New to Gout

[Jeff Chen]

Hello all,

I am a 33 year old male, 6 foot tall about 195lbs. Beginning in March/April this year I started feeling some “soreness” in my left big toe. It kind of felt like a sprain toe, where it wasn’t painful, but there was discomfort (I’d rate it as like 1/10). I didn’t really think too much about it, but the discomfort never subsided. I started to do some research, and kind of ended up thinking it was a bunion. I went to a podiatrist. He took some x-rays and “confirmed” a bunion… He recommended orthotics to help alleviate the pressure on the toe.

I started wearing these orthotics, and I would say when wearing them the pain/discomfort was better. But would never fully go away. Interestingly enough, a couple of weeks later, I started to develop a creaky knee, this time on my right side, whenever I bent or flexed my knee. There was no pain at all, but it just felt very awkward and not normal. I called the podiatrist and he said that this was normal and to give it a few weeks. A few weeks went by, and the creakyness has gotten worse. Now running or going up and down stairs gives me extreme discomfort (still to this day). My right foot would also randomly swell up, like I had a sprained ankle a couple of times. I go in to see the podiatrist. He hears my knee and was like this isn’t caused by orthotics. “You have a loose patella. You need to go see your primary about this”.

I went to go see my primary, he has xrays done. It comes back as pretty much normal, but a hint of Osteo arthritis. I thought there’s no way this is just OA. The creakyness was way to abnormal sounding (almost like a grinding noise). I decided to make an appointment with an orthopedic sports medicine doctor. When he does my exam, he also has no clue what it is. He told me he had never heard anything like this before. He drew some knee fluid out and ordered a bunch of tests. Then gave me a cortisone injection in the knee. The next couple of days were interesting. My knee started to feel better. The creakyness and grinding subsided, and strangely enough so did my “bunion.” At the same time, even this discomfort in my elbow (which I though I got from leaning on my elbow too much) started to feel better too. All this was short lived, as a couple days later, the creakyness in my knee slowly came back. The orthopedic doctor then called me and told me they found Uric acid crystals in the knee fluid. I was so surprised. How can I have gout at 33? I mean I was overweight, but not that overweight. A rush of thoughts go through my head. Are my kidneys okay? Do I have kidney disease? Am I dying? That day I was determined to eat healthier and lose a lot of weight.

I went back to the orthopedic surgeon, he ordered a bunch of labs and an MRI. MRI came back normal. No tissue damage. ESR was high, but everything else was relatively normal (CRP, CMP, BMP). He then told me I should go see a Rheumatologist. I saw my Rheumatologist this week, and described to her everything I had just said. She told me she didn’t think it was gout because I was too young, and the symptoms didn’t match because none of my pain seemed to be acute. At this time, I also started getting some discomfort in my right hand knuckle. She told me she suspected psoriatic arthritis, but still wanted to rule out gout. She said usually Uric acid crystals in the knee is diagnostic of gout, but I just didn’t seem to fit the bill. She then ordered a bunch of labs and xrays and told me to come back in a couple months for another knee tap since I recently had a cortisone injection (she also mentioned that cortisone should have wiped out all the uric acid crystal inflammation so it didn’t seem right that it would come back so soon). Anyways, later that night, the doctor emails me and said we found extremely high uric acid levels in your blood. I think at this point, we can diagnose you with gout. I now am waiting for Monday to go over some treatment options with her.

