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    Al O’Purinol


    Around the start of this year I woke up one day with a very painful foot. It was red, swollen, and inflamed, but wasn’t anywhere near as painful as what I read gout is supposed to be like. I could hobble around on it without it being too painful, but stepping directly on my foot was very painful. The pain was centered in the top left of my left midfoot area.

    Knowing my personal history (extreme weight gain in the last 2 years in conjunction with very high alcohol intake — talking on the scale of +100 lbs) and the symptoms and suddenness of the attack, I came to the conclusion it was likely gout.

    I saw a GP and then a Rheumatologist about 2 weeks later (couldn’t get an appointment sooner). By that time the symptoms had subsided (lasted about 3-4 days). I had many blood tests run and had no typical arthritic ANAs etc that would suggest an arthritis other than gout. My Uric Acid level was a 6.8, which I believe is higher than is good but the doctor told me was within normal range. She told me that she would not diagnose me with gout unless she was able to withdraw my synovial fluid if/when another attack occurred, and that she thought it was likely “low level” arthritis related to my weight.

    A little after that I had a slight flare up, but it wasn’t really painful and I could ignore it. After taking NSAIDs for about a week that one went away.

    Now it’s been about 3 months. I have lost about 30 lbs since then, still have quite awhile to go. I have stopped drinking anywhere near as much but still do drink, and I haven’t really modified my eating habits. I’m almost trying to make another attack occur just to see if I do in fact have gout or not.

    My foot is in pretty much constant, but very low level, achey-type pain. It is worst when I don’t move for awhile, then goes away rapidly when I start moving/exercising. I also feel random twinges ALL over my body, like in my fingers/thumbs occasionally, in my toes, in my other foot, even in areas that don’t have joints like the middle of the femur. It’s worth noting I’ve never felt anything in the typical big toe joint, but I do feel twinges in the more distal joints. If I am sitting still at a chair like I am now typing this I can feel all these little twinges all over, but once I start using those body parts they go away. The left foot, where I had the initial biggest attack, can just throb with moderate pain out of nowhere with no movement or provocation and then stop a few seconds later.

    So does gout do that in an intercritical period? Do gout sufferers have this low-level constant pain or is the time in-between acute attacks supposed to be literally asymptomatic? Could only 2 years of being unhealthy and hyperuricemia result in crystal depositing that rapidly? And if I do have gout, shouldn’t it be focused more on individual joints rather than all over, and this type of chronic pain should only occur after it’s been around for a long time and has really developed into a severe case? I have only had one acute attack, if this is gout.

    And if it’s not gout, what else could it possibly be? There are only a few other options that fit the overnight-very painful-acute attack MO, and those are all significantly more serious in the short term – bacterial infection etc. Can a gout-like attack come from normal, rheumatoid arthritis? But my blood tests didn’t show arthritis-indicating antibodies.

    Thank you for any information. I have tried looking these things up over and over using google but it’s very difficult to find this kind of information. I have a followup visit scheduled with my doctor in the next month sometime, I forget when.


    There are a few issues here.

    On pain, be aware that gout pain intensity varies enormously from person to person. Some people do not generate the same level of inflammation as others. Some people have better pain tolerance than others. Ultimately, with gout, pain control is not the issue – uric acid control is.

    Drastic weight change up or down is a well known cause of increased uric acid. More importantly, it is a serious indication that your diet is out of control. Keep that up for a few years, and you wont need to worry about gout because you’ll be dead from heart disease. Sorry if that is harsh, but best to see gout as a wake-up call. I can help you with some resources to make dieting easier, but you have to make the commitment to stick to a healthy diet or it will not work. Healthy does not mean boring, but you have to balance calorie intake with calories burned.

    Your uric acid is at the high end of what is acceptable. However, what is acceptable to your doctor is not acceptable to me. I believe the upper acceptable level is 5, but you may have difficulty persuading a doctor of this. Of course, if you can show uric acid crystals in a joint fluid draw, that would prove gout. You might have to wait for subsequent attacks, or you can try to control through diet. Diet control means a commitment from you and your doctor for monthly uric acid checks, or buy a home test kit.

    On alcohol, from personal experience, and talking to friends, I am aware that prolonged drinking can cause stiffness that can often be painful. I have not researched the exact reasons for this, but I can repeat the problem at will. Exercise helps overcome this, and abstinence prevents it. The second of those is not an option for me, but I have found that walking more, combined with not drinking every day means I never have any serious issues. I guess you have to work out your own routines based on your social life. Bottom line is, if you can’t control alcohol intake to prevent health problems then you’re on a similar path to poor diet control, with heart, kidneys, and liver at risk.

    I’m not trying to preach a diet of salads and abstinence, but you have to assess your diet and make improvements where you can. There is no magic plan, as every person’s needs are different. You should start wit the big picture and look at total calorie intake, total alcohol intake, total energy requirements, and the balance of major food groups. You follow this with looking at food and drink you really enjoy, and build personal menus around that. You make improvements where you can, and assess improvements in uric acid levels.

    In answer to your headline question: do I have gout? I’d say probably yes, but your uric acid levels and poor diet mean you probably fall into the group that can control gout by diet – if you want to. I say probably, because I really do not have enough information to make a better judgment.

    My best advice is to make a commitment to better diet, and hope this is enough to control your gout. If you cannot commit to that, then you can be certain that your gout will get worse until your doctor can make an obvious diagnosis. If you do decide to go for the diet option, I can offer more detailed help.

    Al O’Purinol

    Thank you for the reply. I think you’re right in terms of the diet thing, I definitely need to be more healthy. Like I said, I’ve been losing weight and I if I keep up what I’m doing now within a year I should be back to a much healthier weight. I thought I had mentioned it in my post but I’m only 25, which is why I wasn’t sure if hyperuricemia could lead to gout in only a few years (barring a genetic predisposition). I was extremely active and healthy prior to the last couple years (a bit of a health/gym nut, which makes my descent into unhealthiness even stranger) so I know how to take care of myself in that regard.

    Time to just hunker down and be healthy and hope that it’s enough to curb any further issues. Thanks again for the detailed response.


    Sounds good.

    High uric acid can definitely cause gout in your twenties. My nephew started around 25. It’s almost certainly genetic with him. I believe gout is often a mixture of genetics and lifestyle.

    There is nothing you can to about the genetics, but improving lifestyle is vital. I’ve recently become aware that many of the bad diet habits that lead to gout also lead to heart disease and other health problems. It’s not just excess fat. Excess iron is also a major contributor to both diseases.

    Exercise is good, but for gout it is important not to over-exercise. There are no hard & fast rules, but commonsense is a good guide. Pushing harder for the extra mile might be good if you are involved in competitive sport, but is not going to help gout.

    Healthy diets for gout include alkalizing or Mediterranean style diets. These have the benefit of being varied, so you can always include foods you enjoy.

    Finally, even if lifestyle improvements keep the painful inflammation away, it is a good idea to get tested for uric acid at least once a year. That gives a good history of what is normal for you, and an early warning if it starts to creep up.

    Good luck.

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