Do I really have gout? And if so...what next?

September 17, 2007 11:33 AM

I'm a woman in my 20s, and I've been told I have gout. Misdiagnosis? What next?

I have been having significant pain in my big toe. Not excruciating, but bad enough that it causes me to limp and I can't stand to even have a bed sheet on top of it.

I thought maybe I had previously broken my toe and perhaps was now dealing with a hairline fracture of some sort, so I went to an urgent care clinic (I couldn't get in to see primary care doc). They took x-rays, which were normal. At that point gout was suspected, and even though my uric acid levels were normal in the blood sample, I was diagnosed with gout.

Given that I'm a woman in her 20s (90% of gout cases affect men - women are typically affected only after menopause), not overweight, not a red meat eater, and consume only 2-3 drinks a month, is it possible that this is wrong and I have bunions or something else?

And if the diagnosis of gout *is* correct, what kind of things do I need to look for and ask my doctor to check out? (The doctor is nice, but not particularly aggressive in treatment.) From what I gather, gout in young women = possible kidney disease.

I finally talked my way into an appointment for tomorrow, and I want to make sure she's taking the right course of action...

posted by jennak to health & fitness (15 answers total)

I was in the same situation - I was told it was gout but it turned out to be sesamoiditis. Wikipedia has a good article on it. I'd recommend a sports medicine doc specializing in feet.
posted by TorontoSandy at 11:47 AM on September 17, 2007

No one on the internet can tell you if you have gout and you should not take the advice of anyone who suggests that they can. You should go to a different doctor, probably a specialist, for further evaluation and diagnosis.
posted by OmieWise at 11:58 AM on September 17, 2007

Why are you so offended by gout? It's not leprosy...

Not sure where you got your info? A quick scan through what wikipedia had to offer made me doubtful that it was your source? :) Because 'gout in young women' could possibly indicate a whole list of dreadful illnesses... or it could just be the gout? :)
posted by mu~ha~ha~ha~har at 12:00 PM on September 17, 2007

Yes, it's really possible. I had it in my twenties.

Couldn't hurt to increase your water intake.
posted by idb at 12:04 PM on September 17, 2007

idb, someone in North Carolina, my mother just smiled.
posted by jennak at 12:06 PM on September 17, 2007

get a second opinion. your insurance should cover it.
posted by thinkingwoman at 12:31 PM on September 17, 2007

Thanks, TorontoSandy and idb.

I guess most people don't read the question all the way through, so I'll make it clear that I AM going to another doctor tomorrow. Given that this will be the 3rd doctor I've seen regarding this, I wanted to get some feedback so I'm going in there a bit more informed.
posted by jennak at 12:51 PM on September 17, 2007

I'm currently getting over a bout of gout in my ankle that I've been dealing with for two and a half weeks.

I do find it odd that your uric acid levels are normal if you're having an attack. I've always had high levels when I've been tested mid-attack. Not saying that this should be the case with you, but it would seem to be the norm for me.

If you do in fact have gout, talk to your doc about allopurinol (helps the body process uric acid, thus normalizing the level). I have resisted taking it at my age due to fear of long-term side effects, but this attack has convinced me. If you think the toe feels bad now, just get it in your ankle...I wouldn't wish this pain on my worst enemy. Well, maybe my worst enemy ;)
posted by JaxJaggywires at 1:18 PM on September 17, 2007

I'm not sure I'd read I finally talked my way into an appointment for tomorrow, and I want to make sure she's taking the right course of action... as telling anyone you've had a second, and are going for a third, opinion.

However, to focus on your comment about Uric Acid levels being normal, I'd seriously question that with your next doctor. Not sure how they could diagnose gout without a confirmation of high Uric Acid - major pain in big toe aside.

IANAD, but boy, have I had gout.
posted by Sk4n at 1:22 PM on September 17, 2007

Uric acid need not be elevated in the blood. I couldn't (quickly) find a number to give you, but in practice a normal serum uric acid doesn't rule out gout. The diagnosis is most definitively made by aspirating the fluid out of the joint and looking for the crystals, not always necessary if the diagnosis is a slam dunk but if you want a definitive answer, this is what they should do.

