Gout Symptoms Section

If you are worried about a particular gout symptom or treatment, or if you want to clarify something on the GoutPal website, then simply ask GoutPal. Here is a recent letter about a puzzling gout symptom (moving gout) and diet.

Why is it that if I eat anything with tomato in it I’ll have a severe attack. Also I’ve been having moving gout attacks. It attacks my knee, I’ll take my colchicine till I vomit. The attack will move to my heel, elbow or wrist. These attacks have lasted for weeks at a time.
Gout Sufferer, United States.

Dear Gout Sufferer,

Let me first point out that I am not a doctor – just an ordinary Joe with gout, getting a bit tired of confusing information and also fed up with gout not being taken seriously. Sometimes I get a bit frustrated, which is why idiotic things like my ‘Gout, Odious Gout’ song appear – perhaps madness is a gout symptom!

If colchicine is making you vomit, I really think that you should talk to your doctor about it. As an anti-inflammatory it is often very effective for gout, but it is not for everyone. Upset stomachs are a common side-effect, and there are alternatives. Incidentally, I use Ibuprofen to help reduce swelling and ease the pain, but again it isn’t for everybody.

What you should realize is that both these drugs are simple anti-inflammatory medicines that help to ease pain through reduced swelling. In the case of Ibuprofen, it can also be taken at the same time as Paracetamol which will further help pain relief. That is as much as I can say – I’m really not qualified to advise on medicines. The best approach is to discuss alternatives with your doctor and find out which suits you.

Anti-inflammatory drugs treat the gout symptom but do nothing to reduce uric acid which is the cause of gout. Uric acid should be excreted through urine, but when the levels are too high it is deposited as crystals in the joints, hence the painful swelling, and eventually as semi-solid lumps under the skin called tophi. I have experienced similar moving gout attacks to yours and you have my sympathy. I have learned that they will continue until you do something to reduce your uric acid levels. What actually happens is that crystals will normally form in the joints that are easiest to start crystallization – usually because blood flow in those joints is lowest. So if you are sat for long periods, it is likely to be the knee or foot area. Asleep it can be the hand, wrist, elbow etc. When these crystals form, and the pain starts, your blood uric acid levels actually fall, which is what your body is seeking. When the crystals breakdown again, they will dissolve back into your blood, raising the level and increasing the risk of another attack.

One option – which you can discuss with your doctor when talking about pain relief – is a drug to encourage excretion of uric acid. This is a personal matter, but I prefer not to take medicines unless I can avoid them. I have found that it is usually possible to manage your own uric acid levels. Unfortunately, there is no simple test, and so this relies on self-management and common sense.

All you really have to figure is reducing uric acid in, and increasing uric acid out. Some substances behave differently depending on how much you take, e.g. aspirin. (A recent study into aspirin and uric acid now suggests that this may not be the case.)

This complicates things, but don’t worry too much about this now – just concentrate on reducing your uric acid levels. My diet tips page is a good starting point.

As for tomatoes, this is another example of why I approach gout by saying, “see what works for you”. The human body is so complicated, and everybody is different, that it is hard to generalize. There is not much research done on gout, though I have heard elsewhere that tomatoes can be a problem, I can find no scientific information about this (yet). My theory, for what it is worth, is that you have a high uric acid level nearly all the time. This doesn’t always lead to gout, but as soon as something triggers it, the crystals start being deposited at the easiest point. Another explanation is that tomatoes might be lowering uric acid, which can also trigger a gout attack. Only a uric acid test will help you determine if, and how, tomatoes are affecting your gout. Contact me if you need more help on uric acid testing – I have some great news on this that I will publish when I have the full details.

Good luck with managing your gout – please get in touch again if anything I’ve suggested isn’t clear.

Keith GoutPal.com

Since replying to this, I have done more research into the effects of acidity and alkalinity in diet. Though diet and gout is very complicated, I have highlighted the key points in my Diet section. There are also some relevant tables in my Food section.

If you have questions about your gout symptom, or any aspect of gout, you can get them answered quickly at the gout forum.

These are the results showing which joints are affected by gout.

Joints Affected By Gout

In my survey, I also ask you about other symptoms of gout. Pain is an obvious symptom, but others are common. I have prepared another graph showing tingling swollen hands and other gout symptoms.

I’ve republished this Swollen Joint page here, first published before 2008, as part of ongoing website maintenance. Updates to the survey results will be summarized in the Gout Symptoms help section.

Tophi, the plural of tophus, are not usually painful but they should be taken seriously. The form of gout when this particular gout symptom occurs is also known as tophaceous gout.

What are tophi?

A Tophus (from the Latin for stone) is a deposit of crystallized uric acid normally found just under the skin. Commonly, they occur on the ear, fingers and toes and around the ankle and elbow. When small they are not always obvious, but appear as movable lumps. When they grow larger they can be seen as whitish nodules that can become painful, particularly if they are near enough to a joint to restrict movement. They usually occur around 10 years after the onset of gout, but can occur earlier, particularly for older people.

Are tophi serious?

Continue reading Why are tophi important to gout sufferers?

Before asking questions about gout symptoms, I recommend that you browse the Gout Symptoms Section, which covers causes, symptoms and diagnosis of gouty arthritis.

Gout symptoms questions are usually about causes and triggers of gout, or gout diagnosis. I answer these questions on my gout forums almost every day.

Here are the answers to some recent gout symptoms questions. Click on any that you are interested in, for as much information as you are likely to need, and ways to get even more gout diagnosis answers if you want them.

How Long Between Gout Attacks?

Here is the answer to your short gout question, “How long between gout attacks?”

As with many gout questions, the short answer is, “It depends.”

