Doctor thinks I have gout but I'm not so sure - what does everyone here think?

Hi,

Hope people might be offer some advice as I’m really not sure what I should be doing.

I’m currently sitting here with a stiff and swollen big toe/foot that I agree, when you look at it, looks like classic gout. This is probably the third or fourth time it has hurt like this in the last four years (though the first time for at least two years), and each time it follows the same pattern.

1. I play hockey (field not ice) and either put too much pressure on the ball joint of my left foot by twisting and turning too much during the course of the match, or there is one moment when I can feel something actually go ‘sproing’.

2. The big toe is usually a bit stiff after the game, particulary when I raise it up but not too painful. I can walk on it OK and it either gets gradually better over the next two to three days or at least stays the same.

3. On day three, my toe quickly starts to get more painful, the ball joint goes red and starts to swell and when I press on the side of the joint it hurts a lot (but is ok when I press anywhere else on the foot or the joint). It gradually gets worse over night and by morning I struggle to be able to put shoes or even socks on without wincing.

4. This carries on for at least the next few days. More painful early in the morning, especially as I get up, even though it looks less swollen, is better after I have been up on it for 30 minutes or so, and then gradually gets more swollen throughout the day. I also get very painful twinges if I twitch or just move it at the wrong angle.

5. After a couple of weeks, it is usually back to normal, though the toe feels stiff and if I go back to doing excercise too soon I know there is a good chance it will recur.

I saw the doctor first time it happened in 2010, they took a blood test and told me my uric acid level was 'not high'. I am due to get the results of a second blood test next week. Both doctors I have seen think it is gout (despite the uric acid test) but this is based on a two 30 second examinations and not much else. It’s the easiest diagnosis for them to make and get’s me out of their surgery nice and quickly (even if it is actually gout, I’ve received no advice on what I should do other than take some ibuprofen or diclofenac and wait for it to go better).

Despite the symptoms, there are several things about this that make it hard for me to believe this is gout:

A. It only even happens after I’ve done something playing sport (but bizarrely, always 3-4 days after). I have never had a spontaneous attack.

B. My uric acid test last time was not high.

C. I have no family history of gout, I drink 7 units of beer and 7 of red wine a week, don’t overdo the seafood or other foods supposedly rich in purines, and am in the middle of my healthy BMI range.

What do you think though? Does my experience chime with any other gout sufferers or do you think it more likely to be something else (tendinitis, sesamoiditis maybe). What should I be doing or saying to my doctor? I have had problems with my kidneys in the distant past and have next to no function in one and slight damage to the other so worry that if this is gout I will start causing problems, but at the same time I don’t want to start treating gout if I don’t actually have it!

Thanks for listening – sorry it’s so long. This is all the stuff I wanted to say to the doctor that he didn’t have time or inclination to listen to.

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