Note that allopurinol can actually make an attack worse if started in the middle of an attack, it is only given afterward if you want to prevent future recurrences. Bottom line, take some ibuprofen and drink lots of water.
posted by Slarty Bartfast at 3:24 PM on September 17, 2007

Seconding TorontoSandy. What could have been gout for me turned out to be sesamoiditis. You need to see a podiatrist.
posted by charlesv at 4:25 PM on September 17, 2007

For the last decade, I've had gout attacks randomly around once a year or two - Toe, ankle, knee. One defining characteristic is redness of the skin covering the joint. Since they are so infrequent the doc says it doesn't make sense to go prevention medicine.

My episodes generally run where the sensation builds up for a few days, the pain peaks, and then builds down for a few days. At peak, the pain can be quite severe (usually at night in bed) and twice I have resorted to taking half a Vicodan from a left-over prescription.

Normally Ibuprofin is recommended and some claim aspirin aggravates gout.
posted by MonkeySaltedNuts at 4:55 PM on September 17, 2007

1. Yes, regardless of your demographics, you can have gout.

2. Yes, you can have gout with normal serum uric acid levels. It happens quite frequently in fact.

3. Gout is a diagnosis confirmed by looking at a sample of fluid drawn from an affected joint. In the absence of visible gout crystals from a joint, it remains presumptive. There are a handful of common conditions that can look and act a lot like gout so until someone sticks a needle in one of your joints and runs tests on the fluid, you certainly don't have a confirmed diagnosis.
posted by drpynchon at 6:44 PM on September 17, 2007

Man, crazy. I always thought gout was like scurvy--a 19th century disease--but I've known two people in the last couple years who've gotten it.

Both of them were very heavy drinkers and unhealthy eaters, though.
posted by Joseph Gurl at 7:19 PM on September 17, 2007

A uric acid test in the middle of a gout attack will not necessarily be a good indicator. The attack is caused by uric acid precipitating out of the blood and crystals depositing in the joint... mid-attack, the uric acid in the blood can actually be low.

The standard anti-inflammatory treatment for gout is indomethacin. 300mg up to 3 times/day. During an attack, they may also prescribe colchicine, although it is less common now. Colchicine will flush your system. You basically take 0.6mg once every hour until pain stops or you have diarrhea. Allopurinol is the long term, preventative treatment for gout, usually 100-300 mg/daily as a starting dose. I'm not aware of any long term side effects, although JaxJaggwires suggests there are some. Some docs will prescribe this (once the initial bout is over) even if they aren't yet certain it's gout, as it does no harm.

There are conditions other than gout which exihibit similar symptoms and are caused by precipitates of compunds other than uric acid. This, combined with what happens to uric acid levels during an attack, is why the best way to get a certain diagnosis of gout is to aspirate the joint, as Slarty Bartfast and drpynchon said previously.

Given what you've said about lifestyle and diet, gout seems unlikely, though certainly not impossible. Some things you amy want to discuss with the next doc:

1. Indomethacin. If you are still in pain, get a scrip for this. If you have gout, it should be effective (and moreso than ibuprofen). If it doesn't help, that may help with the next round of diagnosis.

2. Your diet. It's not simply red meat. Certain seafood and poultry are high in purines and thought to increase the risk of gout.

3. Your family history. If others in your family have had gout, kidney stones, etc., it may be helpful for a doc to know about it.

4. If they determine that you do have elevated uric acid, ask the doc to try and figure out whether this is caused by overproduction of uric acid or underexcretion, as the difference may affect treatment.

5. If the docs think it's gout but the treatments they recommend do not work, ask them to consider referring you to a rheumatologist. Gout is an inflammation of the joints, and rheums may be more knowledgeable than podiatrists if that is the underlying problem.

Good luck
posted by jewishbuddha at 8:10 PM on September 17, 2007