Gout pain finally gone, but swelling persists

[BigA]

This popular topic answers some individual questions about persistent gout pain. So I urge you to read BigAl’s question and replies below. Because they give a good insight into different aspects of lingering gout pain control. But first, you should read some relevant gout facts. Then you can add to this discussion with your own questions, experiences, and opinions.

Gout swelling won’t go away.

See Heat Or Ice For Gout Relief. Because this compares two ways to reduce gout swelling.

Gout pain gone but still swollen.

See 3 Unusual Signs Of Gout. Because this looks at unusual aspects of swollen joints.

How long for gout swelling to go down?

How long does gout flare up last? Because this explains the factors that affect how long for gout swelling to go down.

Original question follows…

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Hi, all.

I’m 37 and had my first attack 7! Years ago and when to a&e thinking I’d broke my toe as and whacked it running up the steps the night before. Was told it was gout and given a course of colchicine.

Three years after that I had another attack after a stag weekend (I knew the trigger).

Both these in my left toe.

Now a further 3-4 years on I have my 3rd after another stag do (I should really give these stag parties a miss)

Anyway, I went to the docs who tested my blood and I was .401 which she said I was just over the normal range. Before placing me on allopurinol she wanted me to lose 2stn (I’m just into the obese category with a BMI of 31) and increase my water intake as I’m usually just tea and coffee.

Anyway, that’s my history. My first attacks in my left foot went after a week or two and that foot is I would say 100% normal. This 3rd attack which is the 1st in my right foot has gone pain wise… it took about a month but some gout swelling and redness persists which is holding me back in terms of exercise.

Does it normally take so long to go? What can I do to assist it along?

I’m also drinking black cherry juice to help with my levels of uric acid.

Thanks

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Gouty swelling in left toe even after gout pain has gone

[nobody]

Hi,

About the persistent swelling, there might be a few things you could try. But what you already done for that foot treatment-wise? And what tests (if any) were done on the painful location?
Some of us have had lingering symptoms for more than a month after what we assumed to be a gout attack. Insufficient treatment might be part of the reason why the symptoms lingered so long.
I’ve not experienced this problem recently. Perhaps it’s because my uric acid is lower and perhaps it’s because I’ve been taking more colchicine when dealing with worrying arthritic symptoms.

About your uric acid, my concern with your doctor’s approach is that a single blood test is insufficient as a basis for long-term treatment (you shouldn’t try to lose that weight over a few weeks). But maybe your doctor had more data than you posted here.
Also, do I understand correctly that your blood was tested during or shortly after an attack? That sometimes skews the result.
If all you have is the one blood test, I strongly recommend you get at least one more test. When you’re experiencing gout symptoms and especially when uric acid is borderline rather than very high or safely low, test results can randomly vary a lot.

It is possible to manage uric acid without allopurinol, even if the average amount of uric acid in your blood is actually a bit higher than 0.41. But it would be easier if your average was a bit below 0.41.
And I’ve got to warn you that you’re likely to experience more pain and disability over the adjustment period than if you temporarily took a drug such as allopurinol. The higher your average uric acid, the more hardship you would likely face.
The reason is that gout is mainly caused by uric acid crystals which build up in your body over the years and not by what you ate or drank yesterday or even by the amount of uric acid currently in your blood. If you eat right and start losing weight, these crystals wouldn’t go away instantly. Instead, they would slowly start to dissolve in your bloodstream which would likely cause both minor and serious gout symptoms. As a result, you risk feeling worse instead of feeling better for a while.
The same thing usually happens with allopurinol but you’d get over the bad patch quicker. You might also experience less serious symptoms while in that patch.

If you want to try lower your uric acid without drugs, there’s more you can do than drinking water and cherry juice by the way. But maybe you already know all about that…

[Rich Blazeski]

Hi there,

@nobody, what do you mean by shortly after an attack when doing the blood test, what time do you consider?

@ big fellow, my attack started on 1st of May, and today I was walking and had gout pain in my both feet, so the other days, and there are about 2 and a half months.

[morgano70 herbs]

I’ve had gout flareups for many years now. Toes, feet, elbows, hand. Taking colchicine for a few days and Arthrotec for really bad attacks works for me. I do not take allupurinol because once you take it you have to take it for life. Pls correct me if I’m wrong on this.

