Does Gout move from joint to joint?

[Irma Reitz]

I’m a 71-year-old female and have been fairly active until the last five years when my feet have been really painful. This has stopped me doing most activities.

But about 2 weeks ago I woke up with a really painful lower back. Just 3 days before I left for a road trip to a game park. So, I thought that I would have to cancel our trip. But it eased and I thought I would be ok.

I’m not sure whether it is referred pain from my back. Or whether it was caused by sitting in the vehicle for 6+ hours per day. But now my right hip is so painful. I don’t think I have damaged it. But I cannot put any weight on my leg and have hobbled around taking tiny steps to get around. The pain seems to radiate down my leg and is excruciating. So have detoured to a larger city on our way home to see a chiropractor on Monday morning before undertaking the last 1000 kilometer trip home.

Now taking NSAIDs 3x daily (1 cox flam and 2 Vimovo) 2 paracetamol with codeine every four hours and 1 colchicine. Also, I use Voltaren gel which I have been rubbing into my hip and back area. But I am worried that this many painkillers etc could cause kidney damage.

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Gout pain travels to Hip Joint. Which Joint gets Gout Next?

[Keith Taylor]

Hi Irma,

I’m sad reading your pain problems. It’s really bad timing when it spoils a holiday. We tend to push ourselves. And unfamiliar sleeping and traveling adds extra stresses and strains. In the past, I’ve comforted myself with gout pain therapy that works for me. But, you seem to be taking the sort of combination that I’ve relied on in the past.

I’m concerned that you’re mixing 3 different NSAIDs. I believe: coxflam is meloxicam (Mobic), Vimovo is naproxen (Aleve, Naprosyn), and Volaren is diclofenac. Is this prescription controlled?

I think you need a doctor or pharmacist to review your combination urgently. Apart from my safety concern, I’m worried that you are not on the right dose. When pain is particularly severe, it’s vital to get the dose right. Of course, we always have to avoid overdose. We also need to see pain control as a short term solution. And, we need monthly kidney and liver function tests to guard against side effects. But, if the dose is not strong enough, the pain relief is largely a waste of time.

This applies to everyone, Irma. I’m not just picking on you. But, dosage is crucial when we are talking about gout medicines. One colchicine means nothing. Dosage descriptions should be something like: “0.6mg colchicine at bedtime, followed by 0.6mg colchicine in the morning if symptoms persist.”

Similarly, the anti-inflammatory and analgesic descriptions are very vague. I feel you’re floating somewhere between overdose risk and ineffectual underdose. It’s very worrying.

Finally, Irma, you’ve posted this in Personal Gout Diaries. Are you applying for a diary, or shall I move this to General Gout?

[Irma Reitz]

Hi Keith.
First things first. I am applying for a Personal Gout Diary, as you suggested previously.
I quite agree with you regarding taking different NSAIDs willynilly is really not a good idea. I have been stuck in the middle of the bush with no access to doctors or pharmacist and have just taken whatever I could get my hands on, although nothing seems to help. I am seeing a chiropractor first thing tomorrow morning now that I am in the city and will ask him to prescribe a pain management schedule and also to advise me on what might be the cause of the problem. I’m just trying to get some relief. I have still not had a definitive diagnosis of gout, but hoping that when I see the rheumatologist in a weeks time, he will be able to give me some answers.

[Keith Taylor]

OK, Irma. I’m just catching up with other recent forum postings. Then, I will create a Personal Gout Diary for you. It will be later today, or early tomorrow.

[Irma Reitz]

Hi Keith. I’m now back home after a hectic 2 week road trip. I think sitting in the car for 6 plus hours per day really was not good for my back. I was unable to put any weight on my right leg and hobbled about really uncomfortably. I saw a chiropractor on the way home who manipulated my back but I really did not get much relief from that. I asked him to prescribe anti inflammatories, because as you said I had been mixing up several different Meds which was not a great idea. Anyway he prescribed 50 mg of Cataflam. I took one but got a pain in my stomach so I have not taken another and have gone back to using the Vimovo 500 twice daily and the paracetamol with codeine when necessary. I am still using 1 cholchine 1 mg tablet daily.
I had an appointment with Doctor, a holistic health care practitioner, who agreed that it was gout and suggested I try to reduce the Uric acid with natural products (I would gave preferred to try the allopurinol but thought I would try what he recommended first). He said to continue with cholicine, NSAIDs and painkillers because my feet are riddled with arthritis and are full of nodules and Spurs which he says is an ideal place for the Uric acid crystal to form. He has prescribed the following:-

For Sulfation

Lifetones – 2.5 ml twice daily (a herbal tincture containing celery, birch, nettle, alfalfa,willow and boswella serrate.

