PSA: Gouty Imitations

[BarkingGhostar]

When I had my first case of gout ~3 years ago it was a mis-diagnosis. The location was the left Achilles tendon. I skipped seeing my primary care physician and went to a quack foot and ankle doctor. That quack treated it as anything other than gout and since I had never been diagnosed with gout before I guess I'm half to blame for not suggesting that first. With an ankle brace and six weeks of physical therapy, of which I went twice, the initial incident resolved itself. The second incident I didn't recognize initially because I had done a lot of hard surface walking and just thought the ball of my right foot was sore for that reason. Again, it self-resolved. The third incident was finally diagnosed as gout when it hit my left big toe knuckle and god was that fucking painful. But the treatment meant it was over with in less than two weeks with a simple anti-inflammatory drug and Prednisone. My primary care physician treated me for this.

The next attack was the right Achilles tendon and my right foot, with my primary care physician diagnosing it as gout, taking blood sample of uric acid level measurements and then prescribing me an anti-inflammatory drug and Prednisone as treatment. We concluded that if it were gout it would be over with in less than two weeks, and if not it wouldn't be resolved in two weeks. It was resolved in less than four days! From painful immobility to fully cured. Blood work showed my uric acid level as normal. It should be noted from my NIH research during this period of time revealed gout as being difficult to diagnose and to treat because you can have normal uric acid levels and have gout cases and also can have extremely high levels of uric acid and never have a case. Lucky fucking me, huh?

Anyway, I had another case that was in the right big toe knuckle and was treated like the last two to perfect resolution and now my primacy care physician has me on Allopurinol to reduce uric acid levels that were already normal in my body. This has worked for me these past 14-15 months until two weeks ago. The day following a trail-waling event caused a case with my right knee cap preventing my from placing weight on the leg if the leg is anything but straight (e.g. femur and tibia in alignment). A week goes by before I go to see my primary care physician and he refers me to an orthopedic physician. At no time was gout talked about--not even considered, and here is the most important message I can relay to anyone with a history of gout.

I was about to go have an MRI to figure out what was going on in the knee after the initial orthopedic exam found nothing wrong. I got pricing, prechecked with my insurance and was about to schedule an appointment and something caused me to hold off yesterday. Last night I typed into Google 'knee tendon gout' and the third and forth result from NIH revealed a sneaky bastard gouty form that can mask itself (imitate) as a form of tendinitis. Someone wrote of an article about what he believed to be a situation in which many cases of Tophaveous gout were imitating patellar tendinitis, and as a result being misdiagnosed. I about laughed as I read the NIH article. Caution, for some (including me, this can make you sick to your stomach.

The end solution was to surgically go in and remove portions of the deep tendon and calcium buildup as the ONLY solution for the condition. It also required, MRI, X-rays and a CT scan. All I can say is I am investigating whether or not this might be a case in which I am going through (started taking Prednisone this morning). If it is, I can only wonder if in time the gout in me will reach my ass, and beyond. So, be aware that gout can mask itself in may ways, the uric acid levels in you can be normal and you can still be under attack.

 

[Kaido]

So, be aware that gout can mask itself in may ways, the uric acid levels in you can be normal and you can still be under attack.

Yeah, it can be tricky to diagnose. Like, I've gone through various experimental food-allergy medication over the years. One of them had the side effect of raising my uric acid levels & caused gout in my foot, which I had never experienced before. Holy horrible pain batman. I thought my toe had somehow gotten broken! It was a little bit tricky because I'm not a drinker & primarily eat stuff like chicken, so I didn't have a traditional high-purine diet or other typical indicators, plus I stay well-hydrated with plain water throughout the day. I ended up switching allergy medicines & taking prednisone to resolve it. They said fasting actually complicates the problem & recommended continuing to eat & drink to help my system keep things moving & flush it all out of my body. Never had it before & haven't experienced it since, but it was super awful. It was like a gust of wind would cause my toe pain! Even putting on a sock was excruciating!