[nobody]

People usually take allopurinol for life. Because if you need it, you need it.
But you don’t have to take it for life.
People who do not have a very bad uric acid problem and who change their diets, lifestyles and so forth might be able to quit the drug. Others might be able to make do without the drug for a few years before needing it again.

The first step is to figure whether you would need allopurinol, and how badly. And that starts with getting a few blood tests. There are other tests which might be called for as well, depending.

Rich,
I would think: a bit less than a week. But I don’t know exactly because I’ve never gotten several of these tests during the same week.

[d q]

A few side notes to add to this thread:

Gout Pain Gone But Still Swollen

@BigA – I hear you mate. I had attack followed by another a year later and finally started allopurinol. As I increased the dose of allopurinol I got a severe attack and boy did that put me out for a good month. For that matter, my situation is exactly that of yours. I had to stop allopurinol for a few reasons but I might be starting febuxostat a little later. In any case the main pain is gone but I still get pain from the slight remaining swelling 2 months later! I haven’t been able to do my usual long walks as after a while the swelling starts to hurt a little and I need to put my feet up for a while. So can lingering pain and swelling last a month or two later? In my case definitely yes, in fact it is still slightly swollen and the pain is still lingering. I’ve been given Colchicine to try and speed the healing process but for the time being I am staying away from all drugs until another medical condition I have is checked.

@morgano70herbs – this is not entirely true. Refer to this: http://www.goutpal.com/1629/is-allopurinol-a-lifetime-drug/

The general advice for treatment is:
1. Find out if you actually have gout and not similar conditions.
2. If it is gout, then find the cause for your gout and treat that.
3. If there is no apparent cause, try and treat it with diet “if” possible.
4. If that cannot be achieved then go onto drugs.

Whilst it is true that gout is insidious and takes time to develop, not everyone with high uric acid will develop it.

Don’t let gout scare you, it is treatable, you just need patience and will.

[BigA]

Thanks for the replies. Let me try summarise if I was a bit vague

1. Fist attacks in left foot 6 years ago. (Too much beer over weekend) went to a&e had a blood test and told it was gout.

2. Three years later another attack on left foot after too much beer (stag do)

3. Third attack in April this year which is approx 6 years after my first attack. This time in my right foot.

I’ve been told that taking a blood test while having an attack is pointless because you have either low or high uric acid. I can’t remember which.

Yes I’ve only had one blood test after this attack which was over 2 months after the attack. Which was 0.401.

I purchased a digital blood test device to test myself more regular once I’ve lost some weight.

About the weight… of only I could lose weight that quick. But watching what I eat and eating a health and varied diet. I have also joined a gym and started swimming after work.

To stress that I’ve not had an attack since this one in April and I’d like to elaborate on what the foot is like now. It’s not painful it’s just like a feeling of not compleatly healed. Visually my effected foot looks slightly ‘puffy’ if that’s the word, or fatter than the other but that’s it. I can run jump and walk fine. It’s more that I can feel it’s different than it’s painful. Being on my feet all day is probably hindering the healing for sure.

I’d be happy to take advice on this and what else I can do other than losing weight, drinking water and cherry juice to help.

The doctor wanted to try the weightloss etc because my test were so close to being within an acceptable range and I’m all for not taking pills if you can do something about it.

[sujith reddy]

Hello @BigA and Hello All,

I am exactly in the same position like you were in the past.I had my first attack 8months back and while it was being cured I was asked to take Alluporinol and after that I had back to back 4 attacks and from past 5 months there is no attack. However there is still this swelling and feeling different on this joint without pain and time to time it gets red and more swollen especially when I wear shoes and walk for a while. I am continuing Alluporinol which doctor advised for 2 years. Joint movement and everything seems normal. I believe this can better answered by sufferers rather than doctors. Please kindly help me if you have any suggestions.

Thanks a lot in advance

With best regards
Sujith

[nobody]

Gout Swelling Won’t Go Away

So you’ve had about three months without pain? No loss of joint mobility? Just constant slight swelling? Odd. Certainly not something I’ve experienced so I’m kind of at a loss…
I think you’d better get that foot examined by someone who knows about many different types of joint or foot problems, not just about gout. You didn’t say if you ever got a solid gout diagnosis. And it’s possible a gout attack did some damage and that the problem you have now is related to but separate from gout.
But whatever the cause of your lingering swelling, if you can’t or won’t try rest and possibly physical therapy to help with the healing, I’m guessing infiltrating or injecting a drug that fights inflammation in your foot might help without as many side effects as you’d get from taking a similarly nasty drug in pill form. But I’m no doctor and I’ve not even seen your foot so that’s obviously a really wild guess.
There are gentler things some of us have tried to get rid of lingering symptoms and help to heal along but… three months? I think you’re past home remedies and the like.
Your symptoms might not seem like a big deal right now but it might possibly the early signs of something that could get worse over the years. Best see a qualified professional and catch that kind of thing early.

