Uric acid 6.6. Do I have gout?

[GoutPal Arthritis]

For about 3 weeks now I have had swelling pain and have not been able to weight on my knee and leg. I have had pain in my big toe off and on and it has been worse today. My blood work came back with a 6.6 for uric acid and doctor said it was normal. Could I still have gout and is the reading high

[Tom]

Do I have Gout?

Back in approximately June 2015, I noticed some puffy growths on both of my wrists.

My GP thought they were ganglion cysts and sent me to a hand specialist who X rayed them. He rules out ganglion cysts and, since they did not hurt, advised me to leave them alone.

This past August my right wrist began to hurt a little, so I went back to the hand specialist who had an MRI done on it and had my blood tested for Uric acid. Based mostly on the Uric acid blood test, which was a little high, he diagnosed me with gout.

I have no symptoms of extreme pain or pain flare ups. My right wrist almost always hurts a little.

Is it possible I have osteo arthritis instead of gout ?

[Junior GoutPal]

“Based mostly on the Uric acid blood test, which was a little high,”

Please can you post the exact number, instead of “little high”. That will allow Keith to give a better opinion on your gout diagnosis question.

[GoutPal Victim]

Original post from Regina:

Do I have Gout in my Big Toe?

I was going to contact my doctor regarding swelling and pain on my big toe base. I saw this forum and was wondering if it is Gout. I am not sure as the way it started.

Two nights ago, I slightly woke up and my big toe on my right foot felt like it was jammed. So I cracked it by extending (I think) I felt a snap and pain for a moment. I went back to sleep and about an hour later it started to have more pain.

I saw what I thought was a bruise around the base of the big toe on the top, along with slight swelling. I went to work and the foot started to swell in my shoe. Last night I took pictures and took more Tylenol. The Tylenol helps at least during that time. I went to bed and pretty much slept through the whole night. Yes with a blanket on me.

This morning I woke up and the swelling was worse, along with the pain. Tylenol is not helping much. The outside of the foot/big toe at the joint is more swollen along with shiny redness. Went to work and could barely walk in my shoes. If I walked on the outside of the foot I can limp along.

Came home and put ice on the foot/big toe and it seemed to make the pain worse. In the shower, I can use the shower head close to my foot with warm/hot water and there is a lot of relief. The so-called bruising that I saw earlier is gone, can’t see it now. Also, if I elevate my foot for a while most of the pain goes away.

Took a Vicodin and the pain is pretty much gone. I am now three nights into this and have two sets of pictures, including my left foot next to it. Any ideas? Gout hasn’t been a part of the history of our family.

The true question is, do to the circumstances – popping/cracking my big toe joint, is this maybe the build up of the uric acid and even though I had relief at the moment, that it was Gout after all?

Appreciating any suggestions, help. thank you, ~Regina

[Patrick]

Regina,

The only way to properly diagnose if you have Gout is to get a blood test and have your Uric Acid measured. It sure sounds like a Gout Flare, but without the data of your Uric Acid results, one would only be guessing.

Once you get your blood drawn, schedule an appointment with a Rhuemotologist (a General Practiconeer might be hesitant to diagnose Gout) and have the Rhuemotologist go over the results with you.

This is truly the only way to tell if you have Gout. And the reality is, that if you DO have Gout, and this is your first attack, it will probably NOT be your last. Do yourself a favor, if only for piece of mind, get your blood checked.

[Keith Taylor]

“I was going to contact my doctor regarding swelling and pain on my big toe base”

Regina, have you seen your doctor about this yet? Did you get the uric acid test that Patrick recommended? If so, please post the results. We need the exact number, together with the scale (usually mg/dL in the States, and mmol/L in most other countries).

[GoutPal Victim]

I did get my UA back:
Name 12/8/16
Standard range
URIC 8.8
2.0 – 8.0 mg/dL

I talked with my Dr. today and had a prescription of for allopurinol 200 mg. I chose to take a different blood pressure medication – instead ofamiloride hydrochlorothiazide 5/50. She said we will have the blood test again in two weeks, including the CBC and WBC, for liver and kidney functions.

I only took the predinsone 20mg x 2 a day, for three days and found out that umm… no – need to take the dose for the whole 10 days as a recurrence is very high.

To night I rarely ever have a drink, eat red meat once in a while. I am 59, overweight and have been loosing weight slowly over the last 6 months. During the weight loss I eat about 3 to 5 mandarin oranges and 1/2 lb of apples a day.

Feedback please,

[Keith Taylor]

Thanks Regina, for your uric acid blood test results. They answer your headline question – yes, you do have gout. More than that, your blood pressure medication (amiloride hydrochlorothiazide 5/50) is probably the cause. Or, at least a major factor. It’s a pity your doctor is showing such ignorance of gout. But, maybe we can train her.

