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Greeetings all. I could really do with some advice as nothing seems to be working to date. I have spent hours and hours surfing your brilliant site and getting more and more frustrated with the medical profession – not helped by living in a rural area – and a real dilemna.
Until 9 days ago I was a relatively healthy, fit, 90kg 60 year old male with no health problems. (Approximately 15 years ago I had two gout incidents in my big toe, but was never warned about possible future consequences).
THEN, 9 days ago the excrutiating pain in my knee started!
My self diagnosis (after surfing your site) was gout:
– I went from no pain to instant pain late at night
– Had dined on a superb steak & kidney pie with several glasses of wine
– Had worked extremely hard all day in high temperatures with little re-hydration
– Had just completed 2X courses of antibiotics
– Was on low dose asprin (self prescribed – precautionary only)
– Had been on a high purine diet for years!
The knee has remained slightly swollen for the past 9 days, the area of pain is very general – inside and all around the knee but internal, but not sore to touch – just horrendous 24/7.
Have had a huge raft of X-rays/blood/urine/motion tests and the two locum doctors (sigh!) advise that there is NOTHING out of the ordinary showing up in the tests – they have no idea what the problem is. In particular, they advise my UA reading is 2.3 with the average at 3.0 – obviously there must be a different test/scale to what is mentioned on your site. Anyone help there???
I have cut out all purines, am drinking gallons of water, swallowing baking soda, doctors are reluctant to put me on any specific gout medication so I continue suffering by overdosing on Prednisone, anti-inflamatories, codeine etc and am really despairing.
It has almost reached the stage where I will present at the hospital A&E and refuse to leave until I am pain free and a diagnosis has been made.
I would sincerely appreciate ANY thoughts/ideas/suggestions.
Welcome, to the board. Wow! sorry to hear about your pain! I would say imo that with a UA of 2.3-3.0 I would not suspect gout…maybe pseudogout?
Hi Kiwiken!
“(Approximately 15 years ago I had two gout incidents in my big toe, but was never warned about possible future consequences)”
Were they certain it was gout then?
“The knee has remained slightly swollen for the past 9 days, the area of pain is very general – inside and all around the knee but internal, but not sore to touch”
Every attack I've had was EXTREMELY painful to touch.
And I agree with cjeezy, with a UA level that low it seems rare that it would be gout. However, with that being said, there are cases where you can have a high UA level and not get gout, or you can have a low UA level and get it. That's why I'm curious if they were certain it was gout 15 years ago.
You also mentioned the fact that you worked very hard that day. Maybe you injured your knee somehow? You mentioned the x-rays showed nothing wrong, but if you have ligament or tendon damage I don't think they would show up on an x-ray. I may be wrong though.
If I were you, I would see another doctor. See if they can explain it.
Good luck, I know it can really suck.
Many thanks for your speedy responses to date.
In reply:
– The gout in same big toe 15 years ago, was diagnosed as gout and had all the typical symptoms.
– Current problem in same leg. Doubt if it is from damage from the heavy exercise that day (was nothing too unusual for this time of year – working hard on our fig and pomegranate orchard) – no pain whatsoever until I woke up from settee late at night after that lovely purine rich dinner!
Just back from another round of tests (glucose tolerance, Hepatitis A, Denge serology, Leptospira serology, rickettsia serology) – it all seems to me to be getting too far from the reality of the situation/symptoms, although I am recently returned from a malarial area (Solomon Islands) but experienced no problems there. Last bout of malaria was in Zimbabwe in 1993, was there 4 years and not unaccustomed to tropical diseases/symptoms/prevention.
Any idea of the particular UA test I was given, where normal for the test is 3.0 ????
I have been just soooooooooo careful with diet etc over last 9 days – am trying to pluck up courage to have a day off it on high purine diet to test for worsening symptoms.
Again, many thanks
They may be measuring your UA in mmol/L instead of mg/dl, which would give you a reading of about 5 mg/dl – still low, but levels usually drop during an attack, so this may not reflect your true average. Ignorant Drs may not know this; you need to see a rheumatologist really.
Dehydration can send your UA levels through the roof very quickly and could trigger an attack. You might want to give colchicine a try & definitely cut out meat & alcohol
“levels usually drop during an attack, so this may not reflect your true average. Ignorant Drs may not know this”
Truth!
I was always getting my UA levels checked WHILE I was undergoing almost continuous attacks in one joint or another. I was told I didn't have gout because my UA levels were 'normal'. Be wary of this and when you're feeling better, make sure to THEN get your UA levels checked. Try to do it a couple of times to establish an average if possible, but only when you don't feel 'gouty'.
Another approach – have fluid drained from the affected joint and tested for UA crystals. This is the only sure-fire way to know if you truly have gout or not. Over the past six months, I've had my knees drained at least 6 or 7 times. One important thing if you go this route – make sure that the lab they test the samples at is on the premise or very close by. Transporting the samples can destroy the crystals very easily!
I wish you luck! Feel better!
Ken,
Using my imagination there are conversions to molar units that would possibly transpose 6 mg/dL to 360 micro-moles/liter and this would be .36 millimoles per liter or it might be expressed as 3.6 micro-moles per cubic centiliter (or cc.) If so, then a 3 would be normal but not preposterously low. Yes one could have an attack and show 6 mg/dL.
I'm not sure what they use is NZ?
(Wouldn't it be nice if the world would standardize…preferable to the U.S. system because I'm willing to BET that most doctors cannot define what a MOLE is (even though they learned it in chem class.) After all a milligram is a milligram and it can be weighed, unlike a mole which differs from chemical to chemical.
Knees are very hard to diagnose with gout without an actual aspiration showing crystals.
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