Now if you want to try to manage your uric acid without drugs…
You already know about drinking water and losing weight. Good.
But it’s a complicated problem. Many things contribute and there are lots you could do. Some things matter more for some people than others. You’ll have to research this for yourself. But here’s a summary:
-if you’re inclined, become a vegetarian and be careful about shrooms and yeast too (that or you’ll have to be very picky about what meats you eat)
-get much of your protein from dairy instead
-quit sugar, don’t drink or eat stuff containing sugar (especially fructose: watch for “corn syrup” in ingredient lists), watch your consumption of sweet fruits and especially their juices as well (cherries are obviously fine)
-quit alcohol
-eat a whole lot of vegetables containing magnesium, potassium and calcium (which would be pretty much all vegetables, but amounts vary)
-avoid both starvation and very taxing exercise as well as fast weight loss
-review any medication you’re taking or planning to take (including herbal medicine, recreational drugs and such) for potential effects on uric acid
If that sounds like too much of a burden, consider simply taking a daily pill instead.

[Clement Wong]

I’m a 35 year old, skinny Asian guy. Was in good shape before a gout attack over about month and a half ago. I had been eating out a lot due to my wife’s absence, and my uric acid level was at 8.4 at the time of the attack. After a strict diet and some herbs, I brought my uric acid level down down to 5 mg/dl, and at a visit to rheumatologist, was told that no further treatment was needed. But I’m still getting redness, swelling and mild pain on occasion. I can be walkable in the morning, and limping at night. Has anyone had similar experience. I’m baffled why symptoms persist even though I hit the target uric acid level.

[nobody]

Hi Clement!
It’s actually not surprising at all that symptoms persist.
However you reduce uric acid, the result is the same: uric acid that had crystallized in the past dissolves and that often causes frequent gout symptoms for a few months and sometimes even longer. People are commonly told to take a medication such as colchicine or an NSAID daily for a couple of months in order to prevent redness, swelling and pain.
It’s not surprising that walking might trigger symptoms either. Some of these crystals are stashed away from your blood and dislodged by walking or exercise. Then they start dissolving and your immune system reacts…

Congratulations on reducing your uric acid so much by the way! You’ll have to monitor that to make sure it doesn’t creep back up.
While 5 is fine in the long run, you might benefit from temporarily lowering it a bit more (for as long as you’re suffering from gout symptoms).

[BigA]

@nobody. 3rd gout attack was by far the worst. After a week or three of pain the swelling and pain went… mostly leaving a residual swell as I’ve described.

Maybe similar to @clement and his residual. Perhaps it’s the remaining crystals that are slowly desolving. Once I reach my target weight(couple to three months I will re asses and perhaps visit a rhematologist if this percists

[nobody]

A rheumatologist would be the appropriate specialist for gout and a number of more or less similar joint problems. When it comes to diagnosing gout or gout-specific therapies like allopurinol, rheumatologists are the most experienced. For foot symptoms though, you needn’t see a rheumatologists.
I don’t know what’s expensive and what’s not in your country but other specialties routinely deal with patients’ foot problems and help with symptoms.

You apparently have significantly higher uric acid than Clement. So I’m not sure you’re dissolving a great many crystals yet.
And I would expect symptoms caused by crystal dissolution not to be so long-lasting and to include redness and pain. But maybe your body works differently…

[d q]

@BigA – I was wondering what your latest update is. I too have swelling and a slightly puffy joint. Basically some inflammation and it’s been about 2 and a half months. I was told to take the colchicine which I haven’t but I was told that permanent damage may have occurred.

@nobody – “And it’s possible a gout attack did some damage”. This is indeed what my new rhumatologist said about my swelling however I am seeing a professor rhumatologist soon to discuss this with him. I also have a few updates for you and Keith in which I will add to the originally started thread 🙂

[BigA]

I don’t know if my measurement was higher then Clemant as the units are different. 0.401 was my measurement 0.400 being the top end of the normal range.

I think perhaps you are right about not dissolving any crystals but I would have thought I’d be in agony still if they had not gone.

