Lingering pain & weakness 6 weeks after gout flare

[GoutPal Seeker]

The purpose of this topic is to help you get the right information about lingering gout pain from your doctor. Because it covers several related matters that help you learn what questions to ask your doctor about gout pain duration. Then you can understand why your gout is lasting so long. So I urge you to read this topic carefully. But I think you should first read some related facts about gout so that you understand the things we discuss here. However, if you prefer to read the discussion first, I will repeat these links at the end of the topic.

Lingering pain after gout.

See Lingering Pain After Gout because this explains why you get a gout flare that seems to last forever. Then it tells you what you need to do to avoid residual pain after gout attacks.

Gout attack lasting weeks.

See How Long Does a Gout Attack Last because this explains various factors that affect gout flare duration.

Why is my gout lasting so long?

See How Long Does Gout Last? It’s Your Call because guides you to consider what you really mean when you ask “Why is my gout lasting so long?” Then it helps you recover from gout as fast as possible.

The original topic and responses continue below…

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TL;DR: Had a major gout flair in my right knee. Still having lingering pain/stiffness/weakness about 6 weeks later.

The longer version:

I was first diagnosed with gout in my right big toe about 10 years ago. After a treatment with indomethacin, the pain went away and I’ve been symptom-free since then, even though I’ve consistently had high Uric Acid readings (ranging from 8.5-10.7, depending on when the test took place).

That all ended in mid-September. I had some stiffness in my right knee one day. No pain, just some arthritic stiffness that went away when I would move around. The next day I had some pain, weakness, and limited range of motion. The third day I could barely move my knee without major pain, so I finally went to the Dr. There was no pain to the touch, no redness or warmth, just major pain when I moved my knee beyond a very limited range. So I didn’t think “gout” and was just treating it with 800mg ibuprofen 3x/day. The urgent care Dr didn’t think gout either and sent me for x-rays to see if there was any damage. No damage, but there was some fluid so she sent me to see an orthopedist a few days later. I had no improvement in the meantime. The orthopedist aspirated the fluid and gave me a cortisone injection. That helped some. A day or two later he called and said there were crystals in the fluid and I had gout. By that point, I was about 90% better so they didn’t recommend any additional treatment beyond the ibuprofen.

That’s about where I’ve plateaued. I still have stiffness/weakness/pain, especially if I’ve been sitting for a while. And my range of motion in my knee isn’t 100%, more like 90% on a good day and 75% on a bad day. I saw my PCP last week and he said that there can sometimes be some lingering arthritic symptoms after a gout flare. He wants me to wait a while longer to see if I get better on my own before looking to see if there is any undiagnosed structural damage that could have started all of this.

Have any of you had any experience with lingering pain/stiffness/weakness following a major gout flair? This didn’t happen when I had it in my big toe 10 years ago.

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How long does your gout attack linger?

[Keith Taylor]

Hi, Chris

TL;DR Lingering pain, stiffness, and weakness, is common after a gout flare. This situation worsens as the uric acid burden grows.

So, “What’s the uric acid burden?”, I hear you ask.

Every day that uric acid is above the crystallization point, uric acid crystals form in our bodies. Our immune system engulfs uric acid crystal when it sees them. This prevents further inflammatory response. It hides the problem, but our bodies cannot cope indefinitely, with excess uric acid. Gout flares occur when the immune system gets overwhelmed.

As you’ve experienced, Chris, the uric acid burden can grow over several years, without experiencing a gout flare. Eventually, the burden starts to produce low levels of discomfort, even when there is no acute gout flare. Also, the battle of uric acid crystals depresses the natural repair of joint tissues. So, joints become weaker as time passes.

The crystallization point of uric acid is measured in the lab at usual human core body temperature as 6.8mg/dL. But, our joints are cooler than our core. So, uric acid crystals form at lower than 6.8. Anyway, your levels are much higher, Chris. Extensive, your burden is.