Bummer about having to have surgery, but glad you got it resolved (for now, at least!). Did they ever find a root cause for it?

 

[brainhulk]

The following foods contain purines. People with gout should significantly limit or avoid them.

• red meat and organ meat, such as liver or kidneys, which are high in saturated fat
• seafood, such as lobster, shrimp, sardines, anchovies, tuna, trout, mackerel, and haddock
• sugary drinks and foods that are high in fructose
• processed foods and refined carbohydrates
• alcohol, especially beer and hard liquor

Omg i would rather commit seppuku

 

[Scarpozzi]

Half of Medicine is very much taking reported symptoms and trying to align them with a known condition. When you consider how many symptoms overlap, quite a few conditions are difficult to properly identify...especially because the body's often trying to heal whatever is wrong while it's being diagnosed.

My wife works in medicine and she often complains of people getting out and googling their problems because they often find forums like this one or read into WebMD a little too much. By no means am I trying to suggest your assessment isn't correct. I'm just telling you that physicians will give you their opinion and sometimes you have to trust their knowledge if they're linking known, insurable medications/treatments with your symptoms.

If you have chronic knee pain with all that crystalization in there as permanent damage, then maybe surgery is the only viable option to treat it? I state that as a question because if you ask a doctor, they'll prescribe a pill....if you ask a surgeon, they'll suggest going under the knife. They're going to stick with what they know and many are after the money grab. I hope you deal with honest docs and wish you the best of luck getting to the bottom of it.

 

[randay]

stay hydrated

 

[TheVrolok]

I would caution the cancelation of tests that physicians who have evaluated you are ordering. I have to assume they have your best interests at heart and are using their best medical judgment.

I would also offer some caution about reading (literally and figuratively) too much into an article you found through Google, even if it's PubMed indexed.

The article you linked isn't actually from the NIH, it's just hosted by NIH serves because the NCBI maintains the PubMed database and is part of the NIH.

It's "just" a case report written by a couple of dudes. It apparently was published in "The Surgery Journal." Admittedly, I do not regularly read any surgical journals so I can't speak to the quality of this specific journal, but I tried to quick Google it's "impact factor" and didn't find anything which is not a great sign. (might be Google fail on my part sitting here on my phone as well)

Beyond that, I took a minute or two to look at other publications from the first two authors that appear on PubMed and there doesn't seem to be a huge amount of rhyme or reason to what they publish (no area of focus) which is kinda odd and may suggest they just focus on "writing papers" for sheer volume (maybe they're research fellows?).

Lastly I took another few mins to just Google the first author and there's little to be found (not a great sign). I found a LinkedIn page that suggests he changes jobs every year or so (sometimes less). Maybe he's a research fellow who bounces around? I dunno.

Certainly take this with a huge grain of salt because I spent all of 3-4 minutes taking a superficial look at that article but it demonstrates a little bit of my process before even reading the content which may be helpful... And I'm a little skeptical. I could be 100% wrong, though.

To your initial point, acute gout is "generally" a fairly straightforward diagnosis although it can certainly mimic a lot of things. Intercritical gout can definitely be tricky (the period after an acute attack has calmed down). You're absolutely right that a serum uric acid level is not a component of the diagnosis because, as you say, it's quite variable in the acute setting.

 

[RLGL]

Hydration is a must, in my case quit drinking OJ took care of 90% of my issues

 

[BarkingGhostar]

Hey, I am not suggesting I know for a fact that my current patellar are problem is gout, but just that the Orthopedic wasn't sure what was going on considering the location and wanted to start a lets get some imaging and see if that turns something up. I really wasn't included to go down my first gout case path as that was a mis-diagnosis. Right now I am stay well hydrated and nursing the knee while taking Prednisone. If that doesn't work then the imagine continues. Their office hasn't ordered anything yet as I needed to get answers from Anthem first.

Also, I do watch what I eat as I try to eliminate items on the 'very high' in purines.