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.

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