Gout or another type of arthritis?

MichaelKnight

Hi, just found this forum yesterday and thought I'd make a post in case anyone was willing to give me their opinion - thanks.

Would appreciate your views on whether on not you believe Im suffering from gout or something else.

For 5 months I've had fairly symmetrical pains throughout my joints. First felt in my toes, then fingers, knees, wrists, arms and shins. I'm mostly affected now in my fingers, at the finger tips, with my index fingers becoming quite swollen with loss of motion. Also my arms are sore. I find it painful to pick up most objects, typing and putting some of my fingers in cold water is uncomfortable. My fingers are showing signs of what is either herberden nodes or possibly tophi (although not at all as extreme as some pictures you see). Looking at online pics I'm tempted to think they are herberden nodes. My fingers feel like they are almost someone else's, as a result of the swelling. I'm also finding I'm a bit clumsy with them dropping things occasionally.

One of my middle toes has gone quite thick 'bony' but apart from that there are no other physical "tells" that are obvious.

My GP asked for an x-ray of my hands in February which showed only minor wear and tear possibly osteoarthritis he thought in the fingers. However they have become much more swollen since then. At the start of the year uric acid levels were up to 440 from 400 in the previous year; and most recently were recorded as 590. I was put on a course of Colchicine in January to "test" for gout which had no positive effect, Prednisolone has been tried a couple of times which did help, and I've now been taking Allopurinol for 6 weeks with no positive effect, although in the first week of treatment it was combined with Colchicine - when on that occasion I was in less pain than on the first occasion when Colchicine was used.

Im a 47 year old male. Not over weight. Dont drink heavily but do enjoy a beer (which Ive currently cut out) re purines.

I'd imagine most people would agree that these are not the typical symptoms of gout; since they did not begin with swelling of the big toe, I have no 'redness' of skins, and I have sharp pains which have been going on for months, rather than 'flare ups for a few weeks only'.

However I think what's pushing my GP to think in that direction is the symmetrical nature (ie unlikely to be osteoarthritis but rather is inflammation of some kind) and the elevated uric acid. I've asked if I can be referred to a reumatologist and he's said they wouldn't look at my case while my bloods are not showing an issue e.g. no raised rheumatoid factor. Should I be pushing this? Or if necessary trying to get a (hopefully not to costly) private assessment?

I became convinced it was rheumatoid arthritis, however things are not worse in the mornings and as said bloods are not showing raised Rheumatoid factor. Reading about early stage RA experiences, it does however suggest that morning stiffness and positive blood tests may however not be present.

Appreciate greatly you reading my story (sorry for the length). If you have an observations then it would be much appreciated.
Thanks
Michael

PS struggling to get pics of fingers to load but I'll try again later

[Deleted User]

Hi Michael welcome to the forum, sorry you are in a lot of pain at the moment,the forums are very friendly and everyone is understanding and sympathetic as well as trying to provide the answers you need. We also have a number you can contact to speak to a person it is 0808 800 4050.
All the best Christine

stickywicket

Hi Michael and welcome.

We have no training in diagnostics and are not medics of any description but one does acquire a bit of knowledge and experience on the arthritic path.

I have RA and have had for many years. Much of what you describe sounds familiar but, until I was on the appropriate meds, in addition to what you describe was the crushing fatigue which is typical of inflammatory forms of arthritis.

On the other hand, your thread raised an all-too-familiar issue on here ie GPs are not very clued up about arthritis and often think that a negative blood test indicates RA is not possible. That's just not so. The rheumatoid factor is present usually but not always. Have a read here on the trustworthy ARUK site https://tinyurl.com/y9gkpgtx .

There are also other forms of inflammatory arthritis besides RA which are sero-negative eg Psoriatic Arthritis and Ankylosing Spondylitis. The latter tends to affect the spine though.

stickywicket

Further thoughts.

https://tinyurl.com/yc9senys

The above page, from ARUK, tells us what treatments there are for gout. As you'll see, colchicine “should be taken as close as possible to the beginning of an attack, and certainly within the first 24 hours of the attack starting, otherwise it may not be effective.”

Re allopurinol it says “The main reason not to start with a large dose is that lowering urate levels quickly can actually trigger an acute attack. …....... Bringing urate levels down slowly by gradually increasing the dose of allopurinol is much less likely to trigger an acute attack.”

