Gout or not gout ?

I am 44 y.o., male and overweight. I am 6' tall and weigh 17 stones.

Over the past few years I suffered from mild discomfort in my fingers, the top of my hands and various parts of my feet and toes. This comes and goes...

I have also had regular right and occasionally left knee inflammation, temporarily disabling me (making me unable to walk), which has at the time taken a few days to 'die' down.

Last autumn I was working offshore on a vessel and eating a protein-rich meaty diet. My right ankle suddenly became swollen and I was unable to walk without discomfort for many weeks. The ankle was swollen and discoloured (reddish/purple)and the ligaments hurt.

I had URATE tests which were initially inconclusive, but then on the 2nd attempt showed raised levels indicative of gout.

I have recently improved my diet by reducing the protein content and cut out alcohol and I believe that my condition feels much better at present - although they ache, I can walk better and much further without my joints failing.

Questions

A) I thought the symptoms of gout tended to effect one joint suddenly at a time, usually the big right toe; do you feel my ailments 'as described' could be symptomatic of gout ?

B) Is it possible I should consider having a test for a bacterial infection or any other cause of arthritis ? My GP feels sure that gout is the culprit and has refused to consider other possibilities.

C) My GP prescribed Allopurinol. Is it worth trying to get away with sticking to a sensible dietary regime and losing weight instead of tying myself to drug dependence for life ?

D) If I stick rigidly to an improved diet can any minor damage to my joints, which I guess causes the aching sensation, improve in the absence of uric acid crystals ?

I look forward to your kind response. THANKS !

[Kevin Pho, MD]

To answer your questions:
1) Gout is a possible cause of your symptoms.  Infection of the joint is also possible.

2) The best way to come to a diagnosis would be to obtain some synovial fluid and send it off to the lab for analysis.

3) Changing diet can be enough to ward off future episodes of gount.  If you are on medications like diuretics, stopping them might help prevent further attacks.

4) Again, it would depend on the cause of the joint pain.  If it is indeed gout, an improved, low-purine diet can help with the discomfort.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b