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June 22nd, 2011
10:40 AM ET

Do I have gout or tendinitis?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society.

Question asked by Chontelle of Houston, Texas:

I am 35, female and have elevated levels of uric acid. My doctor wants me tested for gout in my left ankle, but the pain in my ankle didn't start until I began using it to overcompensate for my other injured leg by limping. Will the black cherry concentrate I've heard about in pill form lower the uric acid levels, and how can I tell the difference between gout and tendinitis?

Expert answer:

Dear Chontelle,

Gout is a disease in which uric acid salts (urates) are deposited in joints or in soft tissues (this is called tophaceous gout). In joints, gout can cause attacks of extreme inflammation and pain.

The painful attack usually occurs in only one joint at a time and can be confused with extremely painful tendinitis, a very bad sprain, or a broken bone, even in someone with a history of diagnosed gout.

Gout is most commonly associated with pain in the joint of the big toe of middle-aged and older men who are obese, diabetic, hypertensive and drink alcohol, but gout can occur in any joint of adult men and women of any health status and any age. It is estimated that 3 to 5 million Americans have gout.

All patients with gout have a very high amount of uric acid in their blood. This is a condition called hyperuricemia. There are, however, patients with hyperuricemia who do not develop gout. Gout is most easily and commonly diagnosed by placing a needle into the inflamed joint and withdrawing fluid that is examined under a polarized light microscope. Crystals of uric acid salt are seen when the patient has gout.

A typical untreated gouty attack is very painful for two to three days and then starts getting better. The patient may have residual pain for two weeks. Medical suppression of an attack of gouty inflammation can decrease pain faster. It is best done with an oral drug called colchicine. Indomethacin or naproxen or other strong nonsteroidal anti-inflammatory drugs are also useful. In rare cases steroids can be injected into the joint to bring relief.

A number of things are known causes of a gout attack in people with hyperuricemia. These include splurging in a diet high in uric acid, such as meat and shellfish or especially organ meats such as sweetbreads and liver. Trauma or overuse of a joint can cause a gouty attack in someone with hyperuricemia, as can use of certain diuretics used to treat high blood pressure.

While gouty arthritis is diagnosed by aspiration of joint fluid, distinguishing tendinitis versus a sprain versus a fracture requires a clinical examination and possibly an X-ray or magnetic resonance imaging. The treatments differ dramatically. Tendinitis is treated with stretching; a sprain with elevation and rest; and a broken bone is casted to promote healing.

There are drugs, allopurinol and febuxostat, that can be taken daily for long periods of time to lower uric acid levels. These drugs lower risk of a gout attack while being taken, but they can worsen a gout attack if treatment is begun during the attack. A few patients will need to take other drugs to cause increased urinary excretion of uric acid. These are oral medicines and include probenecid and benzbromarone.

Some alternative medicine enthusiasts have promoted use of black cherry concentrate and other substances to lower risk of an attack, but there is little scientific evidence to show that they are effective.


soundoff (41 Responses)
  1. Morris Brown

    I have been have a constant pain in my calf for a few years. My doctor told me to do streches but it doesn't seem to change the the pain. If i where to describe the pain it would feel like have a constant charlie horse in my calf but its not unbareable just a annoyence. Any ideas

    June 22, 2011 at 15:36 | Report abuse | Reply
    • Veritas

      This is not the proper forum for individual diagnoses; you should see your doctor. Besides, why would you put any faith in the opinions of total strangers from the Internet whom you've never met? This makes no sense whatsoever.

      June 22, 2011 at 23:46 | Report abuse |
    • Ed

      I put on knee supports on my calf after hiking and running and wear leg warmers year round. I had painful restless leg for years and this helps

      June 23, 2011 at 08:07 | Report abuse |
  2. R Burns

    Tendonitis? (inflammation of the tendons) Always good to check your grammar and spelling before attempting journalism., especially if the word in question is the headline.