This page, on gout in general, might also be useful. https://tinyurl.com/yap96vhh . Personally, I think your next course of action depends on your relationship with your GP. If (s)he is the sort to whom you can say RA isn't always sero-positive and, if necessary, produce a printout of the ARUK page (Dr Helliwell is an excellent rheumatologist in an excellent rheumatology department at Chapel Allerton Hospital in Leeds) then I'd try that first. If not, I'd try a different GP in the practice. I tend to regard private medicine as a last resort and I don't believe private consultants are necessarily any better than NHS ones. Though they are quicker

dreamdaisy

Hello, my husband is prone to bouts of gout which clear after a few days thanks to naproxen, an anti-inflammatory. It affects his toes and occasionally an ankle, he does not feel extra tired and is not in any great pain (although it may feel sharp to him ). Alcohol consumption is not a factor in gout, even teetotallers can be affected.

I have an auto-immune arthritis plus osteo. Despite medication neither go away preferring instead to spread and get worse. I am in pain 24/365 and have been for years. I am tired all the time, do not sleep well and have rubbish concentration all thanks to the wicked combination of pain and disease. I began back in 1997 when I was 37 with the auto-immune, it wasn't until 2006 when my skin helpfully obliged with a bout of pustular psoriasis that the medical penny dropped and I was given the final diagnosis is psoriatic arthritis. The OA was diagnosed in 2011, my rheumatologist ignores that and my GP ignores the PsA. I do my best to ignore both.

We cannot diagnose but it certainly sounds to me that you could benefit from more tests and investigations. GPs are better informed than they used to be but they are by no means informed enough about the complexities of auto-immune conditions. Please let us know how you get on. DD

MichaelKnight

stickywicket wrote:

Hi Michael and welcome.

We have no training in diagnostics and are not medics of any description but one does acquire a bit of knowledge and experience on the arthritic path.

I have RA and have had for many years. Much of what you describe sounds familiar but, until I was on the appropriate meds, in addition to what you describe was the crushing fatigue which is typical of inflammatory forms of arthritis.

On the other hand, your thread raised an all-too-familiar issue on here ie GPs are not very clued up about arthritis and often think that a negative blood test indicates RA is not possible. That's just not so. The rheumatoid factor is present usually but not always. Have a read here on the trustworthy ARUK site https://tinyurl.com/y9gkpgtx .

There are also other forms of inflammatory arthritis besides RA which are sero-negative eg Psoriatic Arthritis and Ankylosing Spondylitis. The latter tends to affect the spine though.

Thanks very much for your message stickywicket. I'm certainly feeling tired but not sure if I could honestly describe it as crushing fatigue. Don't think it's likely to be Psoriatic (unless skin issues haven't shown yet) or AS (unless spine not shown yet). I have another appointment with my GP at the end of the month after next week's blood test, so will emphasize the non-RA factor issue if that's the case.
Thanks again
MK

MichaelKnight

dreamdaisy wrote:

Hello, my husband is prone to bouts of gout which clear after a few days thanks to naproxen, an anti-inflammatory. It affects his toes and occasionally an ankle, he does not feel extra tired and is not in any great pain (although it may feel sharp to him ). Alcohol consumption is not a factor in gout, even teetotallers can be affected.

I have an auto-immune arthritis plus osteo. Despite medication neither go away preferring instead to spread and get worse. I am in pain 24/365 and have been for years. I am tired all the time, do not sleep well and have rubbish concentration all thanks to the wicked combination of pain and disease. I began back in 1997 when I was 37 with the auto-immune, it wasn't until 2006 when my skin helpfully obliged with a bout of pustular psoriasis that the medical penny dropped and I was given the final diagnosis is psoriatic arthritis. The OA was diagnosed in 2011, my rheumatologist ignores that and my GP ignores the PsA. I do my best to ignore both.

We cannot diagnose but it certainly sounds to me that you could benefit from more tests and investigations. GPs are better informed than they used to be but they are by no means informed enough about the complexities of auto-immune conditions. Please let us know how you get on. DD

Thanks very much for your reply. Have read quite a lot about gout and my understanding is indeed that many people are prone to having raised levels of uric acid, and certainly I've had kidney stone issues for years so that could make sense, however there are certain triggers and alcohol can have two impacts in terms of the likes of brewers yeast raising purines (that convert into uric acid) and also kidneys while working on processing alcohol do not process uric acid as efficiently. So diet can play a part even if it isn't a significant as perhaps historically thought or is relevant to everyone?

