Is this an Arthritis or Gout question?

[GoutPal Arthritis]

GoutPal exists to help gout sufferers. But, sometimes, people are unsure if they have gout, or something else. You cannot treat gout effectively if you are not certain it is gout!

Keith introduced GoutPal Gout Sufferer Types, for 2 reasons:
– To help GoutPal visitors find information relevant to them.
– To help me frame my responses better, when people ask for personal help.

So, the Arthritis Sufferer Discussions help you be sure if you have gout, or a different form of arthritis. If you cannot get a confirmed diagnosis, we can discuss if you should assume that you do have gout. Then, if treatment resolves your symptoms, you can improve your quality of life.

Unfortunately, many questions are not very clear. If there seems to be doubt, but very little information, I will move messages here. If I get more information, I can move the message to it’s own topic. If not, it is helpful to see the type of questions that arthritis sufferers ask.

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

I also add old Arthritis Sufferer discussions here, when GoutPal memberships lapse.

[GoutPal Arthritis]

Hi I was diagnosed with tendinitis about 6months ago in my ankle but for the last 3 months I have been getting attacks of really bad pain in the joint at the top right hand side of my right foot at the ankle . I visited my gp and she tested my uric acid levels which were high she prescribed naproxen and colcohine tablets for relief of gout , I asked her about allopurinol but she said she would rather I changed my diet first which I have done and have lost 7lbs in weight so far but in this time I have had 3 more attacks of the gout which is now getting me depressed as I can not play any sport as walking is really painful . Today I have taken it on myself to start taking allopurinol not sure if this is a good step but I am desperate and was lucky enough to have a wife that takes this drug already . Io have no confidence in my gp she is more interested in my diet than my pain I’m 5ft 6in and weigh 13st 6lb . What would you suggest I do for the best Regards Robert

[originally posted by lapsed GoutPal member: Robert Taylor]

[Gout Patient]

I have had similar problems with my GP. My gout first started in the classic place, the big toe. Uric acid was normal, so he prescribed surgery for bone spurs. Next attack, middle finger. He said it was cellulitis. Gave me antibiotics and sent me to a hand surgeon to look at the ‘mucous cysts’ in that finger. The surgeon took one look, said, ‘that’s gout’ and sent me for lab tests where my uric acid was found to be 10.9. I think gout is too complex an illness for the average run of the mill GP. If I were you, I would make an appointment with a rheumatologist ASAP. You need to be under the care of a physician who understands gout.

[Keith Taylor]

Hi Robert,

Listen to Linda!

Another alternative is that we work together to train your GP. The conversation I would have with her goes something like:

"I absolutely agree that I need to improve my diet, and lose more weight. However, this is going to take me at least a year. It might take longer, because gout pain is limiting the amount of exercise I can do. I am also worried that uric acid crystals are damaging my joints, and strenuous exercise might cause serious damage. If I can start allopurinol now, it will reduce the risks of continuing damage from uric acid crystals. That will help me to exercise more and get healthier."

If she can’t accept that Robert, can you see another GP? I had to consult 4 before I found one smart enough to listen to the facts.

Please don’t play around with pills nicked from your wife. Allopurinol needs to be taken at the right dose for each patient. Sharing just means neither of you are getting enough.
Under-dosing allopurinol does very little to reduce the burden of uric acid crystals.
Under-dosing allopurinol does a lot to increase immediate risk of gout flares! Who wants the science?

[Gout Patient]

Robert: I might add here that weight loss can also raise your uric acid levels and cause flares. Allopurinol is often given prophylactically when patients are in an accelerated weight loss program. So you are in a catch-22 place….She says you must lose weight before you go on medication, but the simple act of losing weight will make you more likely to flare, and then you can’t exercise…and round and round we go.

[Keith Taylor]

Excellent point of view, Linda. The logic to break that cycle of inaction is clear:
1. Control gout pain. In 21st century gout pain after a few hours is a sure indication of a bad gout pain treatment plan.
2. Control uric acid. Those uric acid crystals are just as much a threat to mortality as obesity is, so start ASAP.
3. Get healthy. Slow steady weight loss and healthy exercise are much easier when you know you’ve beaten gout. With respect to Robert’s heritage, I lost over 3 stone once I recovered from my gout illness. For my American friends, that’s over 40 pounds. 🙂

[GoutPal Arthritis]

My doctor says I have gout but I don’t think so. …I have polycystic kidney disease and that has resulted in elevated uric acid about 9.0….my only symptom is tender red raised patches sometimes near a joint but not always. No actual joint pain at all.I also have positive anti rho antibody. …I think this is autoimmune response most likely Sjogrens but he wants me to take uloric

[Keith Taylor]

Gout symptoms are always interesting, Martha. We’ve had quite a few discussions over the years about redness, itching, eczema, and similar symptoms. People don’t realize these are typical of gout. But, they are very common. If you want to know the medical reasons for this, please let me know.

When I did a survey of gout symptoms, redness was the second highest. Over 60% of gout sufferers experience redness, with or without associated pain.

[GoutPal Arthritis]

I have been experiencing symptoms of gout periodically for a couple of years now. Each flare-up brings fairly standard gout symptoms, and the triggers are fairly standard gout triggers. My doctor ran blood tests and my uric acid levels were not high, so he drew fluid from the affected joint
There were no uric acid crystals in the fluid. (There also were no calcium crystals to indicate pseudogout, which was the other possibility.)

I later explained this all to my chiropractor, and she said that it would be diagnosed as non-uric acid gout, which I had never heard of. I tried looking it up for more information and I can’t find anything about it. Has anybody ever heard of it or had a similar experience?

Side note: I don’t know if this has any significance, but I do not fit the typical demographic for a gout-sufferer. I am a 24 year old female. I know it has led my doctors to doubt that I could have it, but does that mean I couldn’t have gout?
Any insight is appreciated!

[Keith Taylor]

Hi Amanda,

I’ve known females of your age with gout. It can’t be ruled out. But, I don’t have enough information to rule it in. This is really a job for a rheumatologist. I say that because differential diagnosis is a specialist subject. It’s beyond what can be accomplished with an Internet chat. But, I’ll give you some partial explanations, based on what I know so far.

Gout symptoms
“Each flare-up brings fairly standard gout symptoms,”
There are no such things as standard gout symptoms. My first doctor I consulted thought gout had standard symptoms. He failed to diagnose my gout.
Can you describe your gout symptoms in detail? ❓

Gout triggers
” and the triggers are fairly standard gout triggers.”
There are no such things as standard gout triggers. Every gout sufferer is different.
Can you describe your gout triggers in detail? ❓

Gout tests
” My doctor ran blood tests and my uric acid levels were not high,”
‘Not high’ is meaningless.
Can you get your full numeric result? ❓

” so he drew fluid from the affected joint
There were no uric acid crystals in the fluid. (There also were no calcium crystals to indicate pseudogout, which was the other possibility.)”
Were tests done immediately with polarizing microscopy? ❓
Was fluid also tested for bugs? ❓
Any other tests for diseases that display gout-like symptoms? ❓

Gout
“non-uric acid gout, which I had never heard of.”
And neither has anyone else because there is no such thing. By definition!

As I say, you really need diagnosing by a specialist. But, the most essential thing, is uric acid numbers. Please find and post the results of every uric acid test you can get. Dates, and exact numbers (with scale) are important.

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