Gout Atomiser – 6 sprays into mouth twice daily (herbal tincture containing alfalfa, cramp bark, cayenne, celery,Devils claw, burdock root, Siberian ginseng) it says on insert that it reduces swelling, eases inflammation, neutralises Uric acid and improves circulation. (We’ll see)!

Pro collagen – 2 capsules at bedtime.

Epsom salts 1/4 – 1/2 teaspoon twice daily

MSM ( didn’t specify amount so am taking 2 X 1000 mg pure MSM capsules)

He wants to retest Uric acid, also vitamin D3 and homocysteine levels in two weeks time.

I have also had physio for my back and hip and it has been feeling much better.

I’m sorry to go on and on with my list of complaints etc, but I thought it might be a good idea to keep a record for my gout diary.

[Keith Taylor]

Thanks for the update Irma.

Sorry I didn’t start your gout diary. But, I now have more information to start it with. I’ll get on with it, as soon as I can.

I hope your latest treatments help you control your pain. Then, if you can get uric acid under control, you can start looking forward to better quality of life.

[Irma Reitz]

Hi Keith, I’ve started on the herbal regimen the doc recommended. He did not say anything about diet or alcohol consumption. I usually have a couple of whiskies in the evening!! I have noticed that if I eat too much red meat I feel more sore, so try to stick to fish or chicken. I love my morning cafe latte and would be really sad to have to forego those. Will you give me some diet guidelines to follow. I have been having physio for my back/hip pain, which is much improved although not totally better yet.

[Keith Taylor]

Thank you for your patience, Irma. We now have Personal Gout Diary: Irma Reitz. It’s your area, to do what you want with. I’m here to help you use your diary, as well as answer gout questions.

The purpose of your gout diary is to help you organize facts, goals, and progress. You can add as much, or as little, as you like. You can organize it in whatever way suits you. If you are ever unsure what to do with your diary, please ask.

I’ve started with your Gout Facts. That’s a starting post that I’ll use for all new Gout Diaries. We can add to it, or change it however suits you.

Your important first decision is “do you want to edit it yourself?” If you do, just get on with it! (don’t forget – if you get stuck, you can always ask for help). And, also bear in mind, that I will use your facts as I’ve described in my next-to-last paragraph below.

If you want me to edit your Gout Facts Summary, just reply to that topic with any changes that you want to make. You will notice I’ve left some red question marks for facts that I don’t have answers to. You might find these are not important to you. That is to be expected, so just ask me to delete that item.

You might think you’ve already answered the question somewhere else. It’s true that I haven’t gone back through all your previous posts. I have to ask you to do that. Then, if there are any missing facts, just tell me in a reply.

On some of the items, I’ve added a small comment after the red question mark. That tells you I’m not sure if you have more information to add. Please either confirm I got it right, or tell me what I should change.

Always remember Irma, anything in your Gout Diary area is for you. When I write anything there in your name, I’m just doing it as your slave. Once you are happy with the way it works, I’ll tackle the outstanding question about diet. Plus any other burning questions you have.

As you get test results, you can add them as new topics. You can also do this for changes in symptoms, or anything else that you feel is relevant/useful. I envisage a topic for:
– Test results
– Today’s Symptoms
– Treatment changes

But, as I say, it’s up to you. Nothing is written in stone. Once facts and progress are recorded, we can summarize whenever you like. The important thing for me is, I can see all relevant facts whenever I answer you. I need that, because I can’t remember everything. And, I don’t have time to keep checking back on old topics.

Thank you, Irma, for helping me making Gout Diaries a useful new service for all gout sufferers.

[Lowell Andrew F.]

Irma, just my opinion, but I’m not sure those whiskeys are actually helping you…even if they don’t cause gout, they are causing dehydration right before (or while) you sleep for hours & hours…and I am blaming that exact factor for what happened to me. I started drinking whiskey to help me sleep back in March, just 1-2 oz per night, but wasn’t drinking enough water. Everything hit for me in June.
No problems even with plenty of regular beer consumption until then.
Just letting you know my experience, not telling you what to do 🙂 & of course at the moment I’m not even 100% sure it’s gout (thanks probably to poor docs), although my kind friends here on the forum know it is, by my symptoms!

