Recent Gout diagnosis

[Katrina]

I was diagnosed with Gout last week by my GP. I am a 50 year old female and my UA was 7. I have no other medical issues. My big toe has been bothering me since December, but the pain is not excruciating or debilitating, just irritating. No real swelling or inflammation. I don’t even take any pain reliever for it. There was also an Xray that shows a couple of tiny bone spurs in the joint and very mild osteoarthritis, no real joint damage. The GP prescribed Allo 100mg for two weeks then up to 200mg for another two weeks then 300mg ongoing. Also, Colchincine, which I understand is to help relieve inflammation and pain, but lots of side effects that I really rather not chance. Does a 20 min doctor visit and one UA test warrant a Gout diagnosis and meds for life. The GP didn’t advise on any follow up appts or tests. I’m wondering if I should get a second opionion. This is a serious diagnosis that my GP seemed to make rather flippantly with zero concern for future care.

[nobody]

Hi!

No, one UA test returning 7mg/dl (are you sure you got the value right? check the unit as well if you can) doesn’t even come close to establishing a diagnosis of gout. The real issue isn’t the test but: is this GP skilled and experienced enough to reliably recognize gout at first sight? I doubt it. In any case, gout doesn’t always mean meds for life.
The relevant specialist you could consult is called a rheumatologist.

If you do start allopurinol (or have already started it), standard procedure is to get another blood test before increasing the dose. There are two main points: it may show that the dose you started with is strong enough for you and it is also improtant to make sure your liver and kidney function are not badly affected by the drug.
You don’t have to take allopurinol for life if you start it. I don’t recommend trying it for no good reason because it is a dangerous drug but it can work as a gout test. If you took it every day without fail (unless of course you get a bad reaction) for a couple years, it should cleanse you thoroughly of any gout you might have. And if your symptoms don’t stop, you’ll know for sure they aren’t caused by gout.
A warning: people who have some East Asian ancestries are especially at risk of getting serious reactions to allopurinol and should take a genetic test before trying allopurinol or simply use an alternative.

You don’t have to take colchicine even if you have gout. If you don’t get serious swelling or pain, there’s not much benefit. If you do end up getting these symptoms, you’ll regret not having taken it earlier but that’s not the end of the world (in such a situation, treat such symptoms with a drug such as irfen if you tolerate this class of drug).

[Katrina]

Thanks for your reply, yes my UA was 7mg/dl. I’ve gone to this clinic for over 20 years and have no past UA tests to compare to. Honestly, I don’t think this doctor is very skilled in Gout, especially after reading posts on this site and hearing the treatment and follow up others are receiving. She made no mention as to any follow up visits or testing. Also, after reading about this Colchicine, doesn’t seem like I’m a candidate with mild pain and really no acute “attack” to reference. Also, she said lifelong use of the Allo, and from what you’ve stated and other posts, doesn’t sound accurate.

I just received a call back from her office wanting to know why I wanted a referral to a Rheumatologist? I was surprised at the question, since it seems evident to me that anyone who received this diagnosis would want to see a specialist. More of her acting flippantly at such a diagnosis. From what I’ve read this isn’t a condition to treat lightly, just seems like she was anymore concerned than she would be writing another script for strep or something.

[nobody]

Writing an allo script is taking the disease seriously. The trouble is that it’s not clear you have it! And I’m not your doctor (or anyone else’s) but depending on your background, history and other tests results, allo could be low-risk. The social cost is also very low compared to many routine drugs. That said, it’s certainly not zero risk and not doing a blood test before increasing the dose beyond 100mg/day in particular is irresponsible considering your only test result suggests 100mg may already be more than you need…
Typically, allo is a lifetime drug but that’s in part because most users have a much more serious gout than yours (assuming you do have it) and also in part because doctors are typically reluctant to prescribe it early enough, when it could stop the disease from progressing to a stage at which gentler ways to control it become ineffective. Taking allopurinol early makes tons of sense so your GP’s approach isn’t totally crazy but on the other hand it’s a slow disease so waiting for a second opinion shouldn’t make much difference (unless you have to deal with crazy waiting lists or something).

[Katrina]

I saw the Rheumatologist today. She doesn’t think the issue with my toe has anything to do with Gout. She see’s zero gout damage in the xray’s and though I have a UA level at 7, doesn’t see that’s it’s caused any issues thus far. She is leaving my diagnosis as is, this makes it easier for me in our clinic system to access her if I have questions, want to test UA again or think maybe I’m having a reaction to foods etc…At this time she does not recommend any treatment other than remaining aware of possible reactions. Thanks for the help, this forum is a great resource!

[nobody]

I’m very impressed by how quickly you were able to see a specialist. In that situation, I do think it was crazy to give you allo.
It took such a long time for me to get to see a specialist (for instance I had to go to the ER and pay for it out of pocket even though that was useless, perhaps in order to document the seriousness of my case) that giving me allo right away without a real diagnosis would have made sense.

One last bit of advice: make it a point to get another UA test. There’s no rush to do it so maybe it could for instance wait for your next regularly scheduled test. But understand single results are sometimes off, especially when people actually have gout. And the test is dirt cheap whenever you are already going to have another blood test.

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