Gout Symptoms: Can Pain Be Intermittent?

I would like to ask the doctor about the symptoms of gout?

Hello, Doctor.
Yesterday afternoon, while going down the stairs, I suddenly felt discomfort in my left ankle halfway down.
Although it was bearable at first, since my job requires me to walk frequently and go up and down stairs, the pain seemed to gradually increase over time.
By the time I returned home and rested, I found that I could no longer walk.
Just standing or putting weight on it felt like a sprain.
However, when I initially went down the stairs, I didn't feel any twisting sensation.
At the peak of the pain, there was no redness or swelling; it looked normal.
Today, I went to the emergency room, where the doctor ordered blood tests and an X-ray.
The verbal report indicated that my uric acid level was slightly elevated at 7, while liver function tests were normal.
The conclusion was that my uric acid was high, and there were no significant issues with the other tests.
The doctor mentioned that the increasing pain could potentially be gout and advised me to follow up with a rheumatologist.
I have some questions regarding the symptoms of gout that I've heard about in the past, which are often described as excruciating pain that makes it impossible to get out of bed.
However, my pain only occurs when my left foot bears weight while standing or walking, and when I sit and rest, it feels normal again.
It's not a constant pain.
Is it possible for gout to present with such symptoms? Or is gout characterized by constant pain regardless of movement? I would greatly appreciate your clarification.

Mr. Wang, 20~29 year old female. Ask Date: 2019/12/08

Dr. Shi Guozheng reply Orthopedics

Gout attacks typically present with localized joint redness, swelling, heat, and pain.
If these symptoms are absent, it is less likely to be gout.
Patients with chronic hyperuricemia may not necessarily experience an attack.
It may be advisable to consult an orthopedic specialist, and possibly obtain an X-ray as a diagnostic reference.

Reply Date: 2019/12/08

More Info

Gout is a type of inflammatory arthritis characterized by sudden and severe pain, redness, and swelling in the joints, often affecting the big toe. However, it can also affect other joints, such as the ankle, as you have experienced. Your symptoms and the elevated uric acid levels suggest that you may be experiencing gout, but it's important to understand that the presentation of gout can vary significantly among individuals.

Firstly, it is entirely possible for gout pain to be intermittent. While many people associate gout with excruciating pain that can make it difficult to move or even touch the affected joint, this is not the only way it can manifest. Some individuals may experience milder pain that only occurs during certain activities, such as standing or walking, as you described. This can be particularly true in the early stages of gout or during a gout flare that is not yet fully developed.
The pain you felt while descending the stairs could have been the initial onset of a gout attack, where the joint becomes inflamed due to the crystallization of uric acid in the joint space. The fact that you did not experience swelling or redness immediately does not rule out gout. In some cases, the inflammation may not be pronounced initially, and the pain can be more pronounced with movement or weight-bearing activities.
Gout attacks can also vary in intensity and duration. Some people may experience severe attacks that last for days, while others may have milder symptoms that come and go. The pain can be exacerbated by certain triggers, such as dietary choices (high purine foods), alcohol consumption, dehydration, or even stress.
Your experience of pain that increases with activity but subsides with rest is not uncommon in gout. It is important to monitor your symptoms and follow up with a rheumatologist, as they can provide a more comprehensive evaluation and management plan. They may recommend lifestyle changes, dietary adjustments, and possibly medications to help control uric acid levels and prevent future attacks.

In summary, while gout is often associated with severe, constant pain, it can also present as intermittent pain that is activity-dependent. Your symptoms align with this possibility, and it is crucial to continue monitoring your condition and seeking medical advice to manage your uric acid levels effectively. Regular follow-ups with your healthcare provider will help ensure that you receive appropriate treatment and guidance to prevent further complications associated with gout.

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