Are my symptoms consistent with gout?

[derekja]

So over the last few months I’ve had some very severe foot pain. It’s not classic gout, in the sense that the pain is really more in my ankle joint than it is my toe and the swelling doesn’t seem to be huge and intense, but the pain sure is!

It usually comes on pretty suddenly. And I thought it was related to the shoes I was wearing. So I got some custom orthotics made. That maybe helps? The smaller, more manageable foot pains seem to be less anyway. But I still get this sharp ankle pain that comes on suddenly overnight.

I first started thinking gout when I realized that it had come on this last time after eating a big meal of pork sausage, and last time after a couple of days of munching mainly on lentil stew. A blood uric acid test about a week after the last attack read 6.2. I bought the UAsure home testing meter, and my first test on it read 5.9 mg/dL. My foot feels a bit tender right now, but I’m not in the midst of an actual attack.

Does all this sound consistent with gout? I’ve had kidney stones before, but they were calcium oxylate kidney stones rather than uric acid stones. That makes me want to do something to rule out pseudo-gout, but I’m not sure what would differentiate between the two.

I guess it’s on to diet changes and regular uric acid testing. Probably once a week or so, right? Uric acid levels won’t change within a couple of hours of a meal like blood glucose does, would they?

Thanks!

-Derek

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[derekja]

Hmm, one more thought. So I took my blood uric acid again here at the end of the day and it was 6.2. How much fluctuation is normal? Does the fact that it is higher at the end of the day mean I'm eating things that are raising it?

Thanks.

[Keith Taylor (GoutPal Admin)]

First off, you need to get away from the often spouted notion that food = gout.

Uric acid levels rise and fall from many factors, of which food is one. Fluid intake, temperature, trauma and use of medications are a few of the other factors.

With gout, a significant factor is the cycle of a gout attack. 6.8 mg/dL is the normal saturation point where crystals can form, but it is common to have levels higher than this without crystals forming (hyperuricemia).

Assuming a normal saturation point, all things being equal, as soon as crystals form, uric acid is removed from the blood stream, and so the level falls. However, all things are not equal – we continue to eat, drink, urinate, and metabolize more (or less) uric acid, and so the levels fluctuate.

Of particular significance is the fact that gout flares can occur when uric acid levels fall, and old crystals start to dissolve. This is the most important point when managing gout. You must not value a treatment, or lifestyle change, against a change in pain – only a change in uric acid level.

You can still experience pain when uric acid levels are below 6.8 mg/dL, but they will reduce in intensity and frequency until they fade completely. Reducing the level to 5 – 5.5 will speed this process. A rise above 6.8 may not be immediately painful, but you increase your risk of gout pain sometime in future.

Over time, you can monitor levels and try to determine patterns, but it is extremely difficult to keep all factors constant, except the one you are measuring. Scientific studies have the advantage of several subjects from which averages can be taken, but even in these, you often see the rider that the conclusions are subject to reservations about factors outside the scope of the study.

By now, you may be wondering “What is the point of measuring uric acid ?” The main reason is to give you a record of your uric acid level so that you can see trends. It gives you factual data every time you do it, often allowing you to rule out factors that you thought were important.

If you lead a very structured, repetitive life, then the data you collect will be more useful than if you always eat, drink and exercise at different times, in different ways, each day.

The most noticeable point about Derek's results are that they are well within the normal range. My first advice would be to get tested by a professional, and compare your own results take immediately before or after.

In any event uric acid tests, for the reasons stated above, are not a satisfactory method of diagnosing gout. They are useful in management of gout for several reasons, but limited use in diagnosis.

I strongly recommend professional analysis of joint fluid. This process, arthrocentesis, is the only way to reliably diagnose gout. It is no more painful than a regular blood test, but it has the massive advantage of confirming gout, and testing for similar conditions.

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