I will update in due course. I’m on target with weight loss and have managed to lose 4 pounds since my last post.

[d q]

@BigA – no worries mate. But generally do you still have any minor inflammation present in your affected joint..?

[nobody]

Clement’s value translates into 0.298 in your terms.
The normal range is not the safe range. Lots of men have too much uric acid so if you do have gout, normal isn’t quite good enough.

People who have untreated gout have lots of crystals in their system. Yet on any random day, they are typically not in agony but feel just fine. Crystals can be isolated from the immune system. And sometimes, the immune system simply doesn’t bother making a big deal out of crystals it’s in contact with.

[BigA]

@dq. Looking at my feet now, the effected doesn’t look swollen but some slight redness is visible on the effected foots toe.

Should I perhaps take some ibuprofen daily to reduce the redness further or is that not going to go until my body shifts these remaining residual crystals?

@nobody. I wasn’t aware that many men had high uric acid without knowing. I only hope my weight loss can get me to match Clements acid level. He’s a lucky guy 🙂

[nobody]

Neatly-localized redness can appear as swelling subsides. This type of painless redness stays exactly at the same location once swelling has fully subsided and can persist a long time. So far as I know, it’s due to minor damage caused by inflammation and in my opinion is nothing to be worried about nor should it be treated with ibuprofen. If pain and/or swelling returns however, ibuprofen might be warranted.
But I have obviously not even seen your foot… if you were examined by a professionnal (not necessarily a rheumatologist or even a doctor), they could give you better advice.

[BigA]

@nobody. Thanks for this. It seems as you describe. While it’s not painful it’s not also normal. Perhaps a stiffness and a loss of range of motion in my big toe is a good description.

I went for a 4k walk with the kids and the wife at the weekend and I was fine. was even running with my little boy on his bike. no issues, it just ached more than the other once id got home and put my feet up.

Hopefully small improvements each month.

[d q]

@BigA – this is exactly what I am witnessing with my situation. Every time I go on a ‘not so lengthy walk’ I would get aching feet and would need to put them up. I too can run but again, aching feet when I get back.
I personally haven’t taken any ibuprofen or colchicine for the persisting inflammation despite my rhumatologist telling me to go on colchicine to speed up inflammation recovery. I think if the pain is tolerable I tend to try and avoid medications.

One thing I would like to mention is to maybe avoid stretching the joint too much (if at all) at this stage until you have gone at least 6 months with no attacks -and- with uric acid under control with medication or with diet as stretching joints can sometimes in itself cause a gout flare due to the dislodging of any crystals. Be careful on this one mate.

I too have lost some stretch motion but can still run and walk but I will be avoiding any stretching beyond what I can normally do under normal foot power until I get my uric acid under control again and a good few months have passed.

Just out of interest what are your current uric acid readings?

[nobody]

I’ve spent many years with SUA in Big’s range (something I wouldn’t recommend if you can avoid it!).
Sure, “stretching joints can sometimes in itself cause a gout flare”. I experienced this myself. But from there to wait for 6 months without attacks to deal with limited range of motion? Really?
The first problem with your recommendation is that Big isn’t on ULT and ain’t likely to get rid of their symptoms anytime soon. And I’ve been told leaving a joint in this condition too long might cause irreversible damage (then again I’ve been told my share BS over the years).
Second, stretching is in my experience most dangerous in two cases:
-if the relevant joint is still swollen and painful (even if the pain and swelling are way down)
-if I do weight-bearing stretching
I’ve spent quite a few years dealing with this and haven’t triggered a serious attack by gentle, non-weight-bearing stretching after the inflammation of the relevant joint was gone (or very nearly so). I don’t mean attack-free because other joints may be affected. And by “after”, I mean as quickly as a few days after I was left with mostly painless loss of range (and sometimes redness).
But of course our bodies work differently so everyone has to carry out their own experiments to see what they can and can’t handle…

[d q]

@nobody – Slight misunderstanding, what I am saying is not to wait 6 months before stretching the joint but to have uric acid under control (in the safe zone) and if 6 months pass with no attacks then the majority of crystals should be dissolved allowing a further buffer when attempting stretching exercises. BigA is able to walk and run so why risk it just yet (providing there is intention to lower uric acid in general).

On reversible joint damage, yes keeping joints in the same place for too long may cause this but as stated he is able to walk and run. Secondly if another attack is provoked as a result of stretching he is further increasing chances of joint damage and another load of pain relieving medications.

