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Jaswir,
While you are waiting for the diagnosis, there's no reason not to treat the pain. Call you doctor and have him prescribe colchicine. Take the .5mg tablets one an hour til the pain stops, you get vicious diahrrhea, or you reach 16 pills.
I have found that the pain stops the instant the diarrhea begins.
IF it works that way, you have probably diagnosed yourself because colchicine is very specific for gout.
If you cannot find a doctor to prescribe colchine, buy some over the counter ibuprofen. It's not the best but it is better than nothing for pain.
My research has shown one antihypertensive regimen that lowers uric acid. I will repeat it here.
It involves the use of two antihypertensive drugs, furosemide and losartan, (Lasix and Cozaar) but they must be taken in a particular way: first take the Lasix (which causes brisk diuresis) and then several hours later, take the Cozaar which causes uric acid elimination. Dosage of both drugs is titrated to get reasonable blood pressure control. Needless to say, people with NORMAL BP should not use this regimen.
The study confirming this regimen is small but rather convincing, but studies showing the uricosuric effect of losartan are all over the net. It;s the ONLY antihypertensive with this capability but used alone its effect is not large.
DuckBoat,
Prednisone is not the drug of choice for a gout attack. Best is colchicine…probable second best is ibuprofen.
But there's no substitute for long term control of uric acid probably with allopurinol IF you have confirmed gout.
The magnesium is a urinary alkalyzer…a good idea (I take Magnesium Odixde daily.)
Once you get your uric acid down with the allopurinol you should be able to enjoy your brandy and meat. (What's a peg? Like an ounce, or a SHOT <1.5 ounces>?)
And for the pain and swelling of an acute attack I have just 3 recommendations: colchicine, colchicine and colchicine.
You get my silver star for endurance being able to swallow 2400 mg. ibuprofen in one day…I'd need a stomach pump.
tony,
Like GoutPal implied, your best choice of BP med is probably losartan (Cozaar.) It is unique among BP meds in that it causes the excretion of uric acid. If it doesn't work well enough alone it will work very well along with Lasix (furosemide) without raising your serum uric acid.
I use 40 mg. furosemide followed by 50 mg. losartan a couple hours later (aftfer I'm done peeing a waterfall.)
Ask your doctor to switch you from Benicar to Cozaar. They're both the same class of drug, angiotensin receptor blockers.
I JUST wish Cozaar was a more potent antihypertensive.
I have taken allopurinol for 20 years and Lipitor for 10. I have never had any of my liver enzymes be anywhere except in the dead middle of the norman range.
Roy,
My gout, too, was precipitatied with antihypertensives but for me the drug was hydrochlorothiazide, the commonest diuretic and the first line of treatment for hypertension for decades. I was in my 30's at the time.
BUT if you examine the way ALL antihypertensive drugs ultimately work, it's through diuresis the only differences is in the route they GET there. There is one rnegade in the bunch which is also a uricosuric drug and that is losartan. A GOOD drug for gout sufferers but, alas no the best antihypertensive and thus it must often be combined with a diuretic for effectiveness. It goes by the brand name COZAAR and unfoirtunately is not yet available as a cheap diuretic.
Cozaar + Diuretic is a good treatment because the losartan at least outweighs the gouty effects of the diuretic.
Duncan,
No, those pains are not typical of allopurinol's side effects, which typically involves a rash after long term use (many years.) Hypersensitivity reactions are quick and involve things like hives, swollen lips and eyelids. As with any drug, STOP at the first sign of these latter anaphylacic reaction.
My guess is that you are suffering pains that might be expected from squash in one's forties…forgive me!
Alternatively, when beginning uric acid lowering treatment, often the stores of uric acid that were safely tucked away deep in joints can be liberated. Before this uric acid can be safely discharged by the kidneys it can cause frank gout attacks or more benighn and hard to define “aches and pains.”
DON'T stop tour allopurinol and likely increase the dosage to get your serum uric acid always and forever below 6.0 mg./dL.
(Wait til you start playing the “what's causing my aches and pains” game when you reach my age, 66…something ALWYS hurts but I push through with weightlifting, bodybuilding and aerobics…and ache, and ache, and ache.)
