So, I took a spill Monday. We have beautiful ceramic tile on our sunroom floor that becomes insanely slippery when wet. My gf was watering her plants and she spilled some water. She went to get a towel while I entered the room from the opposite direction, barefoot, and went BOOM. I fell so hard I bounced.
Other than some bruising/aches/pains I severely twisted/hyperextended the metatarsal-phalangeal joint of my big toe on my right foot. The joint that’s experienced two gout attacks (roughly one every year or two). I was pretty sure I broke something. Throughout the day it became more and more painful.
By Tuesday the pain was intense. By Tuesday night I realized the pain was too intense for a simple fracture, plus I had a fever. So I googled “gout flare-up trauma” and apparently trauma can lead to a gout attack.
Anyone ever had this happen? Can anyone explain the pathophysiology involved?
On the plus side, I’m pretty sure last night was the peak and in a week or so I’ll be ok.
After reading your post I think I may have had it happen. I had a job years ago where I had to use these heavy rubber hammers to seat a centering piece into a heavy roll of mylar packaging film. I had to beat the centering device into place maybe a 100 times a day. I got real bad gout in my wrist and elbow area off and on that year I worked there. Never before and never since.
I’m mostly blind, so I have a serious toe-stubbing problem. I’ve definitely triggered gout attacks after particularly bad hits on the big toe.
I am not a rheumatologist. That said, I’ll speculate on the pathology. I can think of two possible explanations. Possibility one is that there are always some uric acid crystals in the joints of us gouty people, but they aren’t always inflammatory. When the injury causes inflammation, it’s exacerbated by the crystals, and the inflammation blows up into a gout attack. Possibility two is that there aren’t any crystals in the joint before the injury, but the injury or its subsequent inflammation provides nucleation sites for the crystals, and the gout attack is born. Someone with actual knowledge probably has a better explanation.
**synovial: **relating to or denoting a type of joint that is surrounded by a thick flexible membrane forming a sac into which is secreted a viscous fluid that lubricates the joint.
**effusion: **The escape of fluid from the blood vessels or lymphatics into the tissues or a cavity. 2. A collection of the fluid effused.
synovial effusion: An excess of synovial fluid in a joint, often due to inflammation.
monosodium urate: is the salt of sodium plus uric acid, which circulates in the blood and which deposits as crystals in joints, causing gouty arthritis, and tophi in tissues. An excess of plasma urate is referred to as hyperuricemia (See hyperuricemia).
synovial effusion
water reabsorbed at night
uric acid diffuses slower than water leaving behind the supersaturated MSU
I don’t think you can assign blame to any one thing when it comes to gout. It always seems to be a combination of things. Earlier this year I partook in a bike tour that was very physically demanding over 4 days. After the trip, like within a day. I was experiencing a gout attack in both feet, with the right subsiding while the left got much worse during the next couple days. I accounted for this by putting my body thru heavy physical exertion, slight dehydration, and perhaps diet choices. I think the dehydration was in the background, as was some of the food choices, but the thing that put me over the top was the hard physical exertion. So, yes, I can see physical trauma bringing on a gout flare, but I bet there may have been something else going on with you at the same time that had your chemistry out of balance.
Well, that was intense. Pain right after the injury on Monday, peaking horribly Tuesday night, then quickly becoming very bearable.
My diet is filled with gout trigger foods and I drink beer pretty much everyday. No gout meds. I try to stay over hydrated on the (possibly mistaken) belief that it’s something positive I can do. Seems to be working.
In 2013 I cut my left hand resulting in needing 2 stitches. Within about a week and a half I had a major flare up in my R foot/knee that lasted over a month resulting in the loss of a good job due to the fact that I could not work.
Went to the Dr and they ran a battery of test only to show low numbers for gout and low numbers forRA.
Fast forward to Dec. 2017. Again I injured my L hand resulting in 12 stitches and again! within a week a major flare up in my R foot/knee resulting in loss of work. And again! blood work with low numbers all around.
Tons of steroids and anti inflammatory meds. UGH!
This is truly a WTF moment for me with no rhyme or reason. If it’s not gout what is it?
And in a dated thread at that! Your experience may almost be worth redoing as a new thread here; you could get more responses and fewer snarks about zombies.
My gout tends to be like yours; the pain level through the roof but the chemical levels more marginal. But at least mine were clearly enough to warrant the diagnosis. My mind wonders if possibly in trauma-induced incidents that could be normal since the trauma is as much a reason for the attack as something more internal/chemical. Could the trauma some intensify/magnify what chemical imbalance there is?