Misdiagnosed gout

Foot care
1

I have been getting pain and loss of mobility in my wrists and hands for a few months now, it is often hard to pick things up or do things that require wrist strength, driving the car increases the pain.

I went to the doctor and was diagnosed with gout, the medication did not help, and I have now been told by another doctor that I do not have gout, as gout is not permanent but comes in attacks.

I have not been offered any other solution or medication, and the only other explanation the Dr gave me is that it is probably because I spent a lot of time on the computer so it is probably RSI. But I know from experience that RSI generally only occurs on the mouse hand, whereas I have it is both arms, although it is worse in the right one.

Does anyone else have any suggestions?

I do have diabetes as well if that makes any difference.

 

2

If the GPs are disagreeing I would ask to be referred to a specialist. Certainly gout is usually not "permanent" and usually attacks one specific joint and not two at the same time. Good luck!

3

The second doctor is 100% wrong. I know this for three reasons. a) I have done a lot of reading on this subject; b) I have discussed this extensively with researchers and c) I had exactly the same.

I had a few very mild “attacks” on my feet which I barely noticed. Then I got repetive strain injury. Then I explained to my then GP that it was caused by gout. He gave me exactly the same explanation as your GP and would have believed him if I hadn’t printed off articles to prove him wrong. I changed GP.

What can happen is you get a build up of monosodium urate (basically small pieces of stone) in the sheaths of the tendons. My symptoms were like a tingling of the fingers and hands, especially at night. Within a couple of months of taking allopurinol it had improved and in 4 months gone.( I also found I got a pain in the thumb joints as most people get in their feet.)

To make sure you have gout there are two ways: a) take a blood test, now and when you have no symptoms b) start on allopurinol and see if it works (it will take the right dose for many months as microscopic pieces of stone have to reabsorb). Neither Allopurinol nor Fabrixat  work quickly. 

What tests did they do before with Dr 1? What drug did they give? Dr 2 should have referred you to the hospital to test for RSI as per NICE guidelines, or referred you to a rheumatologist if he doubted his previous colleague’s diagnosis. I would think that colleague 1 would have done a blood urate test at least to diagnose gout? 

Do you take any other medication?

4

Early on in gout it attacks one joint and it tends to be podagra (large toe joint inflammation).  Later on polyarticular gout is common. It is perhaps less common than the past because people tend to get treatment. 

If you search polyarticular gout in a search engine there are thousands of articles on the subject. 

Gout symptoms can stick to one joint, jump from joint to joint, or attack several at a time. Some gout symptoms come and go, others persist. Tophi, the most classic symptom of third stage gout is persistent, but there are many other symptoms.

5

Hi,

the 1st Dr sent me for blood test.

First she prescribed Naproxen, I took it for a month but it had no effect. She then prescribed allopurinol and Colchicine, this also did not improve the problem after another month, but instead, I started getting pain and severe weakness in my muscles, particularly my right arm, to the point I am struggling even to lift a cup.  I have since read that this is a side effect of Colchicine. So I stopped taking it, and went back to the Dr and saw Dr no.2

Dr.2 has told me to go and get my hands/wrists scanned at the hospital, but that is all, no solution the side effects of the colchicine, which is worse than the suppsoed gout :-(

 

6

russ, what about good old fashioned rheumatoid arthritis?

​Other than that, it's probably much more likely RSI than gout.

​Do you think age might also be a factor?

7

Did they not tell you how to use the allopurinol and colchesine? 

We must assume the blood urate was high or she would not begin allopurinol. This being the case I don’t understand how Dr 2 decides to discard the blood test result.

Allopurinol reduces levels of blood urate. But you have been building the crystals in all parts of the body for years. These stores will be slowly released and eradicated, a process that takes between a few months and a few years.  Most people have cleared out most in a year or so.

Before giving you allopurinol she should have told you there is a rare but deadly skin reaction that can happen in the first couple of weeks of taking allopurinol. The fact that you are writing shows you don’t have this rare reaction.

Colchesine can be used in two ways - as low level prophylactic or just used at the first sign of a gout flare. It calms down the immune system. The problem with this very old but very well understood drug is the toxic level is close to the medically useful level and the patient needs to find out what that level is. The good thing is you can stop it, wait a few days and start again.

