Gout pain relief – will allopurinol help?

[John Kelly]

Had my first ever gout attack exactly 5 weeks ago. Incredibly painful. After 2 days of it I went to the doctor and was given a prescription for allopurinol. Took 100 mg of allopurinol for 1 week, then 200mg for 1 week, then 300 mg for 1 week (and I continue now with the daily 300mg dose). After the 3rd week was complete I did some blood work and my uric acid went from 7.4 mg/dL to 3.7 mg/dL. I also ended up with a second flare which has since subsided….BUT, I am 5 weeks into this and I still can’t walk without limping or wincing while putting a shoe on and the joint of my big toe appears to have been pushed out of the side of my foot and the joint feels larger than a golf ball. I feel like I now have a permanent disability and it is horrible. When will this go away???? Even though the uric acid is down, is the joint still packed with crystals? If so, when the hell will they be on their way? Should I up the dose of allopurinol?

---

How long for gout pain to go away?

[Mary Trey]

Last week I experienced severe pain & swelling in my hand. It started in my knuckles. It became so bad that I called my rheumatologist hoping he could give me a shot. I only live 15 min. from his office. I was told that he was booked up & couldn’t see me. My only resort was the ER. I thought for sure I could get a shot there, but they didn’t do it. I found out later that the ER won’t give shots in joints affected by Gout. Is this true?

[nobody]

So far as I know it’s not a common procedure so I wouldn’t be surprised if most ER doctors were unqualified. Gout is also a chronic condition and so not something an ER is supposed to deal with if it can be avoided.
I’m sure they would rather give you pills and get you out of the ER quickly. Have you exhausted the common pharmaceutical options by the way?

Can your rheumatologist’s office recommend another specialist?
Anyone who does joint fluid aspiration ought to be able to give you an injection as well. Maybe your rheumatologist does that themselves. But mine would rather refer you to a skilled hand who is setup to handle emergencies.

[Keith Taylor]

Even though the uric acid is down, is the joint still packed with crystals?
Unfortunately, yes.

If so, when the hell will they be on their way?
It depends on how long you had excess uric acid for and how high the excess was. Also, it depends on how low you get uric acid now.

So, you can only influence the third aspect. So my default setting is to increase allopurinol to the maximum dose allowed by your doctor. But it is absolutely essential to monitor kidney function and liver function during this process. Because increasing your allopurinol dose without those vital tests is like jumping out of the window without checking which floor you’re on.

Finally, I’d comment that from years of discussing this I get a feeling that it takes around one month to recover from gout for every year that you had it. As long as you get uric acid below 6mg/dL. So, John, your uric acid test results are well below the average gout patient and you might manage one month for every 18-24 months that you’ve had gout. But if you want to recover quicker from gout, go lower with uric acid.

Finally, going back to the title of your topic “gout pain relief” you will need to consider your pain relief options until most old uric acid crystals have resolved. So, first consider if you want preventative or as required gout pain treatment. Then we can come up with some options that you can discuss with your doctor.

[nobody]

Allopurinol is the only drug you mention, John. But it’s not the only drug you should be taking.
People normally take colchicine and/or common anti-inflammatory drugs during the first months of allopurinol treatmeant. There are lots of drugs which can bring inflammation down but allopurinol isn’t one of them. Maybe there’s a reason for you not to take any other drug (all drugs are dangerous) so that’s something to discuss with your doctor. Your doctor will also be able to make sure nothing is wrong with your foot other than gout (it’s unlikely but you never know). If your doctor isn’t helping, maybe see another one?
You can also take actual painkillers but the way you describe your foot, your priority ought to be to bring that inflammation down.

@Keith: the data from the studies you referenced so far doesn’t show that there’s much if any benefit in lowering the amount uric acid in the blood more than John Kelly already has. On the contrary, it suggests diminshing returns.

[Author]

Posts