Medics have a policy of not prescribing uric acid lowering until you get 2 gout flares in a year. That’s going to happen to you very soon, Chris.

If you’ve been following my recent posts, you will see that I’m obsessed with Gout Groups. They make it easy for me to focus my help. And they also help me to ask the right questions at the right time. So, my question is, where do you want to go next? Questions for Gout Sufferers has the choices.

You can ignore high uric acid, and join the Gout Victim Group. Or, you can start to consider the best uric acid lowering treatment for you, in the Gout Recce Group. You might even know which type of treatment you want and move straight to one of the treatment groups.

What next, Chris?

[GoutPal Seeker]

Thanks for the reply. I’m definitely not interested in ignoring my high uric acid any longer. The earlier attack in my toe was more acutely painful but this knee attack was far more debilitating. I’d like to do what I can to reduce the risk of having it come back, and also to get my knee as close to 100% again as possible.

Everything I’ve read about treatment to lower Uric acid says that you shouldn’t start while in a flare. Is the lingering pain and weakness considered still an active flare or would it be safe to start treatment now? What have you seen to be effective in dealing with the pain and stiffness while working on lowering Uric acid levels? I’d of course talk about these with my doctor prior to starting treatment but I like to be an informed consumer of health care and would like to have some options already in mind when I meet with him.

I’m in the US if that makes a difference in the available treatment options.

[Keith Taylor]

I understand why people suggest waiting until gout flare has gone before starting treatment. I know why I would not wait ( http://www.goutpal.com/4853/start-allopurinol-quickly-but-carefully/ ). What really matters is the view of your mentor.

I believe all gout sufferers need a mentor, who will support them during the planning and therapy stages of uric acid lowering. I can improve my explanation of the importance of mentoring. But, for now, my best effort is my first Gout Mentor article. I believe your gout mentor should be your doctor. But, I’m happy to share that role.

Leaving aside the question of starting allopurinol now, or waiting a week or 3, let’s focus on what is more important.

To successfully manage uric acid lowering, I believe you have to be confident with your gout pain therapy. This is because most gout sufferers will experience gout flares, until allopurinol has worked it’s magic. That is why early start of allopurinol works in the study I mentioned. Because, gout patients who take preventative pain relief can start allopurinol without problem. It is logically and practically correct. But, it won’t work if your mentor doesn’t understand it.

In theory, this is simple logic based on established medical facts. In practice, gaps in knowledge cause problems. That’s why I offer diaries for personal gout facts. And structured help for personal gout therapies. My services should support doctor’s medical history, and doctor’s scheduled consultations. Ideally, you don’t need my help. Especially if, your doctor provides the right treatment, with the right pre-treatment guidance and support.

Pain control should address:
1. Limiting inflammation spread
2. Reducing inflammation
3. Blocking residual pain.
Country mainly affects the first of those 3. Limiting inflammation is usually a job for colchicine. I’m not getting any feedback on the latest situation on the Colcrys price problem. Officially, cheaper generic colchicine should now be available. Anyway, I’m visiting the States in January 2017. So, I can check it out for myself.

Sorry, Chris, this has got a bit long-winded. Detailed timing and dosing must be personal. Also, there are individual choices about specific meds. A general guide for effective gout pain control during urate debulking is:
1) 1 preventative colchicine at bedtime for 2 to 6 months. Additional 1 colchicine in morning, as required if gout symptoms justify.
2) As required, gout strength ibuprofen, naproxen or other NSAID.
3) As required, gout strength acetaminophen/paracetamol between NSAID doses.

I hope it goes without saying that this must be doctor/pharmacist approved. It’s a starting point for discussion. Some doctors advocate steroids for gout pain control. To me, that’s a last resort.

As with all things gouty, there are alternative points of view. So long as the final choice suits the patient best, we cannot ask for more.

