Gout Symptoms: Normal Uric Acid Levels and Foot Discomfort

Q: Gout Symptoms: Normal Uric Acid Levels and Foot Discomfort

Hello, thank you for your question. <br>Here are my responses：<br>1. <br>Can gout occur even with normal uric acid levels? For example, if someone suddenly consumes a large amount of seafood or red meat, or if they haven't been drinking enough water recently, could this trigger a

Regarding normal uric acid levels but slight discomfort in the big toe?

Hello Director Gao,
I apologize for disturbing you, but I would like to consult you regarding a patient.
About ten years ago, the patient experienced sudden severe pain in the foot and was diagnosed with gout.
After that incident, they adjusted their diet, increased water intake, and abstained from alcohol, and have since not had any acute gout attacks.
They have been having blood tests and urinalysis every six months due to diabetes, and have requested their doctor to monitor uric acid levels as well (the rheumatologist asked the endocrinologist for assistance).
The patient visits the rheumatology and immunology department approximately once every one to two years, and since they are at the same large hospital, they review past reports and provide emergency medications (Colchicine + Allopurinol), advising the patient to use them if symptoms arise and to return for a follow-up as soon as possible.
However, a few days ago, the patient felt a dull sensation in the right big toe (persistent), occasionally feeling like an electric shock or being pricked by a needle (intermittent).
However, it was not the same as the previous continuous redness, swelling, heat, and pain that made walking impossible.
After taking the medications mentioned above, the dull sensation disappeared, but the occasional prickling sensation persisted slightly, though it resolved the next day.
The patient had their uric acid level tested last month at 5.9, with an average of 6.1 over the past three years, which raises some questions they would like to ask you:
1.
Can gout occur even with normal uric acid levels? For example, could it be triggered by suddenly consuming a large amount of seafood or red meat, or by insufficient water intake recently? However, it is not the kind of unbearable pain typical of gout, but rather a mild sensation as experienced this time.
2.
I found online that sensations like electric shocks or prickling in the foot could be related to gout or diabetic neuropathy.
There is less mention of gout causing such sensations, but the patient's blood sugar has been controlled around 5.5 for the past three years, and they just completed their annual diabetes check-up (including eye and nerve examinations) last month, which were all normal.
The symptoms gradually disappeared after taking medication.
I would like to ask how to differentiate between these conditions and which department to visit for follow-up if needed.
Given the recent surge in the pandemic, the patient is hesitant to visit a large hospital for minor issues to avoid wasting precious medical resources, so I am reaching out to you for guidance.
Thank you for taking the time to answer my questions.

Yang, 30~39 year old female. Ask Date: 2022/05/13

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1.
Can gout occur even with normal uric acid levels? For example, if someone suddenly consumes a large amount of seafood or red meat, or if they haven't been drinking enough water recently, could this trigger a mild gout attack rather than severe pain? --> Gout attacks are related to significant fluctuations in uric acid levels over a short period.
Even if uric acid levels are normal recently, a sudden large meal or alcohol consumption can cause significant spikes in uric acid, potentially leading to a gout attack.
Additionally, allopurinol is a medication used to lower uric acid levels and does not have analgesic effects.
Generally, allopurinol is prescribed with the intention of regular use rather than as an emergency backup, so you should confirm this with your rheumatologist.
Lastly, the big toe joint is also a common site for joint degeneration, and your rheumatologist can assist with differential diagnosis.
2.
I found online that sensations like electric shocks or tingling in the feet could be related to gout or diabetic neuropathy.
There is less mention of gout causing such sensations, but my blood sugar has been controlled around 5.5 for the past three years, and I just completed my annual diabetes check-up (including eye and nerve examinations) last month, which were all normal.
The symptoms gradually disappeared after taking medication.
How can I differentiate between these conditions, and which department should I visit for follow-up? --> Acute severe pain is more closely related to gout, while chronic pain is more associated with joint degeneration.
If you have been experiencing symptoms frequently, in addition to discussing the previous question with your rheumatologist, they should also evaluate the affected joints to assess your pain.
Some differential diagnoses require a physical examination of the joints for more accurate assessment.
Therefore, I recommend seeing a rheumatologist.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital is here to assist you.

Reply Date: 2022/05/13

More Info

Hello! Thank you for reaching out with your questions regarding gout symptoms and the relationship between uric acid levels and foot discomfort. It's great that you are actively monitoring your health, especially considering your history with gout and diabetes. Let's address your concerns one by one.

1. Can normal uric acid levels still lead to gout symptoms?
Yes, it is possible to experience gout symptoms even when uric acid levels are within the normal range. Gout is primarily caused by the crystallization of uric acid in the joints, leading to inflammation and pain. However, factors such as diet, hydration, and individual susceptibility can influence the onset of gout attacks. For instance, consuming a large amount of purine-rich foods like seafood or red meat can temporarily elevate uric acid levels, even if your baseline levels are normal. Additionally, dehydration can lead to higher concentrations of uric acid in the blood, potentially triggering symptoms. The discomfort you felt in your big toe, characterized by a dull ache or occasional sharp, needle-like sensations, could indeed be related to gout, especially if it is a recurring issue.

2. Differentiating between gout and diabetic neuropathy:
The sensations you described, such as feeling like an electric shock or being pricked by a needle, can be indicative of neuropathy, which is a common complication of diabetes. However, gout typically presents with more acute symptoms, such as intense pain, swelling, and redness in the affected joint. Since your blood sugar levels have been well-controlled and you recently completed a thorough check-up with no signs of neuropathy, it is less likely that your symptoms are related to diabetes. Nevertheless, it is essential to remain vigilant, as the symptoms can overlap.

Given your history of gout and the recent symptoms, it would be prudent to monitor your uric acid levels closely. While your recent test showed a level of 5.9 mg/dL, which is within the normal range, fluctuations can occur. If you notice a pattern of discomfort in your joints, it may be beneficial to keep a food diary to track your diet and hydration levels, as well as any symptoms that arise.

Regarding your next steps, if your symptoms persist or worsen, it would be advisable to consult with a rheumatologist, as they specialize in conditions like gout. They can provide a comprehensive evaluation and may recommend further testing or adjustments to your management plan. If you are concerned about visiting a hospital due to the ongoing pandemic, consider reaching out to your healthcare provider for a telehealth consultation. This can help you determine if an in-person visit is necessary without risking exposure.

In summary, while normal uric acid levels can still lead to gout-like symptoms, it is essential to consider other factors such as diet and hydration. The sensations you are experiencing may be related to gout or could indicate another issue, such as diabetic neuropathy. Keeping track of your symptoms and consulting with a specialist if necessary will help you manage your condition effectively. Stay proactive about your health, and don't hesitate to seek medical advice when needed. Thank you for your thoughtful questions, and I wish you continued health and well-being!

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