    June 22, 2011 at 16:12 | Report abuse | Reply
    • Jared N

      Or we could leave people who actually study medicine to define the disease. Tendinitis is more correct term but I'm sure any doctor would know to what you are referring to with either spelling. I would refer you to the Mayo Clinic which only lists the disease in which this article does.

      June 22, 2011 at 17:26 | Report abuse |
    • Susan

      Tendinitis is right up there with the word marshal as far as how often it is misspelled. Bad enough when they are, but worse when someone tries to correct back to the wrong spelling lol.

      June 22, 2011 at 17:43 | Report abuse |
    • Patti

      Did you really insult someone about their spelling of a word that turned out to be spelled correctly? How foolish you must have felt! I guess if you don't have something nice to say, don't say it at all right?

      January 14, 2012 at 20:16 | Report abuse |
  3. Binky42

    Could it be regular arthritis? I fractured my ankle when I was 11 and later developed arthritis, in that ankle only, in my late 20's. My doctor is convinced that the old injury is the cause.

    June 22, 2011 at 17:12 | Report abuse | Reply
  4. Jake

    I am a middle aged, overweight male who drinks alcohol and get a lot of pain in both ankles, both knees and left calf but my toes are fine!. I had to stop running a year ago and of course have put on even more weight. Is there a life-style change to reduce the uric acid (which I assume is causing all my pain)?

    June 22, 2011 at 18:44 | Report abuse | Reply
    • Princezoltan

      Jake, Stay away from red meats and heavy proteins, eat more green vegetables and cut out the alcohol. For me, beer and red whine are the worst for alcohol. I do get some relief from pure cherry juice. most important see a Doctor. There are a few things that are in this article isn't all that correct. I get severe gout attacks and I can have them in multiple joints at the same time. As for the length of time I have had a severe attach last for over 2 weeks, which is crippling and residue pain last well over a month. As for colchicine, my doctor told me that the FDA took it off the market for a while, which is a shame because that worked good for me and it was inexpensive. Good Luck Jake

      June 23, 2011 at 01:14 | Report abuse |
    • Yanze

      If you're drinking beer, quit. Cut out sodas. Up your foods with avitmin C. Reduce or cut out dark and offal meats and SEAFOOD!! Celery, cherries and cheese are good. Dry beans, spinach, cauliflower, mushrooms and asparagus will potentially make gout worse. Drink at least 64 ounces of water a day. I cannot stress this enough. It will help you expel the uric acid crystals that are causing you pain and your body needs it anyway. Oh, and deli meats/cold cuts are a bad idea.

      March 4, 2012 at 13:48 | Report abuse |
  5. Linda S.

    Jake, sounds to me like it's your weight problem. Your life style change should include under taking a healthy eating program, join weight watchers or Jenny Craig. Eat sensibly, avoid the trigger foods, walk 30 min. a day, been there – done that again and again. moderation is key. One step at a time, little changes, i.e. smaller portions, less red meat, more fish, chicken, veggies. Good luck.

    June 22, 2011 at 19:18 | Report abuse | Reply
    • Princezoltan

      Linda S. I agree with you saying it would help for Jake to lose wait and eat healthier but you are clueless on a few points. For one Jake needs to see a doctor. And walking 30 minutes a days sounds great but you have obviously never had a gout attack, if you have you would know that would be impossible to even walk a few minutes. The pain I have when I have a gout attack is worse than when I have broken a bone. It is not as simple as joining Jenny Craig or wait watchers, you have to see a Doctor. I have had this since I was 25, and now I am 44 I was about 10lbs over ideal weight but that wasn't the cause. Each person is different and not all foods cause attacks in all people, you have to learn what causes gout in the individual.

      June 23, 2011 at 01:24 | Report abuse |
  6. Fran

    I see R Burns is on my page but still . . . A doctor and you cannot properly spell the condition?? Wow.