[William Phelps]

Occasional Gout Keeps Returning

Hello
I’ve just had a recurrence of Gout that was quite painful cleared up after taking Anti Inflammatory (diclofenac ) for a week, my uric acid was 6.6 on my last medical March 2016

Is it best to take allopurinol as a precaution or just accept the occasional bout?

William

[Keith Taylor]

Hi William,

It’s not for me to say what’s best for you. There are arguments for starting uric acid lowering treatment as soon as possible. And, there are arguments against.

Common arguments against medical uric acid lowering treatments are risks of side-effects. Many gout sufferers claim they would rather change their lifestyle to try and lower uric acid. From what I’ve seen, very few people make a real commitment to this. So, they end up as Gout Victims.

Personally, I’m a great believer in allopurinol as an effective treatment for gout. However, there are lots of other choices. My main role is to help you identify what choices you have. Then, when you understand your options, I want to help you manage your gout in the way that is best for you.

Above all, realize that gout is a progressive dangerous disease. There is no such thing as “occasional gout”. However, you can suffer occasional gout attacks. In between those attacks, you suffer what the medics call inter-critical gout. During inter-critical gout, excess uric acid continues to damage you. I mentioned gout is progressive. The progression is:

1. Gout attacks become more intense, more widespread, and more frequent.
2. Bones, tendons, and other joint tissues become permanently damaged.
3. Uric acid deposits (tophi) spread to soft tissues. Skin, kidneys and heart are commonly damaged. But, all organs are at risk, except the brain.

[Patrick]

Is it best to take allopurinol as a precaution or just accept the occasional bout?

William, personally I don’t take Allopurinol as a precaution. I take Colchicine as a precaution. Allopurinol is prescribed for one reason only…..to reduce Uric Acid in your body. That’s not a precaution, that’s a cure. Colchicine, on the other hand, can be taken as a precaution because it helps with inflammation, which comes as a side effect/result of excess Uric Acid. See the difference?

I will give my PERSONAL opinion. Do NOT accept the occasional bout. If your bouts are anything like mine, then can be debilitating. Living with pain is not a way to go through life. For me, I’m lucky. I don’t expereince the side effects of Allopurinol that some people do. I’ve taken it for almost a full year now and it has worked wonders for me. My Uric Acid went from a high of 9.6 to 4.7. I occasionally get a minor flare, but with the knowledge I have obtained here and other places, I know exactly what to do to combat it and I can easily kill the flare in a day.

Gout and Uric Acid can long term health problems to your joints. Do yourself a favor and live pain free. For me (again, personally) I’d rather risk the very minor side effects of Allopurinol than spend one day in Gout pain.

[Chetan]

Can’t bear weight on foot after 2 weeks gout

Hello,

Thanks for creating this forum, i hope this is active and i will get response to my post. Here is my story, One night i felt i had bad dream and twisted my foot in dream, woke up in night with pain in foot (Area before small finger on foot). pain was not deadly, morning i went to office with bit pain in right foot, later evening went to super stores with bit pain in foot. thought its normal and will get better. but later that night i coudnt sleep due to swelling in foot and even i couldnt bear weight of blanket. got fever due to pain and took ibrpofene. Next day saw doctor and did blood test, doc said uric level is 9.2 and i have gout and he put me on indomethacin (3 times) for two days,
Its two week since than still i am using crutches to walk and couldnt bear weight on my right foot. I am not taking indomethacin or any Med. i am not sure if this is gout! did Doc wrongly declared it as Gout. how long it takes for me to start walking normal again.
I am Vegetarian , No alcohol, No meat, No fish, No family history of Gout.

Thanks,
Chetan

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[Keith Taylor]

Hi Chetan,

You posted via my old gout forum. The GoutPal Helpdesk team posted your message here. They’ll be in touch with you about how you can post here yourself.

You definitely have gout. Your first gout attack can be extremely worrying. I’m here to share your worries. A gout attack needs much more than “indomethacin (3 times) for two days”.

