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would a severe gout attack begin with slight fevers?

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would a severe gout attack begin with slight fevers?? and etreme fatique. I have sever gout in both knees, fluid drawn from knee showed no crystals. blood work shows no infection. hospitalized for two days with tons of blood work. all negative. on colchy's, 500 mg keflex and percicet for pain. started with fever, then one knee extreme swelling and red, next day the other knee attack. no lyme disease, no cultures grown from blood drawn, uric acid level just slightly above average.
Original fever 102.5, each day 99 or 100 fever since.
how long will i be unable to walk, what can be done to get a definitive answer?
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replied November 20th, 2011
Gout attacks or not
Yes, gout attacks can cause fever. Also, fatigue can trigger gout attacks which may exacerbate fatigue. Most gouties have lower urate levels in the blood during the gout attacks. Therefore, your near-average blood urate level does not mean that you do not have hyperuricemia and that you do not have urate crystals in the knees. Furthermore, the fact that no crystal was found in the knee fluids can mean there were crystals but just wasn't found. Accurate diagnosis of what is causing gout-attack-like symptoms can be difficult. If you had gout attacks in the knees before, probably you can tell if this is gout attack or not better than others.

In the situation like yours, the utmost importance is to rule in or out the acute and critical conditions such as sepsis. Then try to rule in or out such diseases as reactive arthritis, lyme disease, etc. You mentioned "no cultures grown from the blood drawn". I think you meant: the blood sample was cultured which gave negative results. If so, that is good. However, you are still taking Keflex for infection. Did the doctor mention Keflex is for possible sepsis, lyme disease, or what else?

Based on what you have described, I incline to think you are having a gout attack. A few things that concern me are:

1) Did the fact that you had near average blood urate level and no crystal was found in the joint fluid cause the doctors to "rule out" the gout attacks? If so, that could be wrong.

2) Why didn't the doctors take more aggressive approach to treat gout, such as to give you steroid injections either in i.v. or in muscle? Such injections can suppress gout attacks in a matter of a few hours or a few days.

3) If you are taking colchicine 0.6 mg only 3 times a day now, you have been short changed. This low dose colchicine regiment is only effective if it is started within 12 hours of the first sign of gouty twinge when the size of the attacks are still very small. Otherwise, if gout attacks are already in severe stage, the regiment will help almost nothing. So, if gout attack is what you have, basically, you have not been given any effective treatment. If this is the first time you have gout attack, it may take 1~2 week to resolve it even if you do not treat it. However, if you have gout in the knees for many years, without effective treatments the attacks can linger on for weeks, months, or longer, .

I would keep pressing my rheumatologist for a definite diagnosis and for more aggressive treatments. If I were treating myself in the same situation, I would give me a shot of Methylprednisolone 80 mg in muscle and follow up with oral Indomethacin (Rx) 25~50 mg 4 times a day, or Naproxen (OTC) 500 mg twice a day, or Ibuprofen (OTC) 800 mg 4 times a day -- tapering it down as the attacks subside. In that case, I should be able to walk in a few days.

Good luck and take care.
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