Some rearchers found it helped to cut the (tiny) tab in two and take them say 6 hours apart. 

What the doctor should also have explained is that on allopurinol you need a blood test to see you have the right dose, and you also need to know the long-term consequences of not sorting out high blood urate - long term inflammation doing damage to a host of systems, the most likely being to your blood vessels, leading to a greatly increased risk of heart attack and stroke years down the line. 

When you went back to Dr 1 and said it isn’t working after a month the response should have been a blood test to see if it’s working (if not increase dose), and to explain it took a decade to get to where you are and there is no quick fix. 

If you really can’t take lower doses of cochrcine (I take it only if a slight flare begins), there are alternatives, but it’s not necessary to take it all the time. 

In my experience the hand issues take months rather than weeks to resolve - tiny amounts of stone deposits have to be reabsorbed.  If you search for carpel tunnel syndrome gout, you’ll see you and I are by no means isolated cases.

8

When there has been a  test with *high blood urate 

And he is not working as a touch typist

Why would you assume anything other than gout?

“...gout-related wrist pain can be a sign of polyarticular gout, or gout that affects multiple joints. Since this is less common, gout in the wrist can be difficult to recognize. “

9

Isn't RA a lot more common in older people, and in general, than gout?

10

About 6% of men have RA (women more) whereas it’s 4% with gout.

But Russ has already had a blood test with high blood urate meaning he does have hyperuricemia, and therefore likely to have gout. 

He may of course have both.

11

You reacted to colchesine with myalgia, means you're allergic to it. Although, you could have gout this sounds more like rheumatoid arthritis. I suggest you look up night shade foods, so you can stop eating them. I get similar symptoms when i eat any of the nightshade foods. When it gets really bad I take glucosamine chondroitin and fish oil it seems to help it down. You can also try cherry juice. Good luck.

12

Hi Russ, firstly people with high blood urate do not always have flair ups. I suffer with gout and your symptoms are not gout. I have osteoarthritis and your symptoms sound familiar to mine, and driving does agitate the pain you are getting that's for sure. An Mri scan would confirm this and if it is not, the Mri scan will find the problem.

13

I would suggest that diabetes also raises the chance of other auto-immune diseases, like rheumatoid arthritis.

14

You are correct, the diabetes brings in many possibilities.

But the fact of having a high blood urate indicates that he has gout. Although the second doctor behaved as if there were no such test result. Both cannot be correct. 

The problem *may* be that he has had high blood urate and high blood sugar for a considerable period. 

15

Thanks for all the helpful responses.

FYI I was told that my urate was slightly elevated, not high.

I did have a scan a while back which resulted in my being told I had the onset of osteoarthritis in my neck.

I really was not given any more info about the naproxen or allopurinol or how long I had to take it before it had any effect. I assume then by the fact that she changed the medication after a month, she also had no idea it takes a long time to work.

Unfortunately, the Doctors at my local surgery are not great, they really do not pay attention to patients records or other conditions. I have to make sure I always do my own research on side effects of any medication they give me, and I often had to remind them that I have diabetes and IBS as they don't notice and have prescribed me medication in the past that does not react well with these conditions or the medication I am on for them.

16

Are you in the U.K.  Russ?

I think the others who suggested you see a  rheumatologist are correct. This is your right in the U.K.

As for the the diabetes - look up the videos by Dr Jason Fung and also Dr Michael Mosley, in which they demonstrate that type II can be cured by simple weight loss. 

17

ok thanks,  I will see if I can get the Dr to refer me to a rheumatologist.

 

18

ok so I went and had a scan of my hands and wrists at the hospital, and have been told that all I have is some mild arthritis in my knuckles, and nothing else. So neither the Dr nor the physio has no idea why I am having the pains with my wrists and ankles. It has gotten worse, spreading down my hands and feet, often getting pins and needles as well now.

This is pretty much the situation I have been left in with many of my health problems, I just get a "don't know" from the Doc, and left to suffer. :-(

 

19

Russ, me too, even the best doctors seem to do a lot of eye-rolling and shrugging.  Maybe the science just isn't up to Star Trek levels yet, like we always hope it is. 

What about your diabetes doctors, have you asked them about these pains?  Could be a related nerve condition.

20

it is all the same doctors, so one would hope they would know if it was related to my diabetes. But I suppose that might be too much to assume.