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Gout Patient

[original posted by jeremiah-taylor]

29 year old white male / 6 ft. / 265 lbs. / United States

This all started on 3.13.16 and the only thing that is helping is prednisone. I wake up with ankle pain and by the afternoon my ankles are swollen. I also have what feels like muscular pain in my thighs and it’s very difficult for me to stand up and sit down.

Current meds: Metropolol Succinate XL, Fluoxetine, Amlodipine. Was prescribed Wellbutrin XL on 2.8.2016 and took that up until 3.28.2016 when my prescription was discontinued.
Close to a month ago (3.13.2016) I woke up with pain and swelling in my ankles as well as pain in the heels of both feet. After two days of the pain worsening I went to the ER (3.15.2016) where, upon a visual inspection, the doctor diagnosed it as cellulitis and prescribed antibiotics. Two days later, the pain persisted so I visited my family doctor where I was prescribed Prednisone and had blood labs performed (3.17.2016). I took the Prednisone that day and by the next morning I could walk again. The pain and swelling had disappeared completely.
The tests that were performed were:
Uric Acid (6.8 mg/dL)
Lyme (Negative)
Rheumatoid Factor (11 IU/mL)
Sedimentation Rate (42 mm/hour)
Compr Metab Panel
CBC/Diff – with flags for for the following components: (WBC: 11.83 K/uL; MPV: 11.8 fL; SEGS: 76%; LYMPHS: 12%; ABS. SEGS: 8.96 K/uL)
The Prednisone was a tapered 10-day dosage, and on the day of my last dose (3.26.2016) the pain began to return and was even worse than it was before. On 3.28.2016 I went to the ER and was admitted for testing and observation.
While in the hospital (3/28/2016), in addition to ultrasounds for DVT/blood clots (negative), they ran another series of blood labs:
Uric Acid (6.7 mg/dL)
CRP, Low Sensitivity (18 mg/L)
Rheumatoid Factor (11 IU/mL)
Sedimentation Rate (24 mm/hour)
Compr Metab Panel
CBC/Diff – with flags for for the following components: (WBC: 12.25 K/uL; SEGS: 80%; LYMPHS: 10%; ABS. SEGS: 9.76 K/uL)
25-Hydroxy Vitamin D (16 ng/mL)
Complement C3 (185 mg/dL)
Complement C4 (32 mg/dL)
ANA (Negative)
CCP IGG AB (<16 Units)
That night they gave me more Prednisone and when I woke up the next morning the pain and swelling were gone and I could walk again. They ran another battery of labs that day, with slight changes in the CBC/Diff. I was also visited by a Rheumatologist who diagnosed the whole thing as gout and gave me a 20-day tapered dosage of Prednisone and then discharged me. The results of the labs from the day I was discharged (3.29.2016) were:
Hepatitis C Antibody (Negative)
Hep B Surface Antigen (Negative)
CBC/Diff – with flags for for the following components: (WBC: 11.90 K/uL; SEGS: 87%; LYMPHS: 9%; ABS. SEGS: 10.35 K/uL)
For the first 5 days I was out, I was taking 20mgs of Prednisone per day and everything has been fine. The last two days I have been taking 15mgs of Prednisone. The problem is that last night I experienced some minor swelling and this morning there is a little swelling as well some pain. My fear is that once I taper off the Prednisone the whole thing is going to become awful again and I will spend more time in the ER/hospital with no one being able to figure out what is actually wrong with me. What else should I be telling them to test for? What are they missing? Can this really only be gout? The doctors I met with all seemed a bit perplexed by the whole thing so the final diagnosis was not exactly reassuring.