Fed up with diagnostic process — need answers!

[Keith Taylor (GoutPal Admin)]

I'll try to keep it brief.  Gout symptoms occurred after hysterectomy a few years ago.  Father had it.  Big toe not affected; smaller toes are forming tophi.  Pain, redness, swelling in ankles, knees, elbows, ears.  All problem foods bring it on, mostly meats, spinach, peanuts, and assorted others.  I rarely drink.  Blood test read normal uric acid levels.  Rheumatologist not helpful at all; in fact, seemed apathetic, arrogant, and a little threatened by the level of knowledge with which I came to her office, the result of my own research.  Both she and my primary care physician seem to exhibit a degree of ignorance about symptoms.   Rheumatologist told me to come back when I have an “acute attack,” and she'd aspirate the joint–IF it was a joint that can be aspirated.  I'd already told her I don't have terrible attacks, because I watch what I eat, so I'd try to trigger an attack by having a big prime rib meal with wine.  She said the attack would come by itself, I shouldn't have to trigger it.  Which just left me confused and frustrated.  My problems definitely seem food-related; also, xtreme stress and fatigue can aggravate.  Baking soda helps (although the sodium can be a problem).   Naproxen helps, but I worry about eventual side effects from that. 

I've never returned to the rheumatologist.  At least not that one.  There's another one in town who seems more compassionate.  Meanwhile, I've learned that attacks can occur without consumption of problem foods.

What I'd like to know is why I feel symptoms so soon–I'm talking within minutes–of eating problem foods.  Some tell me I'm just anticipating the pain, symptoms couldn't possibly arise that quickly.  Have had typical attacks where pain sets in within a few hours of eating problem foods, too.

I'm concerned because I know there are drugs that could help, but so far I've been unable to get a firm diagnosis.  I'm in almost constant pain of greater or lesser degree, and am disheartened by the thought of another round of tests and professional ignorance.  It's okay to be ignorant, just not close-minded and opinionated. 

Is it true that you must be in the middle of an acute attack before a joint can be aspirated?  Is it possible to experience pain within minutes of consuming problem foods?    

[Keith Taylor (GoutPal Admin)]

You say that “smaller toes are forming tophi.  Pain, redness, swelling in ankles, knees, elbows, ears. “

I do not understand why these cannot be tested for uric acid crystals, especially the tophi. An attack is an attack, no matter what it's severity, so if you are in constant pain, you are in a constant state of suitability for a fluid test or tophi investigation.

I believe the link between gout and food is very overrated, and often misunderstood. In fact, I've commented on this at length in my reply to a gout sufferer who seems to have similar experiences to you.

If you are experiencing problems within minutes of eating problem foods, then it sounds more like a food allergy to me, or possibly psychosomatic.

By the way, can I please ask all contributors to stop referring to blood uric acid test results as “normal” or “high”. The range that some labs choose to label normal, is anything but. You need to consider specific numbers before you can draw any conclusions. Even better, is to have the results from a series of tests, so that you can identify trends.

[zip2play]

I'm with GoutPal right down the line here. Nothing is so infuriating than to have a dimwitted doctor say “Your uric acid is fine” when he's looking at a lab printout that shows a range extending to 9.0 mg/dL as NORMAL when in fact, for someone with  gout anything over 6 is DISASTROUS.

I'm old school on this VERY old disease and instead of this “aspiration” crap for a diagnosis to use colchicine. If colchicine stops a sore joint in its tracks quickly, it;s GOUT.
After all, when Thom,as Jefferson and Benjamin Franklin had flare ups of their gout, I doubt any doctor was required to aspirate their joints and send the goo off to QUEST DIAGNOSTICS.

[Keith Taylor (GoutPal Admin)]

Actually, I am a big advocate for aspiration, or arthrocentesis as it is also called.

OK, if you are diagnosed with gout, take allopurinol to maintain uric acid level below 6mg/dL for 1 year (and this MUST be monitored), then the chances are that you have gout, but you no longer get gout attacks because you are controlling it properly.

This happy situation is all too rare. Misdiagnosis is common, so I say, if in doubt, get your joint fluid checked. It's a certain, straightforward process that gives you the best indication of gout from the outset. Why take the risk of mistreating pseudogout, septic arthritis or some other gout-like condition?

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