Can Gout Recur Days After First Attack in Patients with No History?

Is it possible for someone with no history of gout to experience a recurrence of symptoms just a few days after the first attack?

Hello Doctor, thank you for taking the time to answer my questions.
My mother, who is 72 years old, has high blood pressure and her height is 153 cm with a weight of 64 kg.
About six days ago, she noticed pain in her left ankle when walking in a certain position.
She didn't think much of it and continued to walk and stand for long periods throughout the day, resulting in significant swelling and pain during the night.
The next day, she visited a nearby clinic where the doctor diagnosed her with inflammation.
However, last month’s blood test showed her uric acid level was 7.9 (normal during last year’s check-up), so she asked the doctor if it could be gout.
The doctor prescribed colchicine, anti-inflammatory medication, and pain relievers, stating that she could stop taking them once the pain subsided.
After taking the medication for two days, her pain went away, and she stopped taking the medication (although the swelling in her ankle has not yet resolved).
However, last night, the pain suddenly returned, just as severe as before.
I would like to ask the doctor: my mother’s symptoms only include swelling and pain in the ankle, with no redness or heat.
Could this be gout? Can gout recur three to four days after the first attack (she has no previous history of gout)? Additionally, my mother is overweight and has a habit of standing for long periods while doing housework.
Her usual diet is quite light, and on the day of the pain, she only ate a small amount of fish and mushrooms.
I apologize for the lengthy message.
Thank you for your valuable time.

Zhang Xiaojie, 40~49 year old female. Ask Date: 2023/02/15

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Gout can indeed have recurrent attacks in a short period of time.
Gout attacks typically present with redness and heat, so the absence of these symptoms does lower the likelihood.
Eating shiitake mushrooms is fine, and consuming fish is also acceptable; however, patients with gout should avoid fish skin.
I recommend returning to your physician for further evaluation.
If there is indeed joint swelling, it may be necessary to perform a joint aspiration.
The presence of uric acid crystals in the joint fluid analysis is the most accurate way to diagnose gout.
Elevated serum uric acid levels alone do not constitute a diagnosis of gout.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital, Ministry of Health and Welfare, is concerned about your well-being.

Reply Date: 2023/02/15

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. It is caused by the accumulation of uric acid crystals in the joints due to elevated levels of uric acid in the blood. In your mother's case, her recent symptoms, including pain and swelling in the ankle, along with a history of elevated uric acid levels (7.9 mg/dL), suggest that gout could indeed be a possibility.

To address your question about whether gout can recur days after the first attack, the answer is yes. Gout attacks can occur intermittently, and it is not uncommon for patients to experience multiple attacks, especially if they have elevated uric acid levels. In fact, gout can manifest as recurrent episodes, and the time between attacks can vary widely among individuals. Some patients may experience attacks weeks or months apart, while others may have them more frequently.

In your mother's case, the fact that she experienced significant pain and swelling in her ankle after a period of being asymptomatic raises the possibility of a recurrent gout attack. It is important to note that gout can occur without the classic signs of redness and heat, especially in its early stages or in certain individuals. The absence of these symptoms does not rule out gout as a diagnosis.

Given that your mother has a history of elevated uric acid levels and is experiencing symptoms consistent with gout, it would be prudent for her to follow up with her healthcare provider for further evaluation. This may include a physical examination, blood tests to check uric acid levels, and possibly imaging studies to assess the joint. If gout is confirmed, her doctor may recommend lifestyle modifications, dietary changes, and medications to manage her uric acid levels and prevent future attacks.

In terms of management, lifestyle changes can play a significant role in controlling gout. These may include:
1. Dietary Modifications: Reducing the intake of purine-rich foods (such as red meat, organ meats, and certain seafood) can help lower uric acid levels. Encouraging a diet rich in fruits, vegetables, whole grains, and low-fat dairy products may be beneficial.

2. Hydration: Staying well-hydrated can help the kidneys excrete uric acid more effectively. Encourage your mother to drink plenty of water throughout the day.

3. Weight Management: Since your mother is overweight, losing weight gradually can help lower uric acid levels and reduce the frequency of gout attacks.

4. Medication: If gout is confirmed, her doctor may prescribe medications such as allopurinol or febuxostat to lower uric acid levels over the long term, as well as anti-inflammatory medications to manage acute attacks.

5. Monitoring: Regular follow-up with her healthcare provider to monitor uric acid levels and adjust treatment as necessary is essential.

In conclusion, gout can recur days after the first attack, and it is important for your mother to seek further evaluation and management from her healthcare provider. With appropriate treatment and lifestyle changes, it is possible to manage gout effectively and reduce the frequency of attacks.

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