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Message: [QUOTE="nephron, post: 185689, member: 23759"] Cam Gout's a bit unusual in a 20 y/o. In fact, I've never seen it, and have only heard of oddball diseases presenting as gout at that age. You MAY hear of an isolated case of idiopathic gout from an oldtime Orthopod or Rheumatologist, but to go into a doc, have him look at your ankle and say "It's the gouch!" without aspirating the joint, performing a serum Uric Acid level, or even considering other possibilities (including the possibility of a septic joint:scream: ) is, well, lame. The typical goucho is a 30-50 y/o obese male that does a bit of, shall we say, imbibing in 2-carbon anesthesia.:) The youngest case I've seen is a 38 y/o. The epidemiologists suggest it exists rarely even under the age of 40. In my mind (which may be, uh, nevermind;) ), one must first establish the diagnosis [I]without question[/I] at your age. ie, tap the joint, look for typical needle-shaped negatively bi-refringent crystals, make sure the cell ct/diff doesn't suggest an infection, check gram stain....blaah, blaah, blaah (hey Jaybird--[I]you[/I] wanted it, right?:D ). Then, if it IS gout, determine if it really is one of those 1 in a million (and I mean that!) cases of idiopathic gout in a 20 y/o, or if it's secondary to underlying disease. If it is gout, per se, it's most likely to fall into one of the 3 following categories (rather than being bread & butter idiopathic stuff): 1) Athlete specific syndromes, such as occurs [I]with[/I] (only examples here) "sesamoid" gout, "os trigonum tarsi", etc.--never heard of ankle disease. 2) Familial/genetic diseases such juvenile familial gouty nephropathy & other inborn errors of metabolism resulting from aberrant renal urate handling--obviously NOT going to be this, since you would have forwarded a positive family history from the beginning..??right??:think 3) Underlying lymphomas/leukemias--unusual to present JUST AS gout. I am just suggesting that you need a better workup. If you were a fat, hypertensive, beer guzzling diabetic male--no problem. But a 20 y/o? Give me a break! It's possible, and yes, I could be wrong...But like I said, medicine is a game of numbers and probabilities. And you, my friend, DO NOT have gout until proven otherwise. This effusion/joint pain could be a LOT of things besides gout (pseudogout, inflammatory effusion nos, trauma/bleeding, infection (septic joint), and many others). Go to a rheumy (rheumatologist), and be sure to get back with me. [/QUOTE]

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