First Gout Attack – Is Colchicine or Naproxen best?

[John Harding]

My Name is John I am 50 and started my first gout attack 7 days ago. It was initially treated with Colchicine for the first 5 days and then I moved onto naproxin. Since taking the naproxen the pain has abated. Yesterday I managed to go swimming and drive and of course sleep!. But my job is a physical one and I still have pain when I put my boots on and some swelling so I am staying off work (unpaid!). I don’t want prolong the attack even further by putting to pressure on it.
Is this the right approach?
I am drinking lots of water and coffee (not alchohol). As I said on the other forum I am getting a UA test in a few weeks. As a side note I am also on 50mg of amytryptyline a day, is there any possible link?
The inactivity is driving me crazy I am quite a physical person and need to exercise!

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Which Gout Medication Do I Need?

[nobody]

Assuming there is no injury or other problem besides gout, the pain and sewlling should have abated quicker. There are special cases where little can be done but you haven’t said anything which would suggest that you are one such case.
Could you state how much colchicine and naproxen you have been instructed to take? Not taking enough will of course not result in the ideal outcome (your weight might be relevant). Have you been told you shouldn’t take both drugs simultaneously? Have you had an opportunity to discuss higher doses or other drugs with your doctor(s) since you noticed that the drugs you were taking weren’t as effective as one could hope?
Rather than soaking your whole body in fairly nasty drugs, there is also the option of injecting (or infiltrating less invasively) drugs exactly where your symptoms are.

Other than drugs, my personal opinion is that resting the affected joint is best. Raising it above your heart should also reduce swelling. But at the same time I think occasionally stimulating bloodflow helps. Bathing the affected joint in hot water is generally recommended but getting your heart pumping by bathing/showering or by exercising (in a way that lets the affected joint rest fully) is in my opinion better.
Finding a way to physically support the affected joint may be helpful because your muscles work unconsciouly in many positions. What they use in hospitals for feet is nice for instance but overkill. Psychological relaxation is also helpful (you may want to try something like vipassana if you don’t have favorite methods).
Drinking lots of water is a good idea but I don’t know about drinking lots of coffee. Coffee isn’t bad for gout in the long run, mind you. It’s just something I wouldn’t overdo when taking largish doses of unfamiliar drugs.
My opinion is that you should also avoid prolonged exposure to cold and if necessary wrap the affected joint delicately to keep it warm.

[John Harding]

Hi, I was prescribed 500 micro grams of colchicine twice a day but after 5 days my doctor switched it to Naproxen 500mg twice a day and told me not to take colchicine with the naproxen.
I have little pain when my foot is not in use, but if I try to do too much (walk) it hurts. The swelling is still there but I think/hope it is slowly getting better!
I have found swimming to be ok. I guess in the next attack I will blitz it in the first day or two with colchicine and Naproxen!!! Thanks for you reply. John

[Keith Taylor]

OK John, here is your new gout diary. It’s up to you how you organize it. But, if you need help, just ask. If you want me to respond to any of your topics in your forum, please check the box that says “This is a support topic” near the submit button.

I’ll respond to this topic without it being marked for support.

1. Colchicine slows inflammation getting worse. But, it does nothing for existing inflammation. So, you should have started naproxen earlier. Also, it should be taken at maximum strength as advised by your doctor/pharmacist. OTC dose is only good for mild gout attacks. In worst gout cases, naproxen can be supported by acetaminophen. So, ask your doc/pharmacist about that too. With the right pain control, you should never need time off work with gout.

2. Gentle exercise is good for gout. So, do as much as your pain relief allows. In my experience, walking helps resolve gout pain below the waist much quicker than resting. But, avoid strenuous exercise. Because uric acid crystals weaken tendons, cartilage, etc. Wearing boots is good, as they support the foot and ankle better. But, make sure they are large enough to take your swollen foot. Then wear extra socks for cushioning and comfort.

3. I cannot find any references that mention raised uric acid or gout in respect to amitriptyline. But, you should mention it when you discuss pain control, as there could be interactions there.

[John Harding]

Thanks Keith, I was originally told to take 500 micrograms of colchicine a day, after 5 days and no improvement I rang my doctor and she gave me naproxen at 500mg twice a day but told me to stop taking the colchicine.
It’s nearly two weeks now and the pain has subsided but the swelling is still there. I have found that swimming is ok with it and obviously puts me in a better state of mind. I have not drunk alcohol for two weeks now.
I have to decide whether to go into work tomorrow and risk inflaming it further ( it will mean 8 hours on my feet) or stay off until it has completely gone down.
If/when I get the next attack I will know to take colchicine and naproxen straight away and hopefully this will shorten the flare up. Many thanks Keith.

[nobody]

It’s good you’re able to swim but if you’re still taking Naproxen and you’re not used to taking anti-inflammatories for so long, it might be prudent to get a blood test done quickly. You need to get your uric acid tested anyway so you might as well get tested for signs of stress caused by prolonged used of Naproxen.

500 micrograms of colchicine ain’t much. That dose may be somewhat useful as a prophylactic but I think you’d need more than that to effectively put the brakes a flareup. If you’re smaller than me, such a low dose may be moderately effective but I’d still inquire about upping the dose. Maybe you have a condition which would make a regular dose of colchicine bad for you but some of us have taken a lot more for a few days without experiencing serious side-effects.
I have no experience with Naproxen but I guess you couldn’t safely take much more than 1000mg a day. Some people may be able to tolerate a bit more though.
Even if you’re feeling better, it’s best to inquire about higher doses or different drugs in order to be prepared in case you get hit by another flareup in the future. You wouldn’t want it to last that long!

In my opinion, a little residual pain is OK but you should find a way to suppress the swelling in case it’s caused by ongoing low-grade inflammation because until that’s resolved, your system may remain primed to go back into full flareup mode quite quickly.

[d q]

@nobody, just wanted to clarify something that may help me. You mention finding a way to suppress the swelling in case it’s caused by an ongoing low grade inflammation which unless resolved will be primed for a full flare up. How does one suppress this..?

The swelling is caused by the inflammation isn’t it..?

[nobody]

I have no idea what might be causing someone else’s swelling. Flareups can be triggered by mechanical damage and can also cause lasting damage. And some people seem to get harmless swelling easily. But I think it’s a possibility that it’s still inflammation (by which I mean the immune system doing its thing but I may be misusing medical words).
My experience with arthritis has been that swelling at rest is a sign I’m out of the woods yet. Ways to deal with this would include drugs that hamper the immune system such as topical corticosteroids or colchicine. Patience works too but if you have a physical job waiting for you…
And as you have seen on this forum, everyone’s symptoms seem to work a bit differently. And the way they work changes over time. So it’s a bit of a guessing game.

[Author]

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