Many questions – could this be gout

[DL]

Hello and good work.

So I’ve had a number of pain related problems for around 3-4 years. Started with shoulder pain which I believed was triggered by a gym session, I remember a few weeks after the initial pain I had a few nights of overwhelming sharp pain under my armpit. After seeing physios, having blood tests, MRIs, x-rays I was given no answers as to the problems. The pain went on for months, I was due to have surgery, at which point they was going to open up my shoulder and deal with what ever they found. THEN my other should started to ache with pain so I decided not to go for surgery. I had another few sharp pains under the other arm pit, the pain was excruciating and happened when laying in bed at night. I then had neck pain and an MRI showed some wear and tear at the top of my spine but no treatment offered. The pain persisted but but not the sharp pain described as Gout. 3 months ago my right hip started to ache and again MRI and x-ray showed nothing conclusive. I has some blood tests recently and my Dr said they showed something… high uric acid levels and mentioned gout. I am due to have my uric levels tested again.

So this all leaves me with some questions. Could the sharp pain under my armpits and dull pain and aching in neck shoulders and hip be cause by Gout? I have never had a swollen toe or anything that many would associate with gout. I do remember a short episode, a few hours, of a finger becoming hot and red but not swollen. I am 35 and have always been medium to slim build. My diet is reasonably healthy. I drink a lot but then so do many of my friends. If this is all gout am I left with permanent damage and pain to my should joints, neck and hip?

Thank you for any assistance you can offer.

[Keith Taylor]

My golden rule is – if diagnosis is not clear, but gout is suspected, then go and see a rheumatologist.

However, there are other ways forward, but we have to break the problem down to consider high uric acid and joint pain separately.

If uric acid is “high” then you may well have gout, but this is likely to be complicated by injury/strain from gym sessions. You might also have another rheumatic condition, but this would need further tests by a rheumatologist to confirm or discount.

As I only know about gout, I’ll have to concentrate on that.

First, “high” is not really good enough to describe uric acid test results. The number is important, and as much history as possible is very useful. The mismatch that we have here is:
A) I am very good at interpreting uric acid blood test results, but I do not have exact numbers and history.
B) Your doctor has exact test results, but might not be good at interpreting them. I say this because 3 out of 4 doctors do not understand uric acid blood test results.

If you can supply better results history, I can make my advice more personal. Without this, I will make general points that I believe could be relevant to your case.

I’m going to use common UK units of measure for uric acid test results – mmol/L, with mg/dL equivalents in brackets for all our American friends reading this.

If uric acid is above 0.36mmol/L (6mg/dL) then it is more likely than not that you have gout. The only way to be certain is to have joint fluid tested by a rheumatologist. Your choice is to get that confirmation, or to proceed as if it is gout. To proceed with assumed gout treatment, you need to get uric acid below 0.30 mmol/L (5mg/dL) then wait to see if pain improves. The waiting time depends on 2 facts:
1) Your uric acid test result history
2) The level you can reduce uric acid to, starting ASAP.

Of course, this is a very broad brush, because I simply do not have enough facts to advise you properly. In my experience, if a doctor describes uric acid as “high” then I see it as “dangerous” because they usually mean over 0.4 mmol/L (over 7 mg/dL). At that level, people are almost certain to suffer gout at some time in future. The trend these days, for those who truly understand gout, is to keep uric acid safe before it does any damage.

Speaking of damage, this is clearly a concern in your case. Again, without decent history, I cannot guess if your wear and tear is gout-related, or something else. If it is gout related, then recent research has shown that gout-damaged joints can recover if uric acid is lowered enough.

Finally, you mention diet. This can be a factor in many gout cases, but it is never as significant as genetics. I always maintain that, if you follow a healthy diet, then changing it is not likely to improve your gout. On the other hand, if you are obese, or consume excess alcohol, then the other health risks outweigh gout. Obesity and alcohol abuse are likely to cause heart-related death, so need to be dealt with irrespective of gout.

I hope you understand that this is all information that you should discuss with your doctor. I can provide relevant references if required, though your doctor can simply consult the British Rheumatologist’s guidelines for facts about uric acid values. I am not a doctor, and there might be other indicators from your history, or from examination, that point to a different diagnosis.

[Keith Taylor]

Hey, @danlord78

Unless there is a massive coincidence, I believe you must be the DL who posted this topic when not logged in. If you post when not logged in, the topics and replies do not get linked to your profile, and you do not get all the benefits from the Members menus near the top of the page. I guess I should try to make this clearer, and I have a mind to do so, though no clear ideas on how to make it easier to understand.

Anyway, DL, if you want me to link your post to your member profile, just ask.

The main reason for me coming here today was a thought I had about my diet paragraph, especially alcohol.

I do not want to imply that you are abusing alcohol, or have any other alcohol-related issues. Maybe I could have responded better to “I drink a lot but then so do many of my friends.” So, I’ll try again.

Lots of gout sufferers get worried by alcohol. It’s often overplayed as a gout factor, but it is a health issue. The problem centers around volume, or specifically ‘excessive alcohol intake’

I’m also part of a culture raised on regular social drinking. I know that, occasionally, I drink too much. But, as you say, so do many of my friends. Firstly, forget comparisons with other people. They are not likely to tell the truth about any fears or health issues they have about alcohol. There are 2 important personal questions:
1. Am I drinking unhealthy amounts of alcohol?
2. Is alcohol affecting my gout?

If (1.) is yes, then you have to cut down, and (2.) is largely irrelevant.
To answer (2.), you have to measure it against 2 things – gout pain and uric acid levels. These are both separate. It is not simple to find a definitive answer, as everyone is different.

Gout pain and alcohol is fairly easy to test, unless you drink every night. Keep a gout pain log, and alcohol intake log. If there is a pattern, you have your answer, but make sure it is proper statistical analysis, and not just picking facts to suit your wishes.

Uric acid and alcohol testing involves longer periods of abstinence, but is quite easy. If you are very careful, you can do it yourself, but best done with a doctor. Agree a test schedule with your doc, then alternate abstinence with normal drinking between tests, then compare trends. You have to repeat this many times to rule out confounding factors. You have to remain true to your abstinence periods. Personally, I’d rather take allopurinol than be bothered with that hassle, but it will give you a definitive personal answer. That is worth far more than all the rubbish that is written about alcohol and gout.

Please login DL, and let me know what you think.

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