[nobody]

After several months of inflammation, a loss in the range of motion is also not surprising. If you can run, it can’t be too bad.
You could try regular and gentle stretching exercises to slowly increase the range of motion. Your muscles and tendons might not be up to the task of giving you the full range anymore. It shouldn’t be painful if you do it gently and only force the range to increase slightly as compared to what you can order your foot to do on its own power.

If you do not see gradual improvement, I recommend you see a professional.
I’ve had very long flareups and while they probably do irreversible damage, my range of motion ended up recovering every time. It just took a good while.

[BigA]

No, you’re right. it’s not bad. And only the 3rd time in 6 years. I’m just going by what the other two were like… Id of expected to recover 100%.

I’ll continue with my own therapy and weight loss and go so a specialist also.

[BigA]

@dq My current readings fluctuate between .310 and .450 depending on the time of day. higher in the morning. What are yours? How old are you?

Sounds like your have exactly the same as me. though I did have colchicine to get the swelling down as it wouldn’t go with ibuprofen.

[d q]

@BigA – Yes, I think we have the same issue. I haven’t tried colchicine for various reasons but I’ve been given the green light to try it. What dose of colchicine did you take and for how long?

My readings from 2 weeks ago were 600ummol but I was previously much lower but had to drop allopurinol for various reasons and its risen again. I’ve got another blood test coming up next week which should indicate what the next course of action to take going forward. I’m in my 30’s.. What about you?

[Clement Wong]

@nobody

Update: I’m still having some swelling and redness which tends to occur at night and after physical activity. It turns out my uric acid levels have been fluctuating as well. The second time I test, a couple weeks after the first one, I had 7.5mg/dl, but the rheumatologist didn’t even tell me! I found out only after I called for the result (I thought they would call me if there was something I needed to know.)

I’m wondering if the uric fluctuation is due to different time of day when blood test was taken, or a change in diet. I relaxed my diet restrictions a little bit, ate more meat (chicken and fish) for example, after my first blood test.

[Keith Taylor]

Hi Clement,

Maybe now is a good time to start a new topic dedicated to your gout problem(s). Because I can’t really see what the true problem is.

It seems like your uric acid results are up and down. But we don’t have enough information. Because details are very important when we look at uric acid blood test results.

It would be best to create a list of dates of test results. Also, if you’ve been taking herbal gout medicine, has that been consistent throughout the period?

Another explanation is the 5mg/dL result is just plain wrong. Because not every blood test is accurate. Which is why a good doctor will always take a second test when they see unexpected results.

[nobody]

Hi again,
I used to have similar fluctuations in my test results even though I didn’t go back to meat or vary the time of the day when blood was taken. But maybe you’ll manage to find an explanation for the fluctuations and confirm it if you do more tests.
In the meantime, unless your 7.5 mg/dl test was carried out after a meal or physical exercise, I would take it as a sign that you need to do more to reduce your uric acid. Your body may for instance have been struggling to get rid of dissolving uric acid which is not a situation you want to perpetuate.
Maybe further testing will reveal that test to be an anomaly but you shouldn’t take that for granted. 7.5 mg/dl is simply too high for someone who is still suffering from symptoms. When there is that much uric acid in your blood, it put your recovery on hold and makes your symptoms worse.
Unless you want to keep suffering from gout for several years, you should consider taking a drug which lowers uric acid. You may be able to achieve consistently acceptable levels of uric acid with the help of more herbal medicine, further dietary restrictions, hydration, alkalization, dairy, vitamins, cherries, salt, coffee and so forth but that may require you to be thorough, patient and disciplined. Pharmaceuticals are easier and more reliable. And people such as yourself who do not have very high uric acid need not necessarily keep taking drugs to prevent the symptoms from coming back after the therapy has succeded.

[Clement Wong]

@Nobody, thanks for you advice. Will allopurinol decrease the low level chronic inflammation (not bad enough to use colchicine), assuming that it does manage to lower my uric acid level. The strange thing is that my symptoms were worse previously when I had a much lower uric acid of 5.0 mg/dl (I’m assuming it was not wrong, though I may go back to the same lab to recheck).

