Gout Diagnosis
Thank you, doctor, for taking the time to respond to my questions.
I really appreciate it! I am a 34-year-old male, 175 cm tall, weighing 93 kg.
I do not drink alcohol but often stay up late.
I have gastroesophageal reflux disease and a duodenal ulcer, for which I am currently on medication.
On February 23, I experienced sudden severe pain in my right knee while sleeping (without any redness or swelling).
I couldn't pinpoint the exact location of the pain, but bending my knee caused discomfort.
There was no recent intense exercise or external injury that could have caused this.
The pain lasted for 1-2 days before gradually subsiding to a level where I could walk normally, but I was unable to squat for about two weeks.
After the pain improved to about 80-90%, I thought it would be good to get it checked.
In mid-March, I visited an orthopedic specialist who took X-rays and noted slight wear in my knee.
My uric acid level was tested at 8.2, which is above the normal range.
The doctor diagnosed me with gout and prescribed Benzbromarone (Uricosuric) for one month, advising me to recheck my uric acid levels after that.
I have read several educational articles written by physicians about gout, which mention that symptoms typically include "redness, swelling, heat, and pain." Therefore, I would like to ask the doctor the following questions:
1.
Is it necessary for gout to present with redness and swelling? Since my knee did not exhibit these symptoms and only had pain, can it still be classified as gout?
2.
If it is not considered gout, can I stop taking Benzbromarone after 11 days of use?
3.
If it is indeed gout, does taking Benzbromarone mean I must continue it long-term? If my uric acid levels normalize after one month, can I discontinue the medication?
Thank you!
Weierxun, 30~39 year old female. Ask Date: 2022/04/02
Dr. Gao Jiankai reply Internal Medicine
Hello, thank you for your question.
Here are my responses:
1.
Is swelling and redness always present in gout? I had pain in my knee at that time, but there was no swelling or redness; can that still be considered gout? --> Most of the time, yes, but some patients may not exhibit these symptoms.
Sometimes, localized warmth may not feel as pronounced, so it still requires a physician's examination and assessment.
Additionally, the best diagnosis for gout is through joint aspiration rather than blood tests.
If your physician detects effusion, they will typically perform a joint aspiration for analysis, which is the most accurate method.
If there is no effusion, blood tests will then be used to assist in the diagnosis.
2.
If it is not gout, can I stop taking Benzbromarone after 11 days? --> If it is uncertain whether it is gout, this medication can generally be discontinued.
3.
If it is gout, does that mean I must take Benzbromarone long-term? If my uric acid levels normalize after a month, can I stop the medication? --> If gout is confirmed, this medication should be continued.
Gout is a chronic condition, and dietary control alone cannot improve it, so long-term medication is necessary.
However, if uric acid levels have consistently decreased after some time, you can discuss the possibility of reducing or discontinuing the medication with your physician.
Department of Allergy, Immunology, and Rheumatology, Changhua Hospital, Ministry of Health and Welfare, cares about you.
Reply Date: 2022/04/02
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 occur in other joints, such as the knees, as you've experienced. Your case presents a few interesting points that warrant further discussion.
1. Symptoms of Gout: While classic gout attacks typically present with redness, swelling, and intense pain, it is important to note that not all gout attacks will exhibit all these symptoms. In some cases, particularly in the early stages or in atypical presentations, you may experience significant pain without the characteristic redness and swelling. The absence of these symptoms does not rule out gout, especially if your uric acid levels are elevated, as they are in your case (8.2 mg/dL).
2. Diagnosis and Treatment: The diagnosis of gout is primarily based on clinical symptoms and laboratory findings. Elevated uric acid levels can indicate a predisposition to gout, but they are not definitive on their own. The fact that you experienced sudden knee pain, even without redness or swelling, combined with your elevated uric acid levels, supports the diagnosis of gout.
Regarding your treatment with Benzbromarone, this medication is used to lower uric acid levels in the blood. It is essential to continue taking it as prescribed, even if your symptoms have improved. Stopping the medication prematurely could lead to a resurgence of symptoms or an increase in uric acid levels, which could precipitate another gout attack.
3. Long-term Management: Gout is often a chronic condition that requires long-term management. Once you start treatment to lower uric acid levels, it is generally recommended to continue it to prevent future attacks. If your uric acid levels normalize after a month of treatment, your doctor may reassess your need for ongoing medication. Some patients can eventually taper off their medication, but this should always be done under medical supervision.
4. Lifestyle Modifications: In addition to medication, lifestyle changes can significantly impact gout management. Maintaining a healthy weight, staying hydrated, and avoiding foods high in purines (such as red meat, shellfish, and sugary beverages) can help manage uric acid levels. Since you mentioned having gastroesophageal reflux disease (GERD) and a history of duodenal ulcers, it’s crucial to discuss any dietary changes with your healthcare provider to ensure they do not exacerbate your gastrointestinal issues.
5. Follow-Up: Regular follow-up with your healthcare provider is essential. After a month of treatment, you should have your uric acid levels checked again. If they remain elevated or if you experience further symptoms, your treatment plan may need to be adjusted.
In summary, while the classic presentation of gout includes redness and swelling, your symptoms and elevated uric acid levels suggest that you may indeed be experiencing gout. It is crucial to continue your medication and maintain regular follow-ups with your healthcare provider to manage your condition effectively. Always consult your doctor before making any changes to your treatment plan.
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