Hi,

Here are my thoughts:

1.). The keto diet stressed your system, you had high proteins causing uric acid build up. Your kidneys struggled processing and filtering this uric acid through your kidneys to excrete it (especially if you were not drinking a lot of water to support the increased animal protein). Your body started to retain fluids. The extra fluids impacted your nerves in your legs/feet due to swelling.

2.) I also had elevated RF/CCP due to inflammation and my immune system activated and was attacking my own body. They ruled out RA/lupus. Since you have been diagnosed with synovitis and gout (painful arthritis), you may not have RA. The fluid retention is due to keto/uric acid overload to your kidneys which triggered synovitis/gout. Gout can affect many joints, including those in your hands. Your RF may have elevated if your immune system activated to defend itself from the stress of the keto diet.

3.) I do not believe fluid retention and swelling is tied to ALS. I do not think you have ALS and your symptoms are tied to keto diet/high uric acid, synovitis/gout and joint and nerve impact due to swelling.

4. Gout can affect many joints throughout your body. Once you have it, you can have flares that bring back the pain/swelling. You will want to make sure to follow a diet to reduce the risk for gout flares and reduce synovitis swelling/prevent further nerve damage. A neurologist can test how synovitis/gout is affecting your peripheral nervous system (through EMG testing of upper and lower body limbs/nerve conduction and small fiber neuropathy punch biopsy).

Hope this helps❣️