Gout Pain Control
Indomethacin is a good component of a gout pain therapy combination. But it only works by itself for mild gout flares.

Normally, I suggest colchicine as the first part of the combination. But, you are probably too late for this. Discuss it with your doctor, if you have to see him again about your gout.

Indomethacin for severe gout pain should be maximum strength. You can take indomethacin, ibuprofen, or any NSAID (Non-Steroidal Anti-Inflammatory Drug). But, never mix them. Usually gout attacks resolve in 3 to 5 days. 7 days is not unusual. Prescription strength anti-inflammatories should help you get mobile quicker. In my experience, gout pain resolves quicker if you stay active, with gentle exercise.

With severe gout attacks, you can get residual pain, even with maximum strength NSAIDs. If you have residual pain 2 hours after an NSAID dose, you should consider support from a compatible drug that blocks pain. Usually, this is acetaminophen/paracetamol. But, you must ask your doctor what is suitable for you. Be sure to tell them about all medicines you take (including herbal medicines). You want a compatible pain killer at maximum strength, which is safe in combination with other meds.

If you are not sure about your best way to control gout pain, please ask for clarification.

Vegetarian Gout
Vegetarians, statistically, have the lowest risk of gout. But, you can still get gout. Because, your body turns the plants that you eat into meat (your flesh). That’s where most uric acid comes from. If your body cannot deal with uric acid, you get gout.

If you have an unhealthy vegetarian diet, you might be able to improve it. But, it’s most likely that you will need uric acid lowering medicine. How do you feel about that?

[geoffz (old forum)]

Why does gout swelling in my ankle linger like this?

I had my worst gout attack ever, 2 weeks ago now. It focused around my ankle bones on my left foot. It was so bad I did not sleep for a couple days and I had to see the doc to get a pain shot.

Anyway, a week plus later I can walk pretty normal but the subtle swelling around both ankle bones just lingers. I’m wondering if that is swelling from lingering gout or inflammation from damaged tissue around the ankle? I can’t seem to get past this “last phase”.

Any advice?

[gout bruise (old forum)]

I have had a gout attack on the same spot.

Just got my 2 days of treatment down, a lot better but spot below ankle is still tender, sort of like a bruised feeling.

[zip2play (old forum)]

An acute attack of gout is an overwhelming insult the joint and some residual swelling might not be unexpected as your body tries to deal with the last remnants of uric acid. For persistent sufferers, the condition never fully resolves and that is often referred to a “chronic gout.”

As long as there’s no pain, there’s not much point to analgesics. To relieve the swelling faster, try to sleep with your leg raised…same for Telly watching or reading.

[Jane (old forum)]

My husband’s latest gout attack seems to be lasting for over two months. He is still in great pain.

Has anyone else had one that has lasted for so long? Or is this a sign that something else is at the bottom of the pain and swelling?

[zip2play (old forum)]

Jane,

What is your husband doing for the attack? Colchicine, Indocin? Has he had gout for a long time, long enough for it to have gotten “chronic?”

My longest attack was 9 days before I started the colchicine…cure took 22 hours.

[gout bruise (old forum)]

I too was surprised how long the attacks can go on and then the pain linger with only a few good days between attacks. For me, it has been 5 months now. I hate myself my tolerance level has become so low and my family is suffering for it.

I have a few good days once in awhile. But, for the most part, I am miserable and in so much pain. As the days go on my Right Big toe swells more and more as does the severity of the pain.

Colchicine does not seem to help and neither do the NSAIDs.

I am on Allopurinol 200 mg. and drink plenty of water.

5 months ago, before the Allopurinol, my serum uric acid was 8.5

One month ago it was 6.5 yet attacks continue.

I search every information I can find as the Dr. wait is always at least 2 months.

6 weeks ago he referred me to a Rheumatologist and that appointment is not until mid-September.

