Hip Bursitis and Gout

[Danish Gnome]

I was diagnosed with gout about 3 months ago by podiatrist. I had very painful foot joints and achilles tendonitis with osteophyte. Not the infamous red toe presentation. My blood uric acid was 7.5. Been on 100mg allopurinol and uric acid down to 6.0 after 3 weeks. Had physical therapy for Achilles tendon. Also Ionophoresis for heel spur. Just pain free and suddenly developed severe hip pain overnight. Couldn’t bear any weight on leg or lay on that side. Diagnosed as trochanteric bursitis and treated with bursa injection of lidocaine and steroids. No relief after 3 days so returned to orthopedist. Started on Medrol dose pack and have had relief of severity for 3 days. Having MRI tomorrow. Docs not sure if gout caused or another problem with hip muscles/tendons.

Anyone have atypical gout flares like Achilles tendonitis or hip bursitis?

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Will gout cause your hip to break?

[Jean Clyne]

Achilles tendonitis, yes, had it years ago was treated and went away but gradually came back. Went on allopurinol, after 6 mos of that, swelling and soreness in affected tendon gone. I didn’t make the connection till I read the article on here about uric acid deposits occurring in Achilles tendons and patellar tendons (kneecap area ). Go figure, but 6 mos later soreness/swelling is still gone. I often had a hip bursitis irritation but never really bad, just got a shoulder bursitis injected with cortisone plus lidocane, wow what an improvement there. Radiologist said significant arthritis in that joint. I don’t think there is any link to gout there just caused from years of wear and tear. I’m currently waiting for dual energy ct scan on hands and feet to determine presence of uric acid crystals or not. Rheumatologist I finally got sent to doesn’t think it is gout? because I didn’t have massively swollen, red, hot joints like his pictures, it was always more subtle than that. He couldn’t answer why 6 mos on allo. would bring down toe swelling and pain, eliminate the tendonitis, and random finger pains, and why eating red meat especially, and sugar would make symptoms worse .I hope he is right, that it is not gput, but then what, inflammatory arthritis? food allergies causing inflammation

[nobody]

One of the first arthritic symptoms I got was achilles tendonitis. I also had random hip pain a while back. It could have been gouty symptoms or it could have been something else. Hard to tell.
I had a number of big toe episodes as well so the gout diagnosis was more obvious. The most-affected locations in my case have been: toes, ankles, wrists, fingers and knees (in that order). Achilles tendons and hips come way behind.

Gnome, you could ask your doctors about a drug more specific to gout symptoms called colchicine. Whether it works for you or does nothing, that might be one more clue to help with your diagnosis.
Regular anti-inflammatories such as Ibuprofen might also be worth trying. They’re not specific to gout but work pretty well if the dose is sufficient.

[Charles George]

Medrol 1/2 dose for gout attack

I’ve got an attack that is classic rt. Big toe. I just did a quick appt. with MDLive and they prescribed Medrol 4mg dose pak but I’m concerned about having an adverse reaction as I’ve never taken it before. I’m thinking it would be good to do just a half a pill instead of a full pill for each dose.

It’s been a week since my attack started and my pain level has gone down from the 6-7 range to now in the 3-4 range. So, at this point I’m more concerned with an adverse event than I am with fully resolving the attack as it is getting better. Also, it would be good to know if I can tolerate it well in case I have any future attacks.

Any thoughts on this hopefully safer approach?

[[email protected]]

Have you had an attack before, or is this the first? I know absolutely nothing about steroids, but…

Colchicine has worked wonders for me for treating an acute attack, it seems to cut straight to the source for me luckily, and with no side effects other than some minor stomach rumbling and a little mental fog. I usually take 2 – 0.6mg pills at first sign it’s a true attack, another a few hours later, and then one a day for the next couple of days. I’ve also backed it up with 500mg Naproxen for serious pain. I feel relief within hours, and my attacks (pain and swelling) have abated fully within 2-3 days, with maybe some residual ache for a few more days.

I’ve used it at a lower rate for some of my more serious flares (gauged by if the flare is serious enough to cause a limp), one or two pills the first day, and again one a day for the next couple of days. I don’t think I’ve ever used it for more than four consecutive days. I plan on never having anything less than ten doses on hand at any given time, probably for the rest of my life.

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Also now being familiar with the Gout Pain Scale, I’d say I never take colchicine for pain levels under 5. Pain levels 5-6 I do a “flare” dosage, 7+ and aggressive “attack” dosage.

[Charles George]

I had 2 attacks a month apart 2 yrs. ago and then did natural remedies & lifestyle changes–but I got out of my good habits over the past 6 months or so. I’m not on allo so I’ll have to see if natural remedies & lifestyle changes will work or if I’ll have to go on allo. Are you on Allo?

Is there an official Gout Pain Scale?

Just to summarize, is this your protocol?:
* Pain levels under 5: No colchicine, but monitor to see if true attack.
* Pain levels 5-6–“flare” dosage: 2 – 60mg pills at first sign it’s a true attack, another a few hours later, and then one a day for the next couple of days.
* Pain level 7+–aggressive “attack” dosage.: Same as 5-6 but also take 500mg Naproxen

[nobody]

I would personally take colchicine or naproxen before pain gets to 5.
But these numbers are of course subjective. And everyone reacts differently to the drugs. It’s useful to read about what other people are doing because it gives you ideas you can try out. But you’ll have to come to your own conclusions.

This warning is probaly pointless but 60mg colchine may very well be a deadly dose. You’re not supposed to take much more than 1mg at once or more than a few mgs over the course of a day. The pills are usually 0.6mg, 1mg, or 0.5mg so I don’t think anyone would accidentally take 60mg but I’d rather clear this up just in case…

As to your original question, yes: trying smaller doses first generally makes a lot of sense when there is no emergency. There are exceptions like antibiotics but I’m not aware of a reason to avoid non-standard steroid doses. But steroids are something I know very little about. I don’t think there’s any forum regular who has much experience with this class of drugs unfortunately.

[[email protected]]

Oh crap, you are right! I edited my original post so no one gets confused by my mistake, they are indeed 0.6mg capsules. Sorry!

And just to be clear, I take two 0.6mg at first sign and attack is going to be bad, and a third 2-3 hours later. So three doses in the first 24 hours, which totals 1.8mg. That initial high dose in the first 24 hours was prescribed to me to really knock back a serious attack, and it’s worked every time so far. The other two examples I made are kind of self regulated.

Any flares I’ve had that have topped out at 4 on the scale haven’t lasted more than a couple of days, and have been well within my range of tolerance. At that level, I focus diligently for any increase in pain or swelling beyond, and that’s where I pop a pill or two.

[Author]

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