[Robs2850]

Migrating joint pain with gout

I had previous episodes of gout but after being bitten by a brown recluse spider, the pain would stay in a joint for 1-2 weeks then take 2 days off and then move to the other side (left to right or vice versa) and stay another 1-2 weeks before moving back. The location (Knee, ankle, foot, wrist, etc.) would vary also.

So, if anyone has migrating pain get checked by a doctor. The bite will have 2 faint puncture sites within the circular reaction area. The bite area will be easily seen for around a year.

I gave up all alcohol, most high fructose corn syrup and reduced my protein consumption and the last attack ended 9 months later. BUT, I have never had another gout attack after 5 years now. All raised deposits disappeared from my knuckles, also.

No need to respond. I just thought you should be aware of that kind of pain (Migrating joint pain) so if anyone gets it, they can be advised check for bites. It was horrible and unrelenting pain. The rheumatologist said insect poisons can stay in your system for about a year.

This is the best gout site.

Thank you.
R

[Judy]

Gout in hip?

Hi,
Late November my left hip area just to the outer edge of my hip bone became sore. Then, the skin flushed a pinkish purple and the flushed area is about the size of four quarters. Also, there is a sort of dent in the tissue.

I have had recurring hip bursitis but this is a different pain. I also encounter my sacroiliac needing adjustment. As it causes pain down my left hip and leg to my knee. Add to this that I have had 4 Phenergan injections in the same area over the past 18 months as a part of migraine treatment.

One doctor told me he would not prescribe Phenergan injection a month ago when I had a migraine. He said Phenergan can cause tissue damage, sort of a wasting–he felt that was my problem so he prescribed Zofran dissolvable tablets.

My chiropractor adjusted my back 2 months ago and he was concerned and said he felt maybe a small fat pocket was ruptured (my now ex-spouse shoved me down 18 months ago and I fell on this hip causing severe bursitis and sacroiliac attack).

I do stretch exercises my chiro recommended but it doesn’t help much. I take Tylenol arthritis formula at least at bedtime. I’ve used ice packs. Nothing makes this go away.

Today I wondered about “gout”. I’ve had gout in my toe 4 times several years ago. I also had pseudo-gout in my ankles about 9 years ago. The tissue near the flushed area is sore. The tissue also appears to have a slightly sunken area to it but today it doesn’t appear to be sunken much, yet flushed and sore. Flushed skin is smooth, no sores or rash and it doesn’t itch yet it is not as excruciating as I remember the pain being on my red toe when I had gout there years ago.

My hip joint feels like bursitis has started over and my sacroiliac appears to be flared again as the hot spots of pain go down my left leg. This is not keeping me from daily activities but it is always there. I wish I could get this resolved. Also, I wrecked a motorcycle 40 years ago and landed on my left hip which is the reason for recurring bursitis.

I have had about 6 steroid injections in that hip over a 10-year span but none in the past 8+ years and I don’t plan on anymore. I was told that these injections can cause muscle deterioration : ( My chiro doesn’t feel this is a muscle issue though). I really hate to doctor hop and my last blood work was perfect.

I am praying this is nothing serious, perhaps gout along with bursitis and sacroiliac all attacking me at once.

[Tim Ricketts]

Moving Gout Attack Sites

Hi I have had gout for many years it was always big toe joint I haven’t had an attack in many, many years but one came on just before Christmas I went to the Dr they gave me a cortisone injection which worked like magic to reduce the pain and inflammation but last week I got an attack in the opposite ankle. I know it’s gout because the suddenness and severity of the pain is different to anything I’ve ever experienced and I haven’t sprained or twisted it recently anyway.

Went back to Dr another cortisone shot helped the pain it’s now out of the ‘active’ phase as I call it but walking is difficult because I don’t have full motion flexibility back in the joint yet and the whole of the rest of my leg hurts after walking a short distance – the doc reckons it’s because of the strain of not walking properly due to the joint not fully working yet but man it’s painful. I go a few yards and have to stop. Does anyone recognise these symptoms? Will it get better?

I’m wondering if some other soft tissue like tendons and ligaments could be inflamed because they hurt up and down my leg when I try to walk.

Thanks, Tim

[d q]

Hi Tim,

Back to the basics for a second. You know you have gout and you haven’t had an attack in years because your taking medication for it or because luck has been on your side?

