From Sprained Ankle to High Uric Acid: Your Symptoms

Visiting an orthopedic specialist for a sprain turned out to be primarily due to high uric acid levels?

Hello, Doctor.
I am 175 cm tall and weigh 99 kg, with a history of hypertension but no other health issues.
I am currently on a weight loss program and have lost 5 kg in the first month (originally 104 kg).
About nine days ago, I sprained my left ankle (it didn't hurt at the time).
Six days ago, my left ankle started to hurt (there was no swelling).
Since my job requires me to stand, run, and squat for long periods, I initially thought it was fatigue.
However, it hurts a lot whenever I walk or touch the ankle, so I went to an orthopedic doctor.
The doctor examined my left ankle and pulled up my health check report from six months ago, noting that my uric acid level was 6.9 mg/dL.
Although the upper limit of the reference value is 8 mg/dL, the doctor indicated that this is already considered high uric acid.
He prescribed medication for gout, and after taking it for three days, I feel a bit better, but my ankle seems to have become slightly swollen.
I would like to ask if this is normal.
If it doesn't improve, should I return to the orthopedic doctor or switch to a rheumatologist? Thank you!

Mr. Hsieh, 30~39 year old female. Ask Date: 2024/03/22

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your inquiry.
For now, I recommend applying ice for one day and suggest that you consult a rheumatologist.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital, Ministry of Health and Welfare, is here to assist you.

Reply Date: 2024/03/22

More Info

When dealing with symptoms ranging from a sprained ankle to elevated uric acid levels, it's essential to understand the underlying mechanisms and how they may interrelate. Your situation presents a combination of musculoskeletal injury and metabolic concerns, particularly regarding your uric acid levels.

Firstly, regarding your sprained ankle, it’s not uncommon for such injuries to initially present with minimal pain and swelling, only to develop discomfort days later. This delayed onset of pain can be attributed to inflammation and soft tissue damage that may not be immediately apparent. The fact that you are experiencing significant pain when walking or touching the ankle suggests that there may be underlying inflammation or even a possible ligamentous injury. The absence of swelling does not rule out a sprain; sometimes, swelling can be minimal or localized.

As for your elevated uric acid levels, a reading of 6.9 mg/dL is indeed on the higher side, especially considering that the upper limit of normal is typically around 6.0 to 7.0 mg/dL for men. While your level is below the threshold for a diagnosis of gout (which is often considered at levels above 7.0 mg/dL), it does indicate that you are at risk for developing gouty arthritis, particularly if you have a history of joint pain or swelling. The medication prescribed by your doctor is likely aimed at managing this risk and alleviating any potential gout flare-ups.

The slight swelling you are noticing in your ankle after starting the medication could be due to several factors. It might be a normal response to the healing process, as inflammation can sometimes increase before it decreases. Alternatively, if the medication is altering your body's uric acid levels, it could also be influencing fluid retention or other metabolic processes. It’s essential to monitor this swelling closely; if it worsens or if you experience increased pain, it would be prudent to consult your physician.

In terms of follow-up care, if your ankle does not improve or if you continue to experience significant pain, it would be advisable to return to the orthopedic specialist. They may want to perform imaging studies, such as an X-ray or MRI, to rule out any fractures or more severe ligamentous injuries. If your symptoms persist and are accompanied by signs of gout, such as redness, warmth, and severe pain in the joint, a referral to a rheumatologist may be warranted. Rheumatologists specialize in metabolic bone diseases and can provide more targeted treatment for conditions like gout.

In summary, your symptoms of ankle pain and elevated uric acid levels are interconnected, and both require careful management. Continue to monitor your symptoms, adhere to your prescribed medication, and maintain communication with your healthcare providers. If you notice any significant changes or worsening of your condition, do not hesitate to seek further medical advice. Additionally, maintaining a healthy lifestyle, including a balanced diet and regular exercise, will be beneficial in managing both your weight and uric acid levels.

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