image created by me using canva
Disclaimer: This post is not medical advice.
The title is a play on words obviously but this post will be talking about medical misogyny, gender blindness and the stark differences of gout presentation in males and females.
If you look up symptoms of gout online you will likely come across something that says sudden onset, usually in the big toe and attacks last for a few days maybe a week or so the symptoms resolve between attacks.
This is the typical/textbook presentation in men. However if you search for symptoms of gout and specify female or women you get an entirely different answer. In women gout tends to affect more than one joint and has a gradual onset and duration is weeks, months or longer. This is the typical presentation of gout in women.
Now of course everyone is different . These are just the "textbook" examples.
The uric acid levels are also different in men than women. For women anything over 6 (though in some countries this number is lower in the US 6 is the standard but 5.8 is also acceptable). In men this cutoff is 7. One could argue the cutoff in men is too high but these are the numbers we work with here.
I do want to note that studies have shown that about 30% of gout patients have uric acid lower than 7 in an attack. This is partly due to medications but also there is a hormone that is released in a gout attack that lowers uric acid.
I recently consulted with a physiotherapist who is also a researcher . He suggested I get tested for gout . He has gout but it is atypical presentation for a man.His gout is more similar to the presentation of a woman and my symptoms were similar to him.
It took a few months for me to be healthy enough to get my blood drawn and I got the results last week. My uric acid is elevated for a female . My number is 6.9. However since the lab and my doctor are using the male standard number of 7 (even though the minimum therapeutic goal for gout patients is 6, sometimes lower) so I was told my results were on the high end of normal.
No they fucking are not. My test results are high particularly for a premenopausal female. I politely asked the medical assistant to make a note in my file and ask my doctor to look into uric acid numbers for females.
This doctor has been practicing almost as long as I have been alive He should already know this. Why am I the patient the one who again needs to educate my doctor and his staff about basic medical shit? Because I am a woman, that's why. How many women patients has he dismissed as not having gout because of this gender blindness and lack of very basic medical knowledge? And he is one of the "good" doctors who in my experience does actually listen to me a female patient.
Gender blindness is when women's sypmtoms deviate from mens and are ignored. This happens in so many medical conditions and can lead to decades of suffering and even death due to not being diagnosed/dismissed as anxious/dramatic/hysterical etc.
I am not sure gout is rare in pre menopausal women.If our symptoms and positive blood tests for elevated uric acid are ignored /dismissed and we don't get diagnosed for decades or never, how do we know the real numbers?
Yes this latest flare is the ankle issue I have been talking about since last year. I was dx with tendonitis in multiple tendons without an injury. Gout can casue tendonitis. Also sudden tendonitis in multiple tendons without injury is so common (sarcasm . it is not and should have been investigated further. this is NOT normal).
Now you may be wondering if this is the first gout attack I have had (going on a year and a half now though it does wax and wane). The answer is no. This has been happening for decades
I first had what I believe to be a gout attack when I was 14. My knee started to hurt out of nowhere and it kept getting worse. It got swollen and very stiff. I described the pain as having sand/glass in my knee. My parents ignored me and said I was being dramatic. I had other flares over time usually in my knee or hands.
When I was old enough to drive I went to see a doctor. I was told again that I was exaggerating my pain and it was simply osteoarthritis. I sought help for years off and on . I was in intense pain. Each time I was dismissed. By the time I hit my mid 20's I stopped describing my pain in that way and stopped seeking help(for everything basically as no one believed any of my symptoms even when tests proved otherwise). I got xrays and joint damage was noted each time but it was said the damage was osteoarthritis.
Joint damage from osteoarthritis is so common in teens/20's (sarcasm). Average onset is more than twice that age but yeah "just arthritis". Keep in mind I also had elevated sed rate and other abnormalities that were ignored and are still ignored to this day.
Ask a man what gout feels like, he will probably tell you it feels like thousands of knives cutting him. He will be believed more times than not. He will not be told it is not that bad or he is being dramatic.In fact I know men with gout who were diagnosed and treated without any tests and not in a flare (no swelling or visible sign of the disease). The doctor just believed them and later tests confirmed the diagnosis but they got treatments immediately- no questions asked.
I do want to mention diet here. I am a vegetarian and have been my whole adult life. I was a social/occasional drinker but have not drank in years due to alcohol intolerance. No meat. No shellfish. No alcohol.Moderate sugars. By all accounts I eat a healthy balanced diet and have for decades. I can't moderate my diet as a "treatment" in this case as I don't consume triggering foods. Something else is going on that needs to be investigated.
One of the men I know with gout is a self proclaimed "fat guy" (his words). I have had conversations with him before about treatments for various diseases. He outright tells his doctor he will not change his diet even if it will make his conditions worse (not just gout). He still gets treatments even for health issues he admits his lifestyle causes (I have no issue with this.I believe everyone deserves treatments) .
Me on the other hand my knee swells so bad it tracks (goes slightly out of place) and I am told to take tylenol and stop whining. Also there are visible bumps sometimes around the knee. Must be psychosomatic too.
Not to mention I have a history of kidney stones, which I passed with no meds. To be honest kidney stone pain is less severe than the pain I deal with every day. I was never tested for uric acid just given imaging tests and was told my kidneys were dilated and then they believed that I "pissed out a rock" . I was young and had no idea wtf happened lol.
I told multiple doctors when my ankle issues (gout) recently started that my big toe was also swollen )and I was getting frequent muscle twitches and spasms. This happens in other joints too for me. I even told an ortho specialist. The response every time from every doctor was silence. My toe was visibly swollen though not severe. My ankle still looks like a severe sprain a year and a half after onset. No one cares.
I wish this story had a happy ending. I finally have answers for some of my pain and tests to back up my symptoms -again(and xrays of damage)Yet I am still not treated because I do not present like a man.
BTW I did ask the physiotherapist for a sanity check and he agreed my blood tests ,symptoms and previous joint damage all indicate gout.
Based on my symptoms and duration of this last flare it is possible I am entering end stage gout(this has been going on for decades untreated) and still have no treatments. Remember I cannot take nsaids due to a life threatening reaction.
There are medicines that can lower uric acid. There is a medicine colchicine that is not an nsaid and would help inflammation(probably help my other inflammatory conditions too). The men I know with gout also get opioids for breakthrough pain and their attacks only last for a few days.
Me? Still no treatments.