gout attack with normal level of uric acid

[Abdullahiswrdu]

I got foot pain 2 years back in third finger joint .

Doctor diagnosed and found the uric acid level is high. he declared that it is gout.

Now my uric acid level is normal. but I got same problem for three days. Pain in third finger joint.

Is it really gout. Is it possible to get attack when the uric acid level is normal? Is it possible to get gout attack in third finger joint.

please advise me

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Is your uric acid blood test result safe or normal?

[Keith Taylor]

Review Risky Uric Acid Levels

From a discussion today, I identified that Risky Uric Acid Levels needs to be reviewed.

So far, I’ve identified:

• It needs a summary of key points.
• Uric acid in the blood usually falls during a gout attack.
• Next step is usually get a followup test to establish Base-line uric acid level.
• Crystallization point falls as temperature falls. So, risks of gout are much more in this range if joint temperature is lower than 98.6F

But also, like all GoutPal pages, it needs a clearly identified audience/purpose and a takehome message.

Most importantly, I think it needs to be more relevant to typical gout sufferers. Because, as we see from this discussion, doctors and patients fail to see that the higher end of the normal uric acid range is risky. Or even dangerous!

So how do you think I could improve my Risky Uric Acid Levels page to make it clear that getting uric acid normal does not remove the risk of gout attacks?

[André Chénier]

I was diagnosed with gout many years ago although my uric acid levels were in the normal range (high normal)

A doctor in a clinic overruled my family physician’s diagnostic (based on a blood test) when he saw my toe when I had to go to emergency. He said that uric levels are not fail-safe predictors.

[Keith Taylor]

You know, I get really angry about “normal uric acid“. So angry, that I started that campaigning website to try and remove the phrase from our language. No chance!

But, I now realize, it’s a language problem.

Normal does not mean OK, though it’s often interpreted as such. Thus, it’s normal for traffic accidents, heart attacks, cancer, war, and many other unpleasant things to happen. So much so, that any area free of those things for an extended time period is considered unusual, or abnormal. Thus, any gout-free country would be abnormal.

Achieving normal uric acid simply means that your chances of having gout are the same as every other patient who has blood tests processed at the particular laboratory. This might have some value for the administrators of your health practice. And, for the health department of your government. Those administrators might assess their performance. Which has nothing to do with individual patient needs.

On a personal level, “normal uric acid” has absolutely no medical value whatsoever. It is medically meaningless.

Gout patients must aim to get their uric acid safe.

I strongly recommend you use my help in these forums to assess your safe uric acid level. Then, we can get your doctor to give you the right uric acid lowering treatment to keep you free from gout.

Failure to make uric acid safe reduces both the quality and length of your life.

In a group of doctors I used to go to, only 1 doctor that I saw agreed that 7mg/dL was high enough to warrant treatment. The other 3 thought it was acceptable because the lab reported it within the normal range. It is impossible to avoid the life-threatening risks of gout when uric acid is as high as 7. Yet 3 out of 4 doctors manage by numbers, rather than by patients needs.

André, your emergency doctor was right to generalize that “uric levels are not fail-safe predictors”. But, in most cases blood test results are reliable enough to dictate appropriate treatment. And, cases of uric acid above 6mg/dL that do not warrant treatment are exceptional. As far from normal as you can get.

[André Chénier]

Thank you. Interesting information about the word “normal”.

The equation normal = safe must come from the deduction that normal levels are the levels found in most people, and since most people don’t suffer from gout, those levels could be considered safe.

But, since individuals are not “most people” that logic doesn’t work in real life.

[Patrick]

Great info guys. The thing is that all bodies cope with things differently. Kind of like Keith’s example of “normal”. Everybody has a differnet machine. My body may cope with issues differently than Keith’s or Andre’s.

Example: If you have European ancestory, you may have a precursor to high cholesterol. Germans and Dutch specifically. Your Cholesterol, through ancestry and DNA, may be high per the FDA (above 200) but you are a normal, healthy person. For me, 200 may be a giant Red Flag, and my doctor may want my to go on Lipitor or some other Cholesterol reducing drug.

I think this is the same for Gout and Uric Acid. If you have a family history of Gout, or are predisposed to it, than a Uric Acid reading of….lets say 6.0 is going to raise a Red Flag. But if you don’t have a family history or any prediposed history of Gout, than you may walk around the planet with a Uric Acid of 6.0 with no symptoms or flare ups.

The word “safe” or “normal” are misnomers. It’s a guideline and that’s it. Try and get your Uric Acid below 5.0 and the chances of having Gout attacks are lower than they would be if your Uric Acid is 8.0. That’s the reality. There is no such thing as “safe” or “normal”.

Again, just my opinion.

[Keith Taylor]

Patrick is absolutely right. It’s really a question of interpreting the language.

This is especially true with tests like liver function and kidney function tests. A good doctor looks at what is usual for the patient, and reacts accordingly. If there is only one test result, it’s hard to know what is “normal” for that patient.

I emphasize safe uric acid levels. But, when I said “assess your safe uric acid level” I didn’t emphasize the personal nature of that assessment. For most people, prolonged periods of uric acid under 5mg/dL is safe. By prolonged periods, I mean every year. But, for people exposed to very low temperatures, that safe assessment might need to be revised downwards.

Rule 1. Gout Treatment must be Personal.
Rule 2. Don’t let language get in the way of acceptable medical management.

I think a snappier version of Rule 2 might be “Never Accept Normal”. Because, it is perfectly normal to be ill medically. Though, it is abnormal personally.

But, all I’m really doing is re-wording Patrick’s closing paragraph. His opinion is very sound advice. “Try and get your Uric Acid below 5.0 and the chances of having Gout attacks are lower than they would be if your Uric Acid is 8.0. That’s the reality.” It’s the foundation of any sound gout treatment plan. So, ignoring that advice makes you a Gout Victim. To avoid being a Gout Victim, you should know what is your personal safe uric acid target. Then, you should monitor whichever uric acid control therapy you choose to ensure it stays safe.

Patrick mentions lowering your chances of a gout attack. Every gout sufferer can lower those chances of attack to zero. I’m here to help. But, I can only do that effectively when I know about you as an individual.

So, let me bring this back to the original questions “Is it possible to get attack when the uric acid level is normal? Is it possible to get gout attack in third finger joint.”

Both those are possible. Your doctor should be able to explain that. And, explain how to avoid both possibilities. If your doctor can’t explain, then Patrick or I can. I hope 2017 encourages other recovered/recovering gout sufferers to share their personal experiences.

Happy New Year, everyone.

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