Thank you, if you are still with me. I am still all very new to this situation. Has anyone here had any similar stories of hunting down mysterious aches and pains just to find out it is gout? Is it strange that I never felt any type of acute type of pain in my joints, like how it is classically described with gout? Will gout treatment help make my knee go back to normal? Does having gout mean there is something wrong with your kidneys? I plan to ask the doctor to order more tests to find out about my renal functions, but it does have me worried, especially since I am relatively young. I also don’t drink hardly ever, and don’t eat seafood. I do enjoy red meat quite a bit, but don’t feel like I eat excessively. Since getting word that I had uric acid crystals in my knee, I’ve been on intense diet restriction as well as increasing my exercise. I’ve lost quite a bit of weight in a short amount of time, which I recently learned can contribute to increased uric acid levels in blood. I am just pretty determined to get to a healthier weight level. Any advice and experience is greatly appreciated to this potentially new member of the gout channel.

tldr: I had discomfort in my big toe that I thought was a bunion. Saw a podiatrist that recommended orthotics. Developed a creak/grinding knee and also sometimes swollen foot. Went to primary and then orthopedic surgeon. Xrays and MRI came back normal. Knee fluid aspirate showed uric acid crystals. Freaked out, started working out and changed diet immediately. Went to see a Rheumatologist. At first she didn’t think it was gout as symptoms and no acute flares didn’t match with gout. Got a blood test that showed high uric acid levels. Waiting on Monday to go over gout treatment. Any advice or similar experiences getting diagnosed would help me feel like I’m not alone in this.

[nobody]

Hello,

Sure, your symptoms aren’t typical of gout. But non-typical symptoms happen.
Developing gout at 33 or younger seems quite common as far as I know, and you don’t need to have kidney disease to get gout (though it would be prudent to rule out such a disease).
For what it’s worth, I’ve gotten the patella misdiagnosis as well as the strangely self-spraining ankle. I haven’t got something that looks like a bunion but if you have enough uric acid, I guess you could get a tophi that looks like a bunion.
Gout treatments work very slowly so you’ll need to be patient but in time, you’ll know if all the problems you’ve experienced were caused by uric acid or not. In the meantime, it might be prudent to investigate other explanations (just in case).

Extremely high levels in the blood plus crystals means you would probably benefit from gout treatment even if you do not actually have gout because these crystals are a problem anyway and you’ll probably get more and more without treatment. You also are at risk of developing gout as long if you don’t already have it. Treatment might actually trigger gout but even if it does, you would probably have ended up with worse problems without treatment.
The one thing to be careful about with gout treatment is the side effects. Some people get bad reactions and the doctor may offer a genetic test or a less risky drug than the one people usually take for gout. Whatever drug you get, start with a very small dose, report anything strange to a doctor and get tested for hidden side effects such as liver toxicity. Hopefully the doctor will take care of all this and more but I’m warning you just in case the doctor you’re seeing Monday isn’t very careful.

[Jeff Chen]

Thank you for the reply. As I dig deeper into the gout forums, I see a lot of people mentioning allo, and how it is a very beneficial treatment without huge side effects. Is this something I should be pushing with my doctor if they don’t already suggest it?

[nobody]

I said “the one people usually take” instead of allo because I didn’t want to suggest specific drugs since that’s your doctor’s job, I don’t know your case anywhere as well as your doctor and I don’t know which drugs are available or how much they cost where you live. But like I said above, there is an alternative that works just as well and would arguably be safer for you so allo might not be your doctor’s first choice.
Unless your case is unusual, your doctor will most likely suggest allo or that alternative so I do not expect you’ll have to push for anything. If your doctor doesn’t suggest either, they’ll probably have a good reason not to so listen to them anyway.

[Jeff Chen]

Is it possible to still have normal kidney functions but still have gout, or does gout usually mean there is some underlying issues with the kidneys not able to get rid of uric acid?

[nobody]

You can have good kidney function and still have gout. I understand this is actually typical when it comes to young gout sufferers.
There are different reasons why one’s uric acid might be high, some of them avoidable and some genetic.
But since your uric acid seems to be “extremely high”, maybe there are several causes combining to make the problem especially bad. So perhaps you are more likely to have a kidney problem than the average gout sufferer. Depending on how high exactly is “extremely”, it might be prudent to ask your doctors to perform whatever tests they can to make sure they’re not missing a serious problem which could in time cause more problems than just gout.

[Author]

Posts