I’m reluctant to go with allopurinol because i) more than one person has suggested that I would have to take it for life, ii) I’ve heard that allopurinol can initially lead to attacks, iii) A family friend of my dad’s been taking it but it doesn’t seem to do much for him. He also says you can get attacks even with low uric acid levels.
That said, I’d be interested in anyone who has had positive experiences with it

@ keith: I started taking celery seed the week before my first blood test, and was pretty much consistent. It is supposed to lower uric acid. Some herbal teas for cleaning I’ve been taking was less consistent, but they are supposed to take effect in the long term anyways. I saw an article on taking celery seed that mentioned uric acid level may initially increase as uric crystal dissolves. Not sure if it is true or not.

[d q]

@BigA – I know your question is directed to nobody but I just want to step in and explain since my symptoms are almost identical to yours in the way of inflammation and ongoing pain until today. My rheumatologist described this as an ongoing low grade inflammation and that it may never resolve itself until you take ULT (uric acid lowering therapy) such as Allopurinol or Febuxostat (there are other drug options that work in other ways too). He mentioned that when UA drops low enough all residual pain should settle. I’ve even gone as far as decline that possibility and forcefully tell my rheumatologist I want an MRI to confirm if there is permanent damage done since him starting me on allopurinol or not (I got hit with a savage attack at 300mgs and then during the same attack increased further to 400mgs).

I know you are not keen on taking a tablet a day and believe me neither was I as I have had a bad experience on allopurinol and had to stop it (side effect issue). I will be soon moving to febuxostat but in all honesty, you will never beat gout alone. Your body simply cannot get rid of uric acid quick enough or it over produces the stuff. Diet, homeopathy, supplementations all decrease uric acid but all it takes is for you not to have access to the above (or an allopurinol tablet) for uric acid to rise. If you are border line Good / Safe levels then yes, I would most definitely try homeopathy first otherwise it really is a tough battle mate.

If you are going to take a Colchicine tablet daily to help with your inflammation then it may be best to throw a 100mg allopurinol tablet into the mix and get your uric acid lower. That way you’ll get the best of both worlds.

Always speak to your rheumatologist for dosage guidelines however.

Cheers.

[nobody]

I see I forgot a “not” in my post above which I just edited: you do NOT have very high uric acid. That means that you probably would not require medication for life.

Yes, allopurinol can lead to attacks but that’s not specific to allopurinol. You noticed yourself that your symptoms were worse when your uric acid was lower. However you reduce uric acid, the result is the same: attacks often increase during the next several months. But if uric acid stays low, the attacks eventually stop (if the cause was indeed gout). If your uric acid goes up and down during that phase however, it may take a very long time for the attacks to stop depending on how high is “up” (7.5 mg/dl is too much).
It’s also true that you can get attacks even with very low uric acid levels.
Lowering uric acid helps in the long run, not only by preventing attacks in the following years but also by protecting your body against further damage. Some of the damage done by uric acid is permanent.

Allopurinol is not the only drug you can take to lower uric acid. And as you know there are plants which seem to lower uric acid.
Keith here has had a good experience with allopurinol.
Allopurinol and its main alternative (which is called febuxostat) are both more effective and reliable than most other solutions. But like most effective drugs, they are also dangerous and should only be used with serious medical supervision. Some people should not take these drugs.

[Kenny Wood]

Worst gout flare I have had

Changed everything in my diet and a course of steroids.
How long can a flare up last?

[d q]

Well, if its any consonance and your counting low grade daily pain as a flare up then 9 months and counting. Recently started medication however and am hoping this will soon become a thing of the past.

Anyway, what is your current situation Kenny? Uric Acid levels?
We can then help further from there.

[Anthony Truong]

Red skin on gout area but no pain

Does anyone else have this issue? The skin on top of my right foot on and near the gout area on my big toe gets very red from time to time. I notice that it is extra red when I take off my socks or after wearing house slippers. Is this a minor attack? The affected area does not swell up like a normal gout attack and there is no pain.

I had my first gout attack back in early September 2017 and did not start on UA medication (Uloric 80 mg) until November. My last major attack was back in early December and have not had a major one yet (fingers crossed). My UA level last time I checked in December was 4 mg/dl.

[nobody]

I used to get little patches of skin redness on a regular basis.
If you don’t have much UA in your blood, small deposits which come in direct contact with the blood could melt away before they have a chance to cause swelling and pain.
If your skin redness is gout-related, considering your UA level it should stop occurring before long.

[Keith Taylor]

I just added a summary to the beginning of this topic which I repeat here. Because this topic attracts lots of interest. So I believe you should read relevant facts before adding to our discussions about controlling persistent gout pain.

