Would love some suggestions on how to diagnose this. As background: I'm a 28 yo male, extremely overweight (I'm working on it), but in good health otherwise.
About a month ago, I had the following symptoms:
Woke up with:
- mild pain in left foot
- centered around the big toe joint
Over the course of the day this developed into:
- entire foot is swollen and extremely sensitive to touch
- can't put any weight on any part of the foot or rotate the foot
- very painful even when resting
- big toe joint is somewhat red
Sounds like classic gout, right? Which is what the doctor diagnosed it as when I went to a clinic two days later (when the pain subsided somewhat). He gave me prednisone and I could walk more or less normally a few hours later. I took ibuprofen for a few days more, and had some soreness and stiffness for a couple of weeks.
They also did a blood test for uric acid level, which was normal (not that uncommon with gout from what I understand?).
I've had similar, but much milder, episodes maybe half a dozen times over the last few years (though not for at least 9 months before this incident), which I wrote off at the time as some injury I didn't notice - these resolved themselves in a day or two.
Now, a couple of days ago, I get a repeat of the exact same symptoms, EXCEPT the big toe is fine, the initial pain started in the outside part of the foot, and there is no redness.
This time the clinic doctor (different one) diagnosed it as a foot sprain mainly because it's not "red and hot" (I'm somewhat skeptical because I definitely didn't injure it) and prescribed indomethacin and vicodin (also common for gout, as I understand) which seem to help with the symptoms (indomethacin takes a really long time to kick in), although after two days, I still can't really walk (but at least there is no pain when resting).
So I guess my main questions are:
Is it possible for a sprain to start out as mild pain, and develop into severe pain over the course of a day with little activity (I have a sitting kind of job)?
Is it possible for a gouty arthritis attack to not have redness and heat?
I'm seeing my GP in a week, would really appreciate advice on topics to bring up, things to test for.
The pain in the outside part of your foot could indeed be gout. If you want a definitive diagnosis, go to a rheumatologist who can remove some fluid from the affected joint and examine it under a polarizing microscope. Measuring the concentration of uric acid in your blood is not definitive.
More importantly, make sure that you don't have sleep apnea. If you do, it is probably the cause of your gout. Your obesity makes sleep apnea more likely. Your gout is your early warning of sleep apnea. If you let it continue, you greatly raise your risk for the development of many life-threatening diseases.
You can definitely have a gout attack without the swelling or redness. I rarely get much redness (and I've had close to 40 attacks). Much of it depends on where you have the attack. Mine can be somewhat nomadic (the pain moves all over the foot).
Talk with your doctors about these medications. They will not prevent an attack, but will relieve your pain when you have one.
I have never had redness or heat, and only occasionally swelling with my attacks. They are also very nomadic. I've gotten them in both feet and both knees, and last week, for the first time, in my left elbow. I thought it was biceps tendonitis at first, but the speed at which the pain has reduced, and the location of the pain (only at the joint after initial swelling gone down) led me to figure it was, in fact, a gout attack.
I was of a similar situation to you, when I was first diagnosed. Late 20s, overweight, etc. I'm now 31 and I've lost 40lbs, and my attacks are virtually gone. The change in diet or weight loss might be the cause, but I think its likely that the massive increase in the amount of water I drink has more to do with it, as I now only get attacks when I don't get much to drink, or if I become dehydrated due to activity.
My uric acid level, when tested in my 20s, was WAY above normal, so I think my attacks being resolved by hydration makes sense.