Gout in the Toe: Understanding Symptoms & Mild Pain

Question
Hello Robert !
I have been diagnosed with having Gout.It is effecting my right foot big toe {mostly} but I have noticed swelling around the other nearby areas near the rest of the toes.
I have had two uric acid test done in past two months--both were normal.And I dont seem to have the usual intense pain that is accociated with Gout. Mostly swelling,redness and discomfort "Only" when I put full body wieght on the toe.
My question:
Can patients with Gout have mild pain without the normal severe symptoms ?
What else might cause what I have described.
For your info-- The x-ray showed no visible Gout as read by the radiologist. "Yet" my primary doctor says that Gout sometimes will not show up on an x-ray Unless you have Chronic Gout,which he does not feel i have at this time. He prescribed Cholcicine pills which helped with the swelling but I am still concerned that it may be something else due to the lack of what would normally be described as intense pain in the toe.
I realize that I am throwing alot of info at you but I would really appreciate any thoughts you may have to offer. Thanks ! Ron

I am 48 yrs.old--non smoker.
Only medicine I take is Bp med--acupril 5mg daily.
Had treadmill done and artery scan--both were okay,so i am assuming that swelling is not due to heart problem.

Answer
The diagnosis of gouty arthritis, is most often made clinically, meaning that you come in with a painful joint, it is red and hot and hasn't been injured.  We presume gout.  We can get supporting data from the uric acid levels.  Yours were normal which doesn't exclude gout, but makes other kinds of acute inflammatory arthritis a little more likely.  The definitive way to diagnose would be to extract a little joint fluid from the "hot joint" and then look at it under the microscope.  There is a condition called pseudogout which are calcium crystals instead of uric acid crystals causing the inflammation reaction.  Both are treated similarly, but it is important to get a diagnosis because the recurrences are prevented differently.  Xrays are not helpful early on with gout or pseudogout.  It would be appropriate now to try and get some joint fluid out of that toe.  To answer your questions specifically, yes you can have gout with a range of pain, from very severe to annoying.  What else- many inflammatory arthritis', but next guess, if not gout, then pseudogout.  Also, could be some of the others-lupus, rheumatoid, just very very early in their presentation.  But these are much less likely since it is in one area only.

I don't know how aggressive your primary care doctor wants to be, but this would be a good case to do the joint aspiration.  I rarely do them unless I am not sure which one I am dealing with.

Hope this helps...