The combination of illnesses that you describe you are suffering from sound very challenging, and I appreciate that I'm not effected at that same level at this time. Apologies for my naivety but do you have
OA arthritis which is other than RA, and in which case does it have another specific categorisation of some kind?

MichaelKnight

Sorry message copied twice and can't seem to delete

MichaelKnight

Sorry message copied twice and can't seem to delete!

stickywicket

Just to clarify matters.. DD has Psoriatic Arthritis (PsA) and Osteoarthritis (OA) and I have Rheumatoid Arthritis (RA) and OA. In both cases our OA resulted from the autoimmume/inflammatory arthritis (PsA or RA) not being treated early enough. Good luck with your GP. Please let us know how you get on.

MichaelKnight

stickywicket wrote:

Just to clarify matters.. DD has Psoriatic Arthritis (PsA) and Osteoarthritis (OA) and I have Rheumatoid Arthritis (RA) and OA. In both cases our OA resulted from the autoimmume/inflammatory arthritis (PsA or RA) not being treated early enough. Good luck with your GP. Please let us know how you get on.

Thanks for explaining. I will definitely update you on what I find out - all the best M

MichaelKnight

Hello

SW, you suggested I let you know how I got on. Appreciate almost a year has passed! but I've finally been diagnosed following 2 reumatologist appointments.

The short of it is that a consultant has put in writing that my "final diagnosis" is osteoarthritis.

He believed that basically the GP was a bit too quick to jump to the conclusion that the cause of the symptoms was gout, based on high uric acid levels.

The first consultant I saw thought it could be either osteoarthritis or inflammatory arthritis (of a type to be further diagnosed, but with a history of Crohns thought it may be linked). However the second consultant has narrowed in on osteoarthritis. I noted that all the symptoms in my feet, hands, arms, knees came on at the same time and was that typical of osteo, but he suggested that it can happen. I have been told that I will not be seen again by a consultant (unless some surgical intervention was needed one day), and I should see my GP if necessary. I have been taking Tulmeric for 6 months and with the consultant's recommendation started Glucosamine / Chondroitin and Omega 3 almost 4 months ago but am not convinced they are helping, I will however keep trying for a couple more months. It could well be argued that my symptoms are not unbearable and I appreciate are not on the same level as many peoples, however they are distracting and v unpleasant with a sharp pain shooting through my fingers whenever picking up everyday objects, in my knees when walking and my toes fairly spontaneously. I did wonder if this is normal re osteoarthritis at 47 years old. Although realise there is no real 'normal' I assume lots of people just have to go about their days in pain and without any likelihood of it getting better (and realistically the opposite happening).

My doctor gave my cocodamol and also tramadol at one point but seems a little reluctant to keep prescribing as I am to take it long term.

Thanks for any thoughts.
All the best
M

dreamdaisy

If it is OA then you will be discharged from rheumatology and your GP will take over as that falls within their purlieu. The treatment is pain relief, maybe an anti-inflammatory medication and a possible referral to physiotherapy for exercises which will not solve the problem, nor diminish any pain, but will help to keep the muscles surrounding the affected joints as strong and flexible as possible to better support the joint. These must be done regularly.

As for pain it's best to get used to living with it and keeping pain relief to a minimum so you always have room to maneouvre when things worsen (which, quite handily with OA, one can predict when they will). Low pressure weather can aggravate it, the cold and also overdoing things. I find that eating too many acidic foods can make things worse so I steer clear of pickles, some fruit and my adored pickles. It's always things one likes that make things worse. :roll: DD

daffy2

I sympathise with your shooting pains problems as it's the thing I find most tiresome about the OA in my hands(the multiple other sites haven't - so far!- gone down that route) In the early days there were crockery casualties but as the joints involved have got lumpy and less mobile the problem becomes more limited. I assume it's some sort of process the body is going through - in response to, or caused by inflammation? - which tends to come and go in terms of activity and intensity. The thing I find very difficult when it's kicking off is the acute sensitivity to touch which sets off flashes of pain, and makes handles, keys etc even more of a challenge. There doesn't seem to be a consistent direct correlation between the OA episodes and other health issues. If my gut is playing up then the OA is more in evidence throughout, and I have a suspicion that active hayfever can set the finger joints off, but they can crop up seemingly at random. A topical gel is sometimes helpful(it took a couple of attempts to find one that worked as they have different active ingredients), but not the easiest to deal with on the hands, and I don't use oral pain 'relief' for the hands playing up(sledgehammer/nut, and anyway not very effective for me for that problem).
The nature of the pain I find is less amenable to the usual techniques; distraction is helpful for the consistent grind kind of pain but has its limitations when a redhot pin is suddenly stuck into a finger joint when nothing is being done to provoke it!

stickywicket

Thanks for the update. It's always good to know how people are getting on especially when their diagnosis is not immediately clear cut.