Gout swelling won’t go away.

See Heat Or Ice For Gout Relief. Because this compares two ways to reduce gout swelling.

Gout pain gone but still swollen.

See 3 Unusual Signs Of Gout. Because this looks at unusual aspects of swollen joints.

How long for gout swelling to go down?

How long does gout flare up last? Because this explains the factors that affect how long for gout swelling to go down.

After reading those facts, you can continue the discussion here. But it is usually best to start your own new gout topic.

[sujith reddy]

Hello All,

I am in the exact situation now where you were in the past. I had my first gout attack in 2020 August and had a strong sequence of attacks for 4 times consecutively. Because I started using Alluporinol after the first attack and I guess that is the reason for following. Anyway I am attck free from then but I still have this affected toe joint very different and often becomes red, hot and swollen without pain after walking with shoe for sometime or even after a long hot shower. Please please help me as most of were exactly in the same situation like I am now. Thank you in Advance.

Greetings,
Sujith

[nobody]

Hi Sujith,
It would be easier to answer your messages outside of this messy thread but here goes…
What type(s) of doctor(s) have seen your foot in its current condition?
Do you know how much uric acid there is in your blood?
How long have you been on your current allopurinol dose?
What other drugs have you been taking, either on a daily basis or in response to the swelling you describe?
Answers to these questions are necessary in order to understand your situation.

[sujith reddy]

Hi Nobody,

Thanks a lot for your reply.

Initially when I was affected my uric acid was 9.0 md/dl. But later controlled it to 4.9mg/dl after 2months with 300mg Alluporinol. I have not stopped the medication but after 2 months it again showed 7.0mg/dl. I am controlling my diet strictly with occasional cheat meals. Now my uric acid level is between 4.2 mg/dl to 5.0 mg/dl from past 2 months. Also the joint movement is normal but I feel it little different kind of numbness.. As long as I am wearing loose foot wear without socks it always feel very normal. But if wear socks and walk inside a warm place like a supermarket or my workplace I will have the joint irritated, swollen, red and hot but almost no pain but limited movement in the joint due to swelling o guess. Also with the warm footwear I was walking in snow last month it felt very normal. So I came to a conclusion that what ever keeps my foot warm like blankets, socks, weather, hot water is irritating and making it bad.. But this is totally surprising and no doctor have answer for this. I have been to the general practitioner then orthopedic and recently to rheumatologist but no success 😔. I have used colchine 0.5mg for a month recently and when I feel little painful I will have etoricoxib 90mg. Also I took 0.5mg steroids for 25days before 3months. At present I am only taking alluporinol 300mg with out any NSAIDs. Every night I drink 1tbsp of baking soda dissolved in 250ml water. Also 1 important point like lot of people suggested I drank apple cider vinegar in the past and I can tell you it is making my situation more worse…

Thank you once again for your willingness to support.

Cheers
Sujith

[nobody]

It sounds like the normal flow of blood is impaired somewhere in your foot. I once had something a bit like this after a flareup, except more localized and much less annoying. It went away on its own, but only after many months.
Did the coxib suppress the strange swelling as well as the pain for a while?

If I understand correctly, you got a 7mg/dl test result about 3 months ago. That and the high initial result suggests there still was solid uric acid in your body recently, and perhaps there still is some. In that case, and considering you already have been to several doctors about this swelling, I would simply recommend patience and regular uric acid tests.
In some cases, solid uric acid has been detected in the body of patients years after starting medication. And the last time I used crutches was more than a year after starting medication. So a few months is not much at all.
As long as you are drinking plenty of water and that the amount of uric acid in your blood remains low (4.2 to 5 is fine), your body should progressively get rid of that old uric acid. As a result, if this swelling is directly caused by gout, it will go away for good. And if it is indirectly caused by gout, there is a good chance the damage will heal in time. Either way, if it was to persist much longer (more than 6 more months) or if it was to worsen substantially, I’d try more doctors such as an angiologist or perhaps another rheuma.

I do not know if it is advisable to take that much baking soda. Discuss this with your doctor if you haven’t already.

[sujith reddy]

Thanks a lot for inputs. After taking Coxib it will not reduce the swelling but the irritation, redness and heat will go away. Sure I can say it is not getting worse indeed very slow improvement but in between having some bad peaks. I will keep you updated and once again thanks a lot for your help. 😊👍

Cheers
Sujith

[Author]

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