[Keith Taylor]

At 6.5, you are just on the cusp of uric acid control. Because I believe what is happening is that you are moving constantly around the point where urate crystals form (around 6.8). So as soon as the crystals start to dissolve, the uric acid rises again, and new ones might form. For more information, use the search box near the top of each page to Google “Gout Hell”.

Ask your doctor to approve 300mg, to get your level down more. Please don’t give up on the allopurinol, as it is your best chance of controlling the gout.

You will still get some attacks for a few months, but they will reduce in intensity and frequency. Colchicine should help. How much do you take?

[cjeezy (old forum)]

Lingering gout symptom question

Like many, mine started with the pulsating burning, throbbing feeling in the bunion area.

Over the past weeks, the pain has subsided and that area is basically healed. The odd thing is that now the lingering pain is different spots that are NOT joints.

First I now have pain in between the 2 tendons that stretch across the top of my foot (big toe and 2nd toe tendons). 2nd, I have slight pain on the pad of my foot (under neath the ball joint of the big toe).

Is all this normal with gout? I thought it was a joint disorder.

[cjeezy (old forum)]

Looks like I spoke too soon! Woke up this morning and my bunion area is VERY sore again. What the hell?!?! This is starting to get really annoying.

Do most people have lingering symptoms all the time. Or do you completely heal eventually?

It’s now been almost 5 weeks. I go back to the Dr next week to have UA levels tested, but how can one ever even consider starting Allopurinol if you can’t ever get over the damn attacks, to begin with? What else can I do to get through this? I’ve watched my diet, I drink at least 3 liters of water/juice a day, cut out beer entirely, I take celery seed and cherry pills.

I stopped taking Indocin (switched to Ibuprofen)because it was hurting my stomach and making me depressed. But I started it back up again today (gonna call Dr and see if there is an alternative).

Any words of encouragement? Will I ever completely heal?

[cjeezy (old forum)]

Thanks Zip. I’ll post an update later today. Do most people eventually get back to normal or is there typically some sort of lingering pain at all times for gout sufferers. I guess what I’m getting at is is this pain something I’ll have to accept and live with daily?

[zip2play (old forum)]

Colchicine!

[cjeezy (old forum)]

I called my Dr this morning and explained that I had an appointment next week but wanted to see if they could call me in some Colchicine and renew my pain meds. She said that they would probably not do that unless I came in for a visit. I explained to her that the Indo was hurting my stomach and making me depressed…and didn’t work that well anyway. I also told her that I could not wait until next week to come in and I needed something now before I have a full blown attack again. She took my number down and said they would call me back.

[zip2play (old forum)]

Good luck,

cjeezy

(Indomethacin makes me dizzy)

[Tavery (old forum)]

It’s funny to read your posts because they are nearly carbon copies of my own posts over the last few months. I was at this stage a couple months ago and asking the same question.

Yes, it will get better. I had lingering soreness for quite a while also and it will eventually fade.

For general soreness, I would stick with Ibuprofen and only go back to Indo if the pain became problematic. In general, if you continue on a path similar to mine, it will go something like this.

• Soreness around bunion, by the end of the day you are ready to put your feet up. Wife gets mad the grass isn’t getting mowed and the dog crap needs to be picked up.
• Soreness fades after three days or so, but the area is still sensitive to the touch (i.e. it hurts if you push on the bunion area) This lasts a couple weeks and you spend a lot of time in loose fitting shoes or soft slippers. You mow the lawn, but by the early evening, you are looking for excuses to park your butt on the couch in the evening. Folding laundry became a personal favorite.
• Twinge! You wake up one morning and feel something not quite right but it’s not debilitating either. You pop some drugs and up your water intake. It goes away by the next day.
• You slide back into your old routine a bit and after a few weeks you wake up with that familiar pain of a flare-up, except this time it’s maybe half as bad as your original. You hobble and whine a lot and the wife reaches deep into her well of patience to keep from killing you.
• You hobble to the computer and spend the $150 to order a home test kit from Britain.
• Drugs, water and a week later you are back to something resembling normal. Just in time to get your new home test kit. Number fascination ensues. You spend a lot of time thinking about how to best poke your finger so you get a great blood sample.
• You spend a month or two being attack free and you think that with the diet changes, a bit more exercise and self-monitoring you got this gout stuff licked.
• One morning you wake up to yet another twinge and you analyze everything you have eaten/drank for the past week and can’t find a solid reason for a gout flare-up. Now you are in pain AND pissed.
• Tired of laying awake and thinking about your own mortality and tired of trying to fight it, you then go back to the doctor and request 100mg of Allopurinol and set a date three months hence for another review.
• You are on a pill every day for the rest of your life, but you sleep better. You make a few changes to your lifestyle anyway because you know it’s the right thing to do.