The internet claims of folic acid as a xanthine oxidase inhibitor (what allopurinol does) calls for taking 10,000- 40,000 micrograms folic acid a day. That's up to 100 pills/day in the iver the counter 400 microgram size. Few people can take pills in that quantity.
My allopurinol Rx costs me $4.00 per month at Target Pharmacy.
Charley,
Waiting until an attack subsides before starting allopurinol is basically sound judgement. BUT you're attack began in min-February. I think waiting it out for months and months is not wise.
You will have to begin treatment for your hyperuricemia eventually and it might as well be now. SInce you seem to be almost in a state of chronic gout I strongly recommend low dose colchicne (maybe 1 or 2 mg./day along) with whatever agent you use, probably allopurinol, until such time as you are pain free…and then maybe even a onth or two afterwards.
No harm in adding daily baking soda to the regimen either.
Have you had another uric acid reading siince February?
My basic aim is to titrate myself by adjusting my dose to get my UA level to 5 or 6 and try to maintain that with as low a dose as possible.
That is exactly the right approach.
I am considering trying the new drugs. Uloric, Febuxostat, Pegloticase are mentioned.
DON'T doo it for two reasons:
1. Both are PREPOSTEROUSLY expensive for a lifetime of useage.
2. Both are NEW so why be a guinea pig to find out the efffects after taking it for 20 years? Allopurinol is over half a century old. The new approaches are sensible only for those who do poorly on allopurinol or are hypersensitive to it.
As for how many people STAY on allopurinol for a lifetime…my guess is the answer is VERY MANY. Untreated hyperuricemia is a slow killer. But I don't have the numbers.
(I think also that 14.9 was probably spurious)
Charley,
Go to a rheumatologist. The doctor you are seeing now is content to work his way through the zillion NSAIDS while you suffer.
For someone withh confirmed gout, a uric acid of 6.2 is high enough to allow an acute attack.
You should be on an agent to lower your uric acid
Histac(raitidine for ulcers,) Danzen( antiinflammatory) Arcoxia (questionalble antiinflammatory…cox-2 inhibitors are showing signs of heart disease and stroke)
It's tough to start on allopurinol or probenecid in the middle of an attack but you HAVE to get on one of them if you want to control your gout.
(Get a new doctor…this one makes sounds like a duck!)
Scott,
In the United States it is common procedure to test uric acid with each routine blood draw…Some labs call it Chemscreen 25, others something different. It might be the same in UK. So yes, your doctor is likely to have your uric acid number, maybe more than one. Just call his nurse and ask him to look it up for you. There should be no charge. It is good policy to keep a personal copy of ALL tests performed on you ANYWHERE and for ANYTHING…it can come in handy later.
Years ago I had the same syndrome waking up with stiff fingers that needed a few minutes soak in hot water…it went on for months and months usually in ciold weather. I never even THOUGHT of gout until today…thank you. I guess the allopurinol “cured” me. Live and Learn.
This topic about gout for 4 months is now closed. Please see How Long Does a Gout Attack Last? which explains why gout attacks can last for 4 months or longer. If you still have questions, please start a new topic.
You're doing GREAT Charlie.
I think after a reasonably short period of time you can probably back off on the allopurinol dose becasue I think most side effects are DOSE related and if you can get good numbers with 400 or 300 mg. allopurinol, then you should. I guess that's exactly what you and your doctor tried.
Dosing:
It is correct that allopurinol has a short half life in the body BUT it is metabolized to oxypurinol which is also a xanthine oxidase inhibitor (prevents xanthines from going to uric acid.) Though the half life of allopurinol is only a couple hours, the half life of oxypurinol is MANY hours, often several days and day after day the amount builds up. The net effect is that it is the OXYPURINOL metabolite that actually prevents uric acid formation. Thus after a week of dosing you build up a HUGE suppply of oxypurinol in the bloodstream and missing a single dose or even two or three is without consequence.
But your numbers are strange:
How often do you miss your dose? On what exact date did you switch from 600 mg. down to 300. That 14.9 is a real head scratcher and would seem to GUARANTEE a fierce atack?????