[Adrian Parsons]

Mystery Moving Gout with Strange Symptoms

Hi everyone
I saw this fantastic website and wondered if I could ask a question please.
I am a 54 year old man.
Nearly 6 years ago I went on a low carb. diet and within 8 days developed gout.
My big toe became painful and the doctor found slightly raised uric acid.
(A low carb diet meant I had eaten more protein.)
I had never had any joint pains in my life before this time.
A scan showed a 5mm kidney stone – Calcium Oxalate Monohydrate which is not gout related – now passed.

My questions to you are because my symptoms are not mentioned, as far as I am aware, under normal gout descriptions.
I had migratory joint pains which would travel round my body. One morning my jaw would feel like it had been punched, another day my left elbow. I have not heard of this moving type of pain with gout. Is that normal please?
Also, I believe gout to be intense attacks for 3-5 few days at a time, whereas I have continuous low level pain day after day. Is that normal?
I briefly have joint stiffness every morning.

The doctor gave me Naproxen, and sent me to a rheumatologist who found no signs of rheumatism.
Now, almost 6 years later, the pains are still low level but not migratory and in 12 joints – quite disconcerting.
What I am asking is does this fit in with gout or is it something else in your opinion?

I get a lower level of joint pain, never excruciating but debilitating.
My feet often feel freezing cold when sitting still.
A long walk leads to bursitis and burning pain in the ankles.
All these symptoms came from nothing is my point.
Also, I don’t drink alcohol or eat organ meats.
I haven’t seen these generalised symptoms being linked to gout but my toe aches again if I eat meat protein e.g 2-3 times a day.

I would really appreciate your thoughts.

Adrian

[nobody]

These symptoms are not typical of gout. You could have low-level pain from gout but the symptoms should be on-and-off rather than constant and you would normally also have the intense bouts. Some people are atypical though. Even so, you should have the most gout pain in the coldest parts of the body (feet, hands are typical).
You could try more doctors, scans and so forth but as far as gout is concerned a couple of simple and affordable uric acid blood test would provide a clue. Maybe you could also describe what Naproxen does and doesn’t do for you.

If you haven’t seen a rheumatologist in 6 years and you have chronic pain in many joints, I don’t think it would be excessive to consult a specialist again. Perhaps see another one this time.
Since you mentionned a calcium deposit I have to wonder: could this be pseudogout or even calcium oxalate crystals in the joints? I don’t know how one would go about diagnozing that other than by drawing joint fluid which is often not a straightforward procedure. Maybe that’s something you could ask a rheumatologist.

[Adrian Parsons]

Thanks for the answers.
My uric acid was 8mg.dL in 09/17, it has gone down to mid 3s in the last few months after taking 100mg Allupurinol daily and severity of pain has lessened. I find that my toe starts lightly throbbing if I stop taking Allupiurinol. The rheumatologist found me to be negative to RA in blood tests and said to return to him if I get visible inflammation. I don’t have visible inflammation nor redness and yet knocking on a door makes my knuckles ache and kneeling is tender and can cause bursitis. All quite strange. I would like to try going up to 200mg Allupurinol to see if it helps lessen the pain further but uric acid levels are good now so I am not sure whether to try it or not.

[nobody]

8mg/dl is enough to develop gout but as you probably know, lots of people have that much uric acid without developing gout.
Since you already started allopurinol, it makes sense to simply stick with it for a while and see what (if any) symptoms persist. In my opinion, the symptoms you described make more sense as gout symptoms in the context of having started allopurinol recently. Having little uric acid in your blood will help keep gouty episodes short, ideally so short that redness and swelling do not develop. Irritating deposits are also known to migrate in the initial phase of therapy. If you’ve had untreated gout for years, gout symptoms could take a long time to go away completely.
But people who had gout (especially untreated for a long time) are at risk of developing joints problems such as OA. These won’t go away after successful allopurinol treatment unfortunately.

I wouldn’t recommend increasing you allopurinol dose if 100mg is enough to drop your uric acid to 3.5 mg/dl. Lowering it further could provide a small benefit but you’ll have to wait for allopurinol to do its work anyway.
I would however recommend verifying that 100mg is indeed enough by getting another blood test if you only had one test returning such a low value after starting allopurinol. If your average result was more like 4.5, increasing your dose would make more sense (but note that you could increase your dose to 150mg rather than 200mg). It would be prudent to get frequent blood tests in the initial phase of allopurinol treatment anyway in order to detect troublesome side effects, especially on the liver and kidneys. If you were to increase your dose, liver and kidney tests would be strongly recommended.