😎

[cjeezy (old forum)]

LOL! Your post is funny! and somewhat true..except I’m not married yet and I already spent the damn $150 bucks for the home kit (should receive it next week).

This stuff is really starting to tick me off but I appreciate your confidence that it will eventually go away (temporarily of course). 5 weeks of this crap and it’s still not gone? wtf? I know I’ll eventually need to take a Rx every day, but I think what I’ll probably do first is try and get through this attack completely (If that ever even happens!) and do the moderation thing for a while…just to see how long it takes for another attack to happen…UNLESS My UA levels are very high. Then I’ll start the pill sooner.

I’m not going to obsess about triggers either. If I get another attack in the next year then I’m going to ask my Dr to start me on 100mg of Allopurinol to see if a minimal dosage can help lower UA levels below 6.5.

Question about the home kit, if I’m on a Rx, is the home kit and accurate way to check my UA levels and the success of the drug? Or do I need to go back to the Dr every couple weeks?

[zip2play (old forum)]

Once you have had an attack, a serum uric acid of 6.5 is NOT low enough to avoid others. It may be fine for some one with NO uric acid crystals, but once you have had your first attack you will NEVER reach the point of no uric acid crystals and thus you cannot have supersaturation.

Control below 6.0 is minimum treatment and control below 5.0 is optimal. Do not settle for 6.5.

I described my 9 days of MURDER TOE and my 22 colchicine ad nauseum. I immediately began 300 mg. allopurinol and took my UA down to 4.7 by the next week. When the pain ended abruptly on colchicine, there was no lingering soreness at all in my toe…not for a single day.

Yes, I get twinges years after if I am walking all day in the Summer sun, but never an attack or what I would call gout-related pain. I don’t doubt that the gout attack DID some damage to my bunion joint permanently and it will never be perfect but that is different from a gout attack.

So there are two different scenarios for gout attack aftermath: with allopurinol and without.

[cjeezy (old forum)]

Rightfully said. Ok, less than 5 will be my goal. I’m curious what my Dr will tell me.

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Before you continue to discuss lingering gout you should read these relevant facts:

Lingering pain after gout.

See Lingering Pain After Gout because this explains why you get a gout flare that seems to last forever. Then it tells you what you need to do to avoid residual pain after gout attacks.

Gout attack lasting weeks.

See How Long Does a Gout Attack Last because this explains various factors that affect gout flare duration.

Why is my gout lasting so long?

See How Long Does Gout Last? It’s Your Call because guides you to consider what you really mean when you ask “Why is my gout lasting so long?” Then it helps you recover from gout as fast as possible.

[Hasan Mahmud]

Suffering from GoutPain for more than 6 years

Hi,
I’m new here. I’ve been suffering from gout pain for more than 5 years. It attacks on the joint of my big toe of my left leg. I can’t even put on shoes comfortably. I visited doctors several times before. They just advised not to take meat. Recently I have visited a doctor, who prescribed faboxtat 40. Now I’m on this medicine. I have been taking this for about one month. But the pain is not improving so much. I’ve got my uric acid test which is 398.

Now can you help me to get out of this.