The long answer needs an explanation of what it depends on. First, let me define what a gout attack is. You know it from painful swelling of one or more joints, usually accompanied [...]

Swollen Toes Diagnosis

This article answers the short gout question “swollen toes diagnosis”. It also addresses a point raised in a recent comment about infection and gout.

Swollen toes are a common sign of gout, but there could be other reasons.

If you go to the doctors with swollen toes, they will usually start by asking about any possible recent [...]

Graph Uric Acid Level

The first of today’s short gout questions is graph uric acid level.

It seems a strange question. Graph uric acid level against what?

A particular gout treatment? A particular gout diet? Let me explain uric acid levels in general terms, then you can interpret your data against particular aspects of your own gout treatment or lifestyle.

The [...]

Gout Symptoms Questions: Next Steps

If you have questions about gout symptoms, look in the Gout Symptoms Section. If you cannot find answers there, please consult the gout forum.

Uric Acid Management

Though pain control is often the first consideration of gout management, long term uric acid control is the only way to prevent gout returning.

Gouty arthritis is a progressive disease. Left untreated, uric acid will continue to build up causing increasing, painful gout flares and joint damage. Many doctors realize this, and take care to manage uric acid with regular tests and medical or lifestyle therapies to manage uric acid levels in the blood.

Unfortunately, there are a significant number of doctors who either do not believe in uric acid management, or do not have sufficient training to ensure that uric acid is controlled to a safe level.

Do any of the following apply to you?

• Your doctor fails to provide frequent uric acid tests, or
• It is inconvenient for you to travel to a blood testing facility, or
• You want extra data to help micro-manage lifestyle changes.

In those cases you need to seriously consider buying your own portable uric acid test kit. But what about cost?

Uric Acid Tester Costs

I am currently researching costs of “official” uric acid test kits. USA costs are around $30 to $60, though much depends on how much is covered by insurance. UK costs are covered by the National Health Service, though travel costs and inconvenience may also be factors.

Test strips for portable uric acid testers are less than $2 each, but there is an initial outlay of around $75 for the testing unit. This implies that you can make savings after very few tests, though much will depend on what you currently pay for tests.

I am researching the costs in more detail, along with insurance implications. I would appreciate your input in the Gout Forum – please let me know what you pay for your uric acid tests. Once I have the information, I will update my uric acid test kit reference page.

The Source Of Uric Acid

I’m often asked, “what causes uric acid?”

The simple answer is: “the natural breakdown of purines in the body.”

But this answer is too simple to be of any real value. In fact, because most people, including many professional medics, do not understand purines, there is an enormous amount of bad advice given to gout sufferers. The result of that bad advice is often a miserable low purine diet that is impossible to stick to.

Even worse, it does nothing (or in some cases very little) to help your gout.

This is a great opportunity to see how a simple question about causes of uric acid can lead to an immediate improvement in your understanding of gout. This is the starting point for you to learn how to control uric acid – the first step on your road to Gout Freedom.

As I’ve mentioned, purines cause uric acid. These are present in food, and released when cells breakdown during digestion. But they are also much more available in our own flesh. Every day, our body cells renew and regenerate our body tissues. We release many more purines as part of our natural metabolism than we eat in food. All these purines are a potential source of uric acid.

Do You Have Simple Or Complex Gout?

Read the rest of What Causes Uric Acid?

I’m not one for scaremongering, but I do get frustrated by people who suffer years of gouty agony because they refuse to control uric acid. OK, so painkillers can mask the pain, but they cannot stop the inevitable invasive growth of uric acid deposits.

The big toe is the most common joint to get affected, but if left untreated, high uric acid levels will lead to urate deposits in every joint. This is more than a painful nuisance – these uric acid deposits known as tophi eat into bone, cartilage, and tendons causing permanent joint damage.

Most of us are lucky enough to live in a society where joint reconstruction surgery is a possibility, but why put yourself at that risk?

And I did mention every joint. Foot gout is a common problem because there are lots of joints in the foot. There are also lots of joints in the spine, and gout in the back, though fairly uncommon, is serious enough for you to be very afraid.

In gout management, there is too much emphasis on short term pain relief, and insufficient awareness of the consequences of allowing gout to reach the tophaceous stage. A single tophus (the name given to uric acid crystals when they form a lump in the body) often means severe joint movement restriction. This is quite common on the hands, where groups of tophi (the plural of tophus) tend to restrict finger movement. When this happens in the spine, back movement restriction becomes critical, and total incapacity from spine distortion is a real risk.

Samuels and colleagues reported a particularly bad case of spinal gout in the June issue of Bulletin of the NYU Hospital for Joint Diseases[1]. The image above shows how tophi in and around the spine have severely distorted the patient’s back. The report reveals that this impaired the ability to stand long enough to take a shower.

Fortunately, the patient responded well to allopurinol, even though he required a dose of:

750 mg daily to achieve a target serum uric acid level less than 6.0 mg/dL.

As I mentioned, uric acid back pain in the form of tophaceous spinal gout is uncommon, but the Samuels report does manage to cite 7 other cases, and there will be many more that go unreported.

It really is not worth letting gout go untreated this long. Are you showing any symptoms of tophaceous gout, or indeed gout symptoms of any kind, such as swollen joints? If so, you need to get your uric acid level checked by your doctor, and controlled today.

Uric Acid Back Pain References

1. Authors: Jonathan Samuels, M.D., Robert T. Keenan, M.D., M.P.H., Rena Yu, M.D., Michael H. Pillinger, M.D., and Tibor Bescke, M.D. Title: Erosive Spinal Tophus in a Patient with Gout and Back Pain. Published: June 2010.