[Adrian Parsons]

In reply to earlier question, Naproxen is quite effective if I take it before going on a longish walk or going swimming to reduce potential pain.
Would pseudo gout respond to Allupurinol?
I suppose uric acid levels would go down if anyone took Allupurinol whether they had gout or not.
(I note that 33% of people with RA do not have it show up on blood tests.)
The rheumatologist suggests drawing fluid from the knee joints if they inflame visually or are red in appearance which they are not.
For these reasons the medical profession are inclined to label it OA which to me seemed absurd as it all started suddenly 8 days after starting a low carb diet and the pain was so migratory at first that ‘wear and tear’ was conceptually ridiculous.
I can confirm that the last 3 monthly uric acid levels are all around 3.5mg. (My local chemist provides the service at 6 Euros per test.)
I wondered if 100mg was enough to actually remove crystals from joints as I had understood it to be only a beginner’s dose to see whether one can tolerate it. I will carry on with 100mg then, thank you!
To be honest, I have a doctor who told me to try Allupurinol only if I had eaten richly that day. As I had never heard of using it ‘as and when’ I decided to take 100mg daily.
I have not had any liver or kidney tests since starting Allupurinol about 4 months ago but have no allergic reactions.
Thank you!

[nobody]

I don’t know what process your chemist uses but there are reports of cheap tests underestimating uric acid so I would recommend you get a full blood test (including liver and kindney function) because allopurinol is usually not that effective (meaning that you might indeed need more than the beginning dose if your chemist’s numbers are off).
I must also stress once more that having at least one liver and kidney function test a month or so after starting allopurinol is strongly recommened. Your doctor is taking chances if they didn’t make sure you got tested at least once.
Taking allopurinol only when you eat richly makes little sense by the way. The drug stays in your system quite a while (you wouldn’t actually need to take it every day but that makes things easier and smoother).
What allopurinol needs to get rid of crystals is an adequate dose (how much that is varies quite a bit between individuals) and a lot of patience. After having thoroughly cleansed their system, some people find that they can discontinue allopurinol for a few months or even years before the symptoms come back.

So far as I know, pseudogout shouldn’t respond to allopurinol.
Both gout and pseudogout should respond to Naproxen however. Naproxen should be immediately effecive in suppressing any kind of inflammation (assuming the dose is adequate) unlike allopurinol which acts on the root cause of gout.

[Adrian Parsons]

Thanks for the advice, I will get a liver and kidney test done by my doctor in that case. The problem is I am temporarily living abroad and am not fully registered here.
All tests are very pricey.
The chemist uses what looks like a centrifuge-type machine.
One thing I forgot to mention is that soon after developing mild gout, I developed some kind of auto-immune response. I have had swollen glands in my neck for 2 years now but causes are unknown. (I even developed a hard bony lump above my right ear but it strangely disappeared within a week!)
The doctor seems a bit unorthodox. Apart from prescribing me Allupurinol ‘as and when,’ he has prescribed me Salazopyrin (which I have not tried by the way) to see if it relieves my symptoms. In which case it would indicate to him that I do have RA.

[Jean Clyne]

Your symptoms sound a bit like me, multiple sites, sometimes mild but still “there”, sometimes in 1 ankle, or maybe the other, various finger joints, big toe, always come and go, always come on with eating meat, especially beef, add sugar to that, then it would start with hot, burning feet, then pins and needles turning into sharp stabbing pains. 2 plus yrs out, turned vegetarian, did 6 mos stint on allopurinol but stopped bec of sideeffects. Finally got apptment with rheumatologist, who said you don’t have big, swollen, red, inflamed joints. Well not now bec I took antiinflammatory especially and changed diet. Osteoarthritis is in all these places, the gout symptoms always went to places of existing osteo. He doesn’t think it is rheumatoid, am waiting for dual ct scan to see if uric acid crystals are there.

[Adrian Parsons]

Thanks Jean. I also managed to control purine levels with a vegetarian diet but found it hard to stick to it in Italy where vegetarians are seen as almost crazy…
The problem with the standard medical definition of OA to me is that, if what I have is just OA, it happened so suddenly and was migratory like an entity attacking different parts of my body.
Please let me know how your scan goes.

[Author]

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