Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group AS or Gout? How do I know?

I posted before, one of my fingers suddenly starting hurting really badly.

It came on suddenly, or somewhat gradually, but then I woke up one day and it was extremely painful, quite swollen, and could not be straightened out.

My doctor was on vacation last week, so I saw a PA who said it was not AS ("only affects large joints" to quote her) She had xrays done, which were normal, and she had blood tests done for RA, Gout etc - all negative.

I went in and saw my regular doctor today, and he is sure it's gout. From what I understand gout mostly affects men and post menopausal women. I have not gone into menopause, and I can't help but wonder if this diagnosis is correct... or if it still might be AS I am dealing with??

I know you can't diagnose me, but I am wondering what might be an indicator that it is gout instead of AS...

Boel

i googled gout and saw that they look for uric acid crystals, that seems to be the definitive test.

i wish i remembered better why the last rheumy thought maybe gout and was going to do blood work (not sure of the blood test), but ruled gout out based on my history.....i think for me it was because its much more tendons and SI and he realized that when he heard my history....

if you only have symptoms similar to what happened to your finger, its possible its gout....if you have lots of other symptoms too....then it would probably be ruled out like it was for me.

sue

Hi Sue, I am not sure I understand why having other symptoms would rule out gout? I definitely do have AS, with SI joints, back, neck pain + recurring iritis.

But why would the mere fact that I have As make it certain it is not gout? On the other hand, I do wonder how a diagnosis can be made without the test for uric crystals? I think that maybe because it is less swollen than it was when I saw the PA a week ago, perhaps the time to test for crystals would have been then, when it was doing even worse than now. I did get the blood test a week ago, which my doctor says can be negative and still be gout.

I am confused. Just wish I knew for sure what I had.

I am not overweight, and I don't eat a high protein diet...

Boel

i think the main reason to get a proper diagnosis is to get a proper treatment. if the diagnosis changing the treatment, then figuring it out is important, otherwise, it probably doesn't matter. maybe the next time it happens, you could see the doctor while it is happening and they could check for crystals.

maybe others are more intimately familiar with gout than am i.

sue

Hi, Boel:

Quote:

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But why would the mere fact that I have As make it certain it is not gout?

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There is no real certainty, but some things are highly unlikely. You could compare getting AS with winning the lottery, but having gout in addition, well, like winning a different lottery, in addition to the first.

The potential for having both is the product of each probability. This is really an over-simplified yet very accurate way to figure it out:

(With the following assumptions: )
The probability of having AS is .5% and that for having gout is 2.0%, so the chances of having both is exactly 0.01%, or one in 10,000; it is possible that person is you, but not very probable.

Somehow, even many doctors don't really get this stuff and they get lost in semantics. This is an easy distinction, but if you biopsy that finger and find crystals, you have hit a jackpot!

I have had swollen, painful fingers and believe it was related to AS, albeit an uncommon consequence. We produce many different immune species and some of them target distinct collagens (types I, III, IV, and V), while others are less selective.

There is no LARGE JOINT in the uvea, yet AS targets that, also.

Be thankful that it is not gout; you (we) need to be on a high protein diet. The sooner you test your "gout" by eating all the 'wrong' things, the better off your AS will become and you will also prove you do not have gout.

Ok, if that finger gets worse, drink some saffron tea (Mexican saffron or safflower is fine).

bon appetit,
John

Hey Boel.

There is nothing excluding you from having two diagnoses, and believe me stranger things have happened.

I haven't been following your threads, so am not up on all your symptoms. However, even on a preexisting diagnosis of AS a new red hot monoarthritis (ie single joint) bears some consideration. The differential diagnosis for such a list is longer than just 'gout' as well. There's gout, pseudogout, septic/infective arthritis, reactive arthritis, etc. I've even seen someone who was admitted ?monoarthritis who had a cellulitis. Medicine doesn't play by hard and fast rules.

To put an end to this once and for all you need someone to stick a needle in there and get a joint aspirate. The fluid can be sent for microscopy, cultura and sensitivity. They'll check for signs of infection (bacteria, white cells) and also look for crystals (different crystals for gout and pseudogout), and then you can plan the appropriate attack.

Good luck,
Jeanna

Hiya Boel!

AS can affect small joints, dactylitis, ( sausage finger/toe ) .... it's one of the diagnostic criteria. However not all the medical people know that ( No offence Jeanna ) . Most think of lumbar spine and SI's if you are lucky.

I've just read your other posts, so I now know you are an AS patient so ( I edited out a line about not sure about your AS status )

I know young ladies with gout, have you tried an nsaid gel ? or icing .....

Strutsy knows her stuff maybe the neeedle is the way to go! but I'd try an nsaid gel or icing before that!

Dave

Sue,

I do n't have the answers I had a lot of trouble for years, my son has been exactly the same.

In my experience

Some Dr.s the one who really springs to mind is my EX GP, my current GP is my ex wifes Dr. He saw the state I was in when I went to see him with my son. He's been really good.

I've seen rheumies where they expect peripheral joints to be swollen as a sign of a flare and in me that's not the case. Peripheral flares can be seperate from axial ones.

Most nurses know nothing in my experience, we do not have nurse assistants in Australia....they think AS is a stiff back and that's it.

and Physio Therapists are dangerous.....male young the worst best avoided, older ladies seem better but still not good. I use them to get exercises and then modify the regime etc for me.

I have noticed the younger Dr.s across the board seem to have a better knowledge of AS SpA in recent years. I know the various National and International Rheumatological Professional Bodies have put alot of effort into that.

From a Dr.s perspective they are trying to prevent joint damage and ankylosis and retain functionality. At the same time using the stronger medications only when absolutely needed.

I think SpondyA is much harder to get diagnosed than AS.

Dave

thanks dave for the reply.
it is nice to have someone listening.

i try very hard to not get angry....i'm lucky that i don't get depressed, but i'm not sure if anger is any healthier....mostly i just try not to think about the run around...and try to stay optimistic that i will find a doctor to diagnose me and give me something to stop (or at least minimize) all of this.

i think i'm just having a particularly stressful day...i'm supposed to go to a meeting in 2 days...trying to get a paper done...other things others at work want me to do before i leave....my hamstring tendons just started bothering me again (and that really scares me, as the meeting in boston in june is what set off the problem that laid me up (off feet entirely) for over a month...i thought i had the problem under control)...and a number of other body parts are also not behaving....

anyway, thanks for listening and responding,

ok, time to give myself a pep talk and get back to work,

sue