesionnal blood test (the less time between the two tests, the better).

[Yafeng Xu]

Thanks, ‘nobody’, again for the suggestion.

In my previous post I replied two participants and sought their opinion about food good for me during this period, but it seems they are not online. It would be great if you can help.

My questions is whether eating kiwi fruit and porridge (made of dry beans such as black bean, green bean, read bean, etc.) is bad for gout. Any opinion?

[nobody]

I think it’s too early for you to worry about food. As I understand it, you never had a blood test showing that you have a uric acid problem.

If you did have too much uric acid in your system, the following basic recommendation would apply: inasmuch as your other health problems allow, get much of your protein from dairy (preferably skimmed milk and yogurt made from such) and eggs. Comsume plant-based protein sources for variety and for the other nutrients they contain. That said, beans and such are preferable to animal flesh or substitutes made from single-celled organisms or mushrooms.
Kiwis are fine as long as you do not eat ridiculous amounts. Depending on the variety, apples might contain twice as much fructose per weight. And since apples are often larger than kiwis, you’d need to eat quite a few kiwis to get as much fructose as you’d get from a large apple. Kiwis also contain a lot more vitamin C which might help with gout.

[Yafeng Xu]

Thanks again, ‘nobody’, for your views. Before I had pain in my left big toe (thus went to see GP), I had Kefir Milk everyday (made by myself from grain) for about 3 months. I stopped drinking it as I suspected that could be cause of my problem especially I had Kefir milk together with fruit jam (with loads of fuctose or syrup).

No, I haven’t done a blood test. But just let you know, ‘nobody’, my brother has gout for a few years already, and I tend to have cold hands/feet in winter due to poor blood circulation. Reading the articles in this forum, I feel my chance of having gout seems not small -:(

Anyway, I will update you after seeing GP next week.

[nobody]

Based on the data I’ve seen, there are not enough bacteria in regular yogurt for them to be a problem in terms of uric acid. I assume kefir doesn’t have many more bateria but I don’t know that for a fact.
Even if your kefir was a problem in terms of uric acid, 3 months is a short time to develop gout. People often have dangerous amounts of uric acid in their blood for years before they start developing symptoms.

Kefir could also be a trigger for gout and other auto-immune problems if it contains things which excite your immune system for whatever reason.
But if you are experiencing gout symptoms, the root cause is uric acid rather than the triggers. Solving your uric acid problem (if you indeed have one) would allow you consume triggering foods without experiencing gout symptoms.

[Yafeng Xu]

Hi ‘nobody’, I had the blood test last Fri (23rd Feb) in the hospital. Today I got the result, 252 umol/L, ie about 4.2 mg/dl, normal. Back to my own measure during last 4 weeks, (3.8, 4.1, 3.2, 5.3, 5.1), it seems these results are relatively accurate. May I say it’s unlikely a gout? Thanks.

[Jean Clyne]

Here in Canada, docs are not going solely on uric acid levels to diagnose gout. In some cases they are not testing for them any more but rather are needling the sore joint to see if any uric acid crystals are present, to give a definitive diagnosis. Toe and ankle pain are both very common sites, if I understand correctly any damage won’t show up on xray until it is quite advanced. I have gout with “normal” range of uric acid levels, between 258 and 361 umol/litre. I have a rheumatologist appointment next week so it will be very interesting to see what he has to say. Your xray may show bone changes as in osteoarthritis or rheumatoid arthritis and as a result give you a different diagnosis. In my case the first symptoms of gout were hot, itchy sore feet, ankles,fingers, always rotating between different sites. I finally realized that these seemingly random symptoms would always come on with eating meat, beef especially and ingestion of sugar.Good luck in finding your answers.

[Yafeng Xu]

Thanks, Jean. Giving my urate level, here GP (UK) thinks it’s unlikely gout and does not recommend needling. Now, I accidently found that my pain might be due to bunion: https://www.scpod.org/foot-health/common-foot-problems/bunions/ . Came across anything like this before, Jean?

[nobody]

Yes, according to mainstream thinking, gout is unlikely given your hospital test.
But it would be worth repeating the test after a few months if your symptoms persist, just to make sure the first professional result wasn’t a fluke and that your uric acid does not vary seasonally.

It is also correct that a blood test is insufficient to diagnose gout while finding crystals in joint fluid is a much better basis for diagnosis.
Unfortunately, it is not the easiest test to perform and a negative result doesn’t rule out gout.

Jean here has significantly higher uric than you do, Yafeng.
I need to take a drug which lowers uric acid in order to get a test result similar to yours and Jean is probably in the same situation.
Whether the test result is “normal” or not is irrevelant as gout is much less likely when people test at the low end of the “normal” range than when they test at the high end of the same range.

There are many potential causes of join pain, especially if the problem is limited to a single joint in which case it might indeed be caused by something like a bunion. Untreated gout on the other hand often goes on to affect other joints.
If your GP doesn’t help, best get a specialist to examine your foot in person and investigate possible causes for your symptoms.

[d q]

Generally speaking pseudo gout is caused by calcium build-up (CPPD) around joints and not Uric Acid build-up [which leads to gout and further complications].

The simplest form of test that can be conducted to accurately rule out pseudo gout is an X-Ray or Ultrasound. Calcium build up on joints normally occurs within your cartilage as opposed to lining the surface of cartilage as with gout and this usually shows up on an X-Ray or Ultrasound (but not always).

Unfortunately however the treatment for pseudo gout caused by calcium build-up is not as easy to treat as gout.

[Jean Clyne]

You mentioned about bunions, now that is an interesting idea, would that show up definitely on your xray? Certainly something to look into. If your brother has gout you may have the hereditary genes to predispose you to it. Try to see a foot specialist or rheumatologist for some answers. This disease is like trying to find all the pieces of a puzzle and each persons puzzle is different.

[Yafeng Xu]

Thank you guys very much for the suggestions and analyses, I really appreciate it.

Yes, if it were not my brother’s gout, I could probably not have worried much given a low urate and GP’s verdicts. However, as said, gout is such a complex puzzle, a puzzle differs individually … a real headache, isn’t it?

No, two weeks ago X-ray did not tell anything wrong – normal as usual. Yeah, X-ray should have revealed if I had a bunion?

Anyway, I will book another blood test a few months later. In the meantime I am going to see a podiatrist about bunion or other potential biomechanical issues (such as imbalanced weight put on two feet), as referred by GP, and report you the result later on.

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