Gout at 22 yrs old?

[bluedragons35t]

Hey everyone my name is Justin. I am a 22 year old soldier in the US Army and have been for the last four years or so. I am 5 foot 9 and weigh about 140 lbs. I am no where near overweight and i am in excellent physical condition. I run a 10K road race about once a month, regularly run about 20 miles per week and muscle training (crossfit) three days a week.

I currently have a swollen Right big toe that is hot to the touch and has a pinkish hue around the 2nd joint. It is painful enough that i cant walk, let alone run or do any physical training. This started one day after a cookout where i ate about three cheeseburgers, drank 5 or 6 light beers and played some volleyball afterward. I didnt have any injuries and i dont believe i was doing anything physically that i dont do every day.

Originally i thought i just had turf toe or a sprained toe but ice packs, ibuprofen and naprosyn didnt help at all. So i went to my doctor on day three of this attack and after a brief argument I was immediately submitted for bloodwork, urine samples and x-rays. Less than ten minutes after getting my blood drawn a physicians assistant came in, looked at my toe and said i had gout. I was prescribed 500 mg naproxen twice a day and 25 mg Indocin 3 times per day. I'm pretty sure the Physicians Assistant never even looked at any of my lab results and a fluid draw was never done because i am deploying to the middle east in
a few days and they didnt want it to get infected while in iraq

The weird thing is i have had 4 cases of toe pain in the last two years that have been misdiagnosed as a sprain everytime. Turns out that i possibly had gout by age 20 and didnt know it.

My question is do i really need to change my diet and what can i do to hopefully prevent these attacks? I drink maybe twice per month @ probably 5 beers per sitting. Obviously i wont be drinking while in iraq but my diet choices may be seriously limited at times while in country.

[Keith Taylor (GoutPal Admin)]

First, you need to lose the idea that gout is a food disease. This is hard when thousands of Internet pages, and a large proportion of doctors, claim otherwise, but you must ignore them.

Gout is an imbalance of uric acid metabolism. In many people, food can act as a bad influence on gout, but it is rarely the root cause. It usually starts with genetic defects that affect the way we process uric acid – we either produce too much, excrete too little, or a combination of the two. Often, this can be compounded by trauma, some medications for other conditions, and environmental factors such as extreme cold.

Competent doctors will first analyze blood levels of uric acid, possibly measure excretion rates using a 24 hour urine test, and confirm or disprove the existence of uric acid crystals by drawing fluid from a joint, and testing it immediately. Uric acid crystals cause gout, not food, though if gout is confirmed, a good analysis of diet might reveal some areas for improvement (this needs proper analysis of existing diet). These competent doctors are usually rheumatologists, but some general practice doctors are good. The examination needs to be meticulous, especially in anyone under 40, as there are conditions that mimic some aspects of gout, but are totally different, and need different treatments.

It is certainly possible to get gout in your twenties, or even your teens, but it is almost always due to genetics or kidney problems. In your case,your height and weight indicate that you are at very low risk of gout from diet. Even in the unlikely event that diet is an issue, it is absolutely pointless restricting, what appears from your question to be, a good diet. Do not even think about diet changes until you have a proper number for your uric acid test results. Come back here with that number (not an opinion such as low/normal/high – we need an exact mumber which should include the scale (in the USA, this is normally mg/dL). If possible, find out if your records have earlier iric acid test results, and get dates and numbers.

[dcdude]

Justin,

Thank you for your service and best of luck in your upcoming Iraq deployment.

As Keith mentions, getting your uric acid number is important and I don't see why you can still get that done for you while you are in country. Once that's confirmed, your doctor may put you on Allopriinol for long-term maintenance. However, it's not good for treating the pain of current outbreaks.

It doesn't sound like you drink too much, so in the interim, I don't see a downside in making dietary changes. Three cheeseburgers is definitely not good for gout. My concern would be the availablility of gout-friendly vegatarian food while you're deployed. However, if you do wind up on Allopurinol or another “maintenance” drug, it should allow you to eat most of what all the other guys eat and not call attention to youself, which I expect is a benefical from a social standpoint.

[Keith Taylor (GoutPal Admin)]

dcdude said:

I don't see a downside in making dietary changes. Three cheeseburgers is definitely not good for gout.?

---

Sorry, I didn't mean to imply that diet is not an issue.

I just feel very strongly that there is a real risk that this is something other than gout, and needs to be investigated properly.

A proper gout management plan, including diet control, is not to be taken lightly, and certainly not worth the effort (or the worry) if gout is not the problem.

[dirkpitt]

I had joint pain in my toes all through my teens and early twenties. Has X-rays and specialist visits and was diagnosed as joint degeneration due to trauma at the time.. at that stage it was just stiff and aches without swelling..

It wasnt until I was about 32 that I had the first of what I would call a “real” gout attack.. had me literally crawling around the house, and put me off work for two weeks.

Looking back, I think there were plenty of warnings.. because my original pain that I had for over ten years has gone now with proper modetaration, and only replaced by the severe attacks. In hindsight, it may have been gout all along and missed at that time, due to my young age.

I think statistics revolve around accute attacks rather than all the other similarities of symptoms that people have which are lurking in the background. Obviously science only cares about what it can prove with evidence.

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