Something is not adding up!
Jesus Scotto,
That's a steep price for that test rig even given the weaker valued Aussie dollar (relative to the U.S.) Make sure you don't test first thing in the morning. Week to week seemns a good idea given that these test strips are several bucks apiece.
Colchicine SEEMS to migrate to a inflammatory site caused by uric acid and alkalyze it, thus stopping further crystallization. That's the best explanation for it's effect that I've seen. It seems to work almost instantaneously.
If the diclofenac works well enough for you, then stick with it. Once the allopurinol kicks in you probably won't need ANYTHING else.
Scott,
A lot of what you describe sounds like repetitive stress injury…a computer age scourge. BUT any such injury can be exacerbated by uric acid and thus gout.
First order of business is to get your uric acid measured. If it's over 7.0 mg/dL gout becomes more suspect…if over 8.0 it's probably confirmed; If it's under 6.0 gout is far less likely. Gout pain, unless its frank podagra of the bunion joint of the big toe can be hard to judfge solely from effect. If you have an amenable doctor, get an Rx for colchicine…it works VERY well for the pain of gout and is useless for other causes of joint pain. It's almost diagnostic
Instead of Paracetamol (acetomenophen) why not use some thing like naproxyn or ibuprofen for your pain. Not only is acetomenophen nearly worthless, it is extremely hard on the liver.
I'm going to stick my neck out on this one: It's Quackery and any benefits are placebo effects.
Magnets are a lot cheaper and a trip to Lourdes a LOT more pleasant…and maybe cheaper.
If I were to try something in this vein I would give ULTRASOUND a hopeful shot at pain relief…at least there's penetration.
Remember, it wasn't too long ago that they were escorting arthritis and gout patients deep into radium mines where they could bathe in the comforting gamma radiation…and then die of cancer a few years later.
It sounds like the treatment is llittle, if any, better than an NSAID and Alleve or Indocin is a LOT cheaper.
I doubt if most insurance companies in the United States would pick up the tab.
My first thought is what possible use could concentrated light on the skin be in the alleviation of pain inside a joint…except perhaps the heating effect (urates dissolve in heat) which you could easily get with a simple heating pad or an infa-red lamp.
I am quite skeptical.
Tying in with the last post it is important to remember that before allopurinol and probenecid were developed, gout was a death sentence…and death came usually from destruction of the kidneys.
That's exactly what many men do to dump excess iron.
I would do the same but since I had Hepatitis A 35 years ago, nobody wants mine. Perhaps I will remain silent about it and let them test my blood after I give it…if they want to discard it, so be it.
Something like a pint donation 4 times a year seems reasonable.
scotto,
Just beginning allopurinol is the reason for your increased attacks. Until allopurinol gets to remove most of your uric acid stores you will be more prone to attacks. Have your doctor prescribe some colchicine to take for a few months while he titrates up your allopurinol, probabaly to 300 mg./day. Something like 2 small colchicine tabs (total 1 mg.) per day should keep these attacks at bay.
Yes, I agree there is more and more gout as we in the “first world” have since 1950 been able to consume more and more meat and fish in our diets…things that were considered “treats” in earlier times are now commonplance.
Be careful wiith the beer AND the soccer injuries…uric acid LOVES to congregate at an injury site.
Let us know how you like your uric acid tester. How much did you pay?
freakballr,
You're at the tough stage. Just diagnosed, infrequent attacks that are not too terrible. (Terrible is trying to get to the bathroom without having your infected foot TOUCH anything…crawling on knees with one foot elevated.)
You naturally do not want to commit to a life of drugs until absolutely forced to do so. We've all been there.
So, get a larger supply of indomethacin…it is very cheap and works well. A better alternative is colchicine for acute attacks but if the indomethacin works, stay with it. (I HATE doctors who give a week's supply of a drug to guarantee a RETURN visit and fee.)
Work your diet although it's effect on gout is slight…avoid the beer, substitute hard liquor, eat more veg and less meat and fish, especially SMALL fish. Avoid organ meats, consommes and gravies. BUT be aware that thesemethods PROBABLY will have only a slight effect on what is basically a metabolic condition.
