Hoping for a little input with this, for the record I’m a reasonably fit male, late 40s, and not overweight with a healthy BMI, etc.
I first had what was considered to be a gout attack some 7-8 years ago in the stereotypical big toe joint, very painful and the GP prescribed Naproxen and basically to keep an eye on what they suspected was gout. I also had maybe 1-2 minor issues with pain in a couple of finger joints, though this was nothing compared with the foot.
After this initial attack I moved to a diet supposedly lower in purines and consumed vast amounts of water, this seemed to work and I was free of any further issues until 12 months ago, at which point I had another attack in my foot, again in the big toe. This attack was much worse and actually lasted several weeks, it eventually settled and I then had subsequent attacks in my other foot affecting several toe joints. The GP prescribed colchicine and Naproxen which helped. Since that attack 12 months ago I have had 3-4 further attacks which I have treated with colchicine. The colchicine does seem to halt things after a couple of days.
I will say that I do have sore feet much of the time, though not anything like the pain I experienced during these suspected gout flares. I do feel like I’m on the edge of an outbreak fairly regularly though, and certain things do seem to exacerbate this.
The GP has suggested moving onto allopurinol and I see the logic in this, but my uric acid levels do confuse the situation. 12 months ago my levels were tested a few weeks after my attack and were 380umol/l, and my most recent set of bloods a few weeks ago (again a few weeks after an attack) were just under 300umol/l. Both these results and especially the most recent set of bloods would suggest I am actually at the desired levels with regards blood urate, and Allopurinol would not be needed.
Has anyone experienced this before with having healthy blood urate levels yet still getting outbreaks? I would think at a urate level under 300umol the crystals would actually be starting to dissolve at this point?
I have the same issues. Gout attack while maintaining perfectly normal uric acid according to my uric acid blood test meter. I check my blood almost every day and have a strict diet. About five years with no attack and then suddenly a very bad one, starting in one foot initially and then the other one a couple of days later.
I am now investigating oxylates as the problem. Doctors have been basically useless other than to dispense colchicine.
This is a recognised situation and a normal serum urate does not completely exclude gout.
Serum urate can fall during an acute flare and may still be misleading shortly afterwards, so a level taken a few weeks after an attack is useful but not definitive. Also, existing urate crystals do not dissolve instantly once the blood urate is lower. People can continue to flare for months while the tissue crystal burden is gradually reducing.
That said, your urate results do make it reasonable to pause and confirm the diagnosis properly before accepting lifelong allopurinol. Your history sounds compatible with gout because of the classic first big-toe joint involvement, recurrent flares, and response to colchicine/naproxen. But recurrent forefoot pain can also come from osteoarthritis of the first MTP, sesamoid problems, stress injury, inflammatory arthritis, CPPD, or biomechanical issues.
I would ask the GP or a rheumatologist about:
repeating serum urate when you are completely well and not soon after a flare;
checking kidney function, inflammatory markers, haematological and liver causes, blood glucose/lipids/blood pressure at the times this occurs;
confirming the diagnosis during a flare with joint aspiration for crystals if feasible and done sterile technique;
If this is confirmed gout, then allopurinol is not an unreasonable suggestion given the number of flares over the last year. The usual logic is not simply “is the urate normal today?”, but whether there is a recurrent gout pattern and whether the long-term crystal burden needs lowering to prevent further attacks and joint damage.