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Gouty swelling in left toe even after gout pain has gone

[nobody]

Hi!

The test result you mentionned is too high. Was your blood drawn after one month on febuxostat?
If so, you have the choice between testing again to make sure (results can vary quite a bit) or increasing your dose without further delay. I think you could try one pill and a half (60 mg) per day. You’ll have to get tested again after a few weeks on the new dose to see if it works. You want your test results to read 350 or lower.
It’s also important you get tested for side effects and liver function in particular whenever you increase the dose and of course after starting the drug. Febuxostat is not an innocuous drug and serious side effects are fairly common.

It takes more than one month for febuxostat to work anyway. If you have as you suspect been suffering from gout for many years, it could easily take the better part of a year to eliminate gout pain.
You can however reduce gout pain and make it last shorter by bringing your uric acid tests under 300. You may even get extra benefits from bringing them under 250 though nowhere (to my knowledge) is that officially recommended.

While febuxostat greatly reduces the formation of uric acid in your body, it doesn’t destroy the uric acid which you are already burdened with. So while your body is slowly getting rid of the stuff, I recommend drinking plenty of water, regularly consuming milk or milk-based products if you tolderate that, abstaining from animal flesh (you can eat eggs instead to get a similar nutritional value) as well as alcohol and making sure you have drugs which suppress gout symptoms on hand. Some people even take a colchicine pill every day during the first months after starting febuxostat.

[Hasan Mahmud]

Thank you very much.

The blood was taken before starting febuxostat. Seeing the test report, the doctor prescribed me the above drug.

I will definitely follow your food plan. However, would you please tell me, as you said febuxostat doesn’t destroy the uric acid which are already burdened, how can I destroy it?

[nobody]

If you tested at 398 before starting the drug, you shouldn’t increase your dose! You should instead get a new test.
But in all likelyhood, you are already taking more than strictly necessary which means you are on the right track (assuming that gout is indeed what causes this pain).
That also means that there’s probably not much sense in avoiding meat in your situation. You need to verify my guess with blood tests but, assuming you weren’t taking another drug which also lowers uric acid when you had your blood drawn, I think that 40 mg is strong enough for someone who used to test at 398 that eating meat won’t matter much. Consuming milk and avoiding alcohol for a few months on the other hand, that should help even if you are taking a stronger dose than necessary.

The idea behind the febuxostat therapy is that reducing the amount of new uric acid created in your body will lower the average amount of uric acid in your blood. This can be verified with blood tests.
Then, since the amount in the blood is depleted, the troublesome stores of uric acid in places like the big toe joint will slowly dissolve in the blood.
Finally, the uric acid in the blood will end up in the toilet, same as always. Except that instead of mostly getting rid of newly created uric acid, you will be getting rid of a lot of old uric acid as well.
It should all happen naturally once the creation of new uric acid is reduced thanks to febuxostat. Only you need to give it time. You can help the process along by drinking lots of water (within reason: don’t torture yourself!) and making sure the places where uric acid is stored (like the joints in your feet) remain fairly warm (you for instance want to avoid clothing or chairs which would prevent blood from flowing easily to and from your feet).

[Hasan Mahmud]

I understood. You are really helpful. Thank you a lot. I will get a new test and will let you know the result. One thing, should I stop taking medicine before getting blood test?

[nobody]

You shouldn’t stop the medicine because the point of the test is to observe the effect of the drug.
In addition to measuring the amount of uric acid in your blood, it is very important in your situation to get standard liver function tests. The drug is known to affect the liver. People usually tolerate 40 mg daily but that dose was too strong for my liver. There are a few other routine tests like kidney function that are worth doing to make sure your body tolerates the drug well.

[Hasan Mahmud]

Would you please name the test of kidney? What are the other tests? If you tell me the name I will do the test.
Thank you again.

[nobody]

The standard blood test for kidney function measures creatinine. You will probably need the help of a doctor to interpret the result. And a doctor who knows you well will know what other tