Gout or Injury, and over what period does gout build up / how does it heal

Hi everyone

Last year (2020) I experienced what I'm fairly sure was my first gout attack. Now, 9 months later, I am potentially having my second.

To complicate matters, on each occasion the pain has coincided with me doing DIY involving prolonged periods of squatting down with lots of weight on the balls of my feet e.g. stripping wall paper low down. (Doh: I should've learnt the first time to sit on the floor in future instead of squatting).

The first attack was about 10 days after a day of DIY with long periods of squatting. BUT, it was just 1 day after 3 consecutive days of heavy alcohol consumption (first time I'd seen friends in 5 months - poor excuse I admit). So I am about 80% sure that this was gout and due to heavy beer consumption. Although 6 days into the attack, the GP did a blood test and said my uric acid levels were normal.

The 2nd "attack?" is now happening. It came a couple of days after I had finished a week of DIY - about 3 of the DIY days involved long periods squatting low again. ALSO, it was 1 day after I had drank a pint-size can of strong beer (11%) - that was the only beer I had consumed in a week.

I spoke to my GP - annoyingly they still won't do face-to-face appointments. Unsurprisingly she says it could be gout or could be injury but she can't tell over the phone or from photos, QUOTE: "but the good news is that the cure is the same either way". So all she did was prescribe painkillers.

I'm not happy with that response. I acknowledge that the cure may be the same, but the measures that need to be taken to prevent a repeat would be different: Injury prevention is more black and white, gout prevention is less clear/controllable, requires big restrictions on food & drink and it sounds like gout would keep reappearing no matter what.

Finally the questions.......

So why couldn't she have sent me for a Synovial fluid analysis (or other joint fluid analysis) to give a definitive answer? Is this as readily available/doable from a GP surgery as a blood test is?

Over what period do the crystals build up before you feel the pain e.g. Does it happen just a few days after a day where you have consumed a lot of food/drink high in purines? Or conversely, do the crystals build up and up gradually over months until they cross a threshold where you start to feel severe pain?

My dad has the belief that they build up and up over months until they cross a threshold. I struggle to believe that, because if the body hasn't been able to wash away the crystals / uric acid gradually over months, then how on earth is it going to get rid of them all in one go as part of the gout clearing itself?

Thanks for reading

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