It seems you do have OA though I don't think your GP was at all hasty, just sensible. OA can be difficult. For some it's just one joint or one limb. For others it's a full on thing.

I can't really help re how one experiences the pain as I'd had RA for so long before getting OA too that it was probably different for me.

As for the dietary supplements. i think turmeric is one of the very few which might help. i think Glucosamine/Chondroitin was taken off the NHS prescribing list as there wasn't enough evidence to show it did anything. However, my husband took it for years and swore it helped. Now, though, it's anti-inflammatories for him. This is a page of some info that's useful to know for anyone taking supplements. https://ods.od.nih.gov/HealthInformation/DS_WhatYouNeedToKnow.aspx

And here's a good, comprehensive page on OA https://www.arthritisresearchuk.org/arthritis-information/arthritis-today-magazine/156-spring-2012/osteoarthritis.aspx

I understand your GP's reluctance to prescribe strong pain relief. Our bodies can grow accustomed to it so that we need stronger and stronger meds just to stay where we're at. I think it's better and safer to find our own 'toleration level' of pain and use pills as a last resort.

I presume x-rays have been done. Usually these will determine whether damage is OA related or not. So I think you probably have to accept you have OA and act accordingly. But if, in the future, anything changes, don't be afraid to go back to the GP.

Airwave!

If I may just chip in with my pennyworth? Most of the newcomers on here and some of the regulars all want to chase after a diagnosis and since it has a great affect on our lives, why not? The real thing most of us live with is pain since OA and RA affects in differents ways but they (types of arther) all cause pain and discomfort which is different for all of us but which when we get sent away from the surgery/hospital we have to deal with on our own and in the middle of the night, in the quiet hours when we are still suffering it can be literally a nightmare.

So we need t1o r3cognise that pain is our foe and to defeat it we must often turn to our own devices, cognisant ability and willpower are our friends. Drugs and aids will only go so far.

Since we suffer in different ways we must all develop our own strategys. I often feel that I will be beaten by pain but somehow manage to rise above it, the mind is a wonderfull ally.

Good luck.

MichaelKnight

Thank you so much for your helpful replies DD, daffy2, SW and Airwave.

It's definitely helpful getting some confirmation that the symptoms are very typical of OA. I realise it's a very naive thing to say, but I had no idea that OA pain at an early stage could be so challanging. It's clearly doesn't have the severity of kidney stone pain (which I have fr time to time) but I think it's the continual, relentless nature of it.

I take the point DD re exercise and pretty much accepting the pain. I'll watch out re acidic food and try to spot any other connections.

Interesting daffy2 you also get the shooting pains in your hands. I should say the pains in other areas e.g knees and arms etc are more achy than shooting, so hands are also the biggest issue for me. Interesting you've seen a link between gut and OA pain. I'll try a gel and indeed distraction as far as I can!
The consultant did mention Capzasin cream altho appreciate my GP would need to prescribe this - could be worth a try.

Far point SW re GP prob not being hasty, just difficult to diagnose. Thanks for links, I expect Tulmeric is the one I'll stick with. Xrays have been done a yr apart showing erosion which they consider fitting with OA. Yes good to know the GP is there.

Thanks Airwave, yes I need to work on strategies, some medications when it's bad, a bit of distraction and coming to terms with it. Realise a lot of people have it at a very extreme level and it's not going to go away.

Thanks again to you all.
M

daffy2

I use a generic ibuprofen over the counter(OTC) gel. I tried Voltarol, which contains diclofenac, after a couple of people I knew said they found it effective. It didn't work for me and even on special offer I thought it expensive. Unless you've been told you shouldn't use either of those drugs then it might be worth trying the OTC gels - suggest the non-branded so it's less to lose if they don't work! I have heard that some folk have had trouble getting GPs to prescribe the capsaicin gel, possibly a cost issue, but it's still included in NICE treatment options for OA.