    June 22, 2011 at 20:41 | Report abuse | Reply
  7. Fred

    I have had both tendinitis (that's how the Mayo Clinic website spells it...odd) and gout flares, and to me there is a big difference in how they feel. The tendinitis for me feels like a burning in the end of the muscle which is where the tendon is, and it feels better to move the joint so as to contract that muscle. Sometimes it hurts so much that I try to avoid using that muscle. That ended up causing a hyperextended knee and strained PCL, but that is another story. Stretching can help in the short term if you can stand the pain. I have taken NSAIDs for it, but they have messed up my GI tract. The one thing that has helped is increasing my water intake and decreasing any diuretics like caffeine and alcohol. If you think about it, the connective tissue (ligaments, tendons, and cartilage) are mostly water, and my knees tell me when I haven't been getting enough water.

    The gout, on the other hand, makes the joint feel stiff, and the joint hurts no matter which way I bend it. I have had it in both ankles and one knee. Oddly, I have never had it in my big toe which seems to be where most people get their flares. The joint becomes hot to the touch from the inflammation, and my knee even swelled. My doc aspirated that knee to make sure that the swelling was not fluid, and nothing but blood came out. I hope I never have to do that again. My doc recommended the daily glass of cherry juice since it has worked for other people, but it didn't work for me. The daily Allopurinol does the trick, though. If you have gout, stay away from any organ meats, like liver (yay!!!), tongue, Rocky Mountain oysters, and hot dogs unless they are kosher. As always with any inflammation, ice eases the pain of a flare enough to use the joint for a little while.

    Hope this helps you if you have these problems.

    June 23, 2011 at 02:14 | Report abuse | Reply
    • Princezoltan

      Fred,
      I agree with you totally except for the ice on the gout, my doctor said that it can cause the uric acid to crystallize, I know that cold feels better but heat is better for it...

      June 23, 2011 at 02:24 | Report abuse |
  8. shea

    As a chronic gout sufferer I would just like to say that I wish I had tendinitis. The pain from a gout flare up can reach the point of a fan blowing across the joint will make me cry in the middle of the night. The larger joints do not hurt near as bad as the smaller joints with my most excruciating flare up being at the base of my pointer finger. The second worse the the "midfoot" joint. If you think or your doctor thinks you have gout, I recommend the needle in the joint test followed by a 24hr urine screen. From my understanding there are 2 forms of gout- 1 is when your but makes too much uric acid and the other is when your body doesn't get rid of the uric acid easily. I was on the wrong kind of medicine for my version and was suffering attacks about 4-6 times a year(down from 8-10) but after a DR finally realized that maybe I was being treated wrong he had me do the urine screen and found out that I needed a different type of medicine. Now I'm down to 1-2 times a year and could probably cut out beer and get that down. In my experience there has also been a correlation between injury and flare ups. If I jam my toe or something like that I have found that I better start taking the max dose of the indomethacin or I can expect a flare-up. I would also suggest that you try not to loose weight too fast or if you are going to then drink as much water as you possible can while you are loosing it.
    Now I am not a DR, I'm just a person who has lived with it for about 17years and I'm only 40. I hopefully have a long life ahead of me so I've been trying to figure out how to live with it. If i was 80 when I started getting it I probably wouldn't worry too much.

    June 23, 2011 at 08:12 | Report abuse | Reply
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  23. Bhargav

    I'm 28 Male, Non-vegetarian, Regular Drinker and Smoker, my Gout attacks started from the last 3 months this this my 4th flare when i consulted the doctor as i has lasted more than 3 days unlike my previous attacks and more pain full, I have visited a doctor, the first thing he has done is to get my blood tested and found the problem of abnormal uric acids, he said that he will start the medicine the pain reduced and gave some pain reveler for the mean time. But i though of knowing more and came online. This site is exactly what i found useful from most of the user comments specially SHEA, its true what you said, even a fan blowing across the joint made me cry in the middle of the night, and for two consecutive nights. I don't know how you lived with it for 17 years bearing such a pain every alternative months, God may bless you.

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