As GoutPal said, control your uric acid to 6 mg./dL. What was the reading from your diagnostic visit. If your doctor didn't measure it, get another doctor.
If all fails, allopurinol will ride in on a white horse and save the day!
Here's a wonderful read with a great bibliograpical links pile to see the research.
http://arthritis-research.com/content/8/s1/s2#B19
And here's a LONG one (8 pages) with special ramifications for cardiovascular health and gout:
dgalati,
Crestor and Lipitor are slightly uricosuric so they will increase uric acid excretion.
Diovan is a good drug, an ARB (angiotensin receptor blocker) but will have either no effect or an adverse effect since almost all anti-hypertensives act as diuretics even if they aren't billed as such and the HCT component is HIGHLY causative of gout, perhaps the worst drug around.
That said there is ONE ARB that is uricosuric, losartan, sold patently under the name COZAAR. Trouble is it is NOT a very good anti-hypertensive and really needs to be taken twice a day becasue it is short lived.
You really need to get rid of the hydrochorothiazide though. I find that Lasic (furosemide) works just as well and the literature says it is only abvout 25% as likely to cause hyperuricema. I use Cozaar and Lasix for my hyoertension…ask your doctor what he thinks.
So I guess what they about one kidney working as well as two isn't completely true, eh?
Don't let internet squawking keep you from allopurinol, the dangers are overstated. It really is among the most innocuous of drugs. In fact, if you read up on Crestor you'll find it called the most dangerous drug since thalidomide.
Quote:from APcoach: Allopurinol if for over-production and Probenecid is for for under-excretion, right? If that is true, why are so many people on Allopurinol?My other question is, just how normal of life do you live when on Allopurinol that gets your uric acid under 5 mg?
From what I undersand, people are put on allopurinol becasue it has far fewer side effects and even if you underexcrete, if you can be made to produce less uric acid you'll improve your numbers. My life under 5 mg. is perfectly normal with no acute attacks.
Stevo,
My right bunion joint where I had my one and only toe attack is ALSO somewhat larger and I attribute it to a tophus…but then it COULD be a bunion. My only other visible tophus is a small one on the end joint of my right little finger. It sometimes aches slightly.
Colin,
Once you have gout you can never be sure about your aches and pains. Some are classic and easy to call but many are borderline. Remember, just becasue we have gout there is no reason that we can't sprain an ankle like the next guy. Worse we can have gouty aggravation of an actual injury.
My test is to take a couple colchicine which is quite specific for gout. If it quickly eases the pain it was gout, if not, NOT!
Ankles are a VERY likely attack point for gout. In fact I had several ankle and instep attacks that were baffling months before I had THE BIG ONE…podagra from Hell in the big toe. THEN I knew.
I wouldn't worry about it because although allopurinol CAN cause hair loss, the odds are very slight that it would. There are very few drugs that absolutely CANNOT cause hair loss as this site attests:
americanhairloss.org/drug_induced_hair_loss
Have you dropped the diuretic? An ACE inhibitor will less likely cause gout and hyperuricemia…IF it works for you and doesn;t cause incessant coughing.
You should be on an analgesic for pain relief…I recommend colchicine along with the allopurinol at least until your pain stops. Give your doctor a call and ask him to call in an Rx.
Welcome to the large world of CONTROLLED gout sufferers.
We may never be rid of the disorder but we can sure be rid of the pain, the disfigured joints, and the shortened lifespans.
tiger balm?
No, becasue although linaments and unguents may produce the SENSATION of warmth they are not changing the temperature (of the foot presmably.) Use a heating pad to keep the area ACTUALLY warm so the urates remain more soluble. When going out in the bold, insulated socks are a good idea.
Don't overdo water because messing up your electrolytes will only give you other problems. Staying out of dehydration is enough water. Distilled? A waste of money unless your tap water iis polluted.
I too had an attack when I owned a stick shift…forget it! 😉
Nick,
best hint is to take allopurinol and enjoy the steaks and some drinks (maybe take Lipitor too?) I, of course take all 4.
