First gout attack in 3 years – with low uric acid

[davidk]

hi guys. I’m puzzled by a gout attack today. I had major gout problems 3-4 years ago. found gout-pal and you guys pointed me in the right direction and 6 mos later i was done having attacks and have done great for about 3 years. until today. I take 40 mg uloric (allergic to allopurinol) per day and get labs done 2x / year. for years my ua has run around 5.0 or lower. now, out of the blue, i have a major flare up in my left big toe- pain, swelling, redness- feels and looks exactly the same as all the other gout attacks. woke up with it. i have been sick the last 2 weeks- got an infection in my liver and have had significantly reduced liver function the last 2 weeks- confirmed by lab tests. but I finally got about 100% better from that as of today (been getting better every day for a week). I suspect that may have something to do with it. It’s been a few months since my last UA lab test, so I guess it’s possible it has built up – or did so just in the last couple weeks. but I thought ua had to build up quite a bit before a gout attack. puzzled how I can go from <5 ua to a gout attack so quickly when I am still taking uloric. any ideas?
if helpful, you can read more of my gout history in my profile including that i had a kidney transplant 20 years ago, so i have about 40% to 45% kidney function. I’m doing repeat liver panel labs on Monday and I’ll have my doctor add a UA test to it.

[Keith Taylor]

Hi David, it’s great to hear from you again, but not in theses circumstances.

After so many years around 5mg/dL or lower, I would have thought all old crystals were dissolved. As you say, even if they started growing again temporarily, they shouldn’t have grown enough to cause an attack in such a short time.

There’s only three explanations I can think of:

1. A deep-seated clump of crystals have suddenly started to dissolve, and triggered an attack.
Or
2. It is not a gout attack.
Or
3. Your toe joints are exposed to prolonged low temperatures, giving a crystallization point below 5mg/dL

The best chance of knowing it is gout is to get a joint fluid draw tested for uric acid crystals. That test might also show it to be something commonly confused with gout, such as pseudo-gout, or septic arthritis. As you might tell, I’m clutching at straws here, but it is the first time I have heard of gout returning like this.

Maybe your doctor might be able to advise better, or at least give a medical opinion on option 3.

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