I’m hoping you’re experiencing no side effects with allopurinol. Professional recommendations are to start with 50 or 100mg per day. Then, increase inline with blood test results. I’m pleased to see you are getting another blood test after two weeks. That’s the perfect interval for allopurinol dose adjustment.

Hopefully, your uric acid will be safely below 5mg/dL soon. And, in the meantime, it’s good that you seem to have effective gout pain control. Once uric acid is safely below 5mg/dL, gout attacks will stop after a few weeks or months. Every gout patient has a different gout recovery time. But, the good news is that you are on the road to recovery.

Gout diet isn’t really an issue. But, if you are concerned, I can give you more feedback. It’s all about balancing your total diet in a healthy, gout-friendly way. Individual foods are only important once we’ve analyzed total diet.

What I’ve written here might raise other questions for you, Regina. Please don’t hesitate to ask for clarification of anything I write. And, please continue to post updates about your uric acid test results, and gout symptoms. I think you are well on the road to recovery. It will make me very happy when you can confirm that you are fully recovered from gout.

Incidentally, you don’t say what your replacement blood pressure medication is. Less of an issue if allopurinol is effective. I’m just nosy!

[Bruce Khavar]

I had stage two colon cancer.on December 4th of 2016 operation on my colon and took tuomr out. Now I have colostomy. Also during operation they made a whole in my bladder it is one month I am on Catherrte.

Four days ago I got gout attack on my left foot.swollen very bad and painfully

I took COLCHICiNE 6 mg for 3 days.
i am on 5 mg warfarrine for last two month.

[nobody]

6.6 is not very high but definitely high enough that gout can not be ruled out. Normal or abnormal doesn’t matter. A single borderline test isn’t definite anyway: if you were tested again, results might be a bit higher or a bit lower.
Gout can not be diagnosed based on a forum post, sorry.

In case your pain and swelling go away, consider getting tested again. In addition to uric acid monitoring, there are other blood tests such as ferritin which might give extra clues.

[Keith Taylor]

Whenever you have gout-like symptoms, but no clear gout diagnosis, you should consult a rheumatologist. Because, as well as further blood tests, joint fluid analysis is vital to rule out other potentially dangerous diseases.

What might arthritis be if it isn’t gout?

[Calum Connor]

Do i have Gout? Not 100% convinced!

Hi All,

Last month i woke up with a severely swollen left ankle, which was that painful that i couldn’t bare any weight on it.
I had worked 5×12 hour shifts(the days leading up to the incident) but i couldn’t remember going over on my ankle or being in pain the day before, which left me confused to why i woke up in such pain. I was literally having to crawl to get around my house.
The swelling was in my tendons around my ankle rather than in the joints which made me think that gout was out of the question.
I tried treating my ankle like it was a sprain, using the P.R.I.C.E method (Protection, Rest, Ice, Compressions and Elevation) and also taking pain killers and ibuprofen to bring down the swelling. Eventually after several days the swelling subsided but then after a few days at work the pain and swelling was back.

I went to see my doctors about it and he recommended that i have a blood test to check my Uric Acid level, although he did mention that i need to wait until the pain and swelling had completely gone. Due to it starting to affect my work and me needing answers, i ended up going for a blood test last Tuesday when i was still limping around in pain. My results came back today and my Uric Acid level was nearly 600umol/L. My doctor is suggesting that i have gout, but i am not fully convinced as i have no redness to the swelling and also it feels like it is more in my tendons around my ankle rather than in my joints.

Please if anyone can help it will be much appreciated.

Thanks in advance,

Calum

[nobody]

Yeah, that diagnosis was kinda quick if no other tests were done. If you have gout, you’ll probably know before very long as your symptoms become more obvious.
But in my modest experience, ankle symptoms are more like you describe than the classic gout symptoms in the toe. Then again, I’ve never had very bad ankle symptoms.
When you talk about the tendons around the ankle, was that more up the leg, towards the foot or both? How did it feel when you pushed on the area next to the tendons or when you tried to move your foot in a sort of circle around your ankle? Would simply lying down in the wrong position cause serious pain?
Any gout in the family?
If the pain and swelling have gone, it might also be worth re-testing uric acid. The result might be even higher now (which would be another clue).

Do get ahold of a pair of crutches. That will save your from crawling next time.
And ask the doctor how much ibuprofen you might take exactly, considering that you wouldn’t take that much every day. A green light to take a higher dose might come in handy next time as well.

[Calum Connor]

Hi,

Thanks for getting back to me, yeah i also thought it was a rather quick diagnosis.

When i pushed on my tendons around the ankle it hurt on both the tendon going up and the tendon going down my foot and it felt like it would if you pushed on your ankle if it was sprained, very sore and tender. The tendons that hurt more specifically:

External View(looking from the outside):
-Common tendinous sheath of fibularis (peroneus) longus and brevis.
-Fibularis (peroneus) longus tendon.
-Fibularis (peroneus) brevis tendon.
-Tendinous sheath of extensor digitorum longus and peroneus tertius.
-Fibularis (peroneus) tertius tendon.

Internal View(Looking from the inside):
-Posterior tibial tendon.

(I only know this as i looked at a diagram on google images).
I literally couldn’t move my foot in a circular motion as my foot/ankles flexibility was severely restricted and yes it did hurt when i slept in certain positions.
My Uncle has been diagnosed with gout but none of my parents have it.

The pain and swelling have almost gone but it is still slightly there so going to get my bloods done again when it fully subsides. If i get my bloods taken when i have fully recovered from the pain and swelling would that not mean that the uric acid levels will have decreased anyway?

Thanks for your help, much appreciated!

Calum.

[nobody]

Your ankle problem affected a more extensive area than mine. You seem to have had more swelling but less pain in response to pressure. Possibly someone who had more uric acid than I did (my tests were never anywhere near 600) would find your description more familiar.
With a test reading as high as yours and gout in your family, it certainly ought to be suspected in any joint pain.

The interaction between uric acid in the blood and gout is complicated.
When you go from being symptom-free to experiencing serious gouty inflammation, the immune system can contribute to uric acid going out of solution. This could turn into a bit of a chain reaction and the process can end up significantly lowering the amount of uric acid in the blood. Likewise, the blood of people who never had gout can sustain more uric acid in solution.
On the other hand, if the gout flareup is caused by a largish deposit of uric acid being activated, dissolved uric acid may cause the amount in the blood to rise.

[Fred Deer]

My gout started in my ankle. I tripped and it didn’t seem to severe and had a slight pain but the next day it got worse and I was unable to walk. I went to the doctor and they treated me for a sprain like you. Making me walk on it.

I spent 3 months in a foot cast not able to climb stairs. Looking back I went to the hospital 3 times at about 3am because the pain was so bad. I showed all the symptoms of gout but because it was in my ankle and it happened after a trip it was never considered as gout by anyone least of all me as I’d never had any signs of gout before.

I had ibuprofen to reduce the sprain inflammation and went to a consultant every week but nothing helped. Not surprising if I was being treated for a sprain which involved me walking on it as much as possible.

I was lucky because a practice nurse at the doctors stepped in on one occasion when they were busy. She asked if I suffered from gout. I said no but and suggested I try Sodium diclofenac and gave me a prescription. Within 2 days it was gone!!))) Three months of unbearable pain disappeared in 48 hours.

The next attack was in my toe about 6 months later but this time they realised it was gout. The diclofenac worked in a few days once again.

Since then I have had other attacks. It is my knee joints and ankle joints on both sides that get it never my toe. Again it was not recognised as gout and I was simply told i was getting old and it was arthritis. It took the 5th attack for me to put 2 and 2 together and then suggest it might be gout to them. A quick blood test and they knew I was right.

After a few attacks you get of recognise the feel of a gout attack. It’s a hot and very painful feeling that feel half inflammation and half like a joint sprain.

Now I am aware that gout can occur around any joint. Now I simply take a single diclofenac pill when i feel an onset and it subsides.

Rest assured gout can attack any joint and not only the toe.

For me the signs are the following

It comes on in the night for no reason (Just as you stated)
The pain is worst during the night at around 1-4am
It feels hot and cooling soothes it
It is not directly in the joint but in the tissues around it. It moves around the knee/ankle over period of a few days and doesn’t stay in the same place.
It hurts like hell especially at night,

Whilst not a be all or end all for gout symptoms these are my personal clues.

Diclofenac is my saviour but I’m sure it does not work for all. I have a supply at hand at all times and take one pill (sometime a follow up) and its gone really quickly. Normally in an hour or 2 but sometimes takes 24 hrs.

Find what works for you and if you get joint pain anywhere and are prone to gout do not think it simply lives in the toe. I’ve only had one toe attack and every other one has been around my knee and ankle joints.

Sounds like you have gout to me.

[nobody]

Hi Fred!
Diclofenac should help all gout sufferers but how much it helps would depend on the dose. So it would be helpful if you specified the doses you’re talking about when comparing its efficacy to similar drugs such as ibuprofen.
Gout in the ankle or knee is supposed to be pretty common. Certainly it didn’t take long for me to get gout-like symptoms there after getting them in the toe. But there are other joints which are normally not affected by gout.
Finally, in case you weren’t aware… diclofenac will not stop the progress of gout and only prevents part of the damage it does to your joints. If you don’t do something about your uric acid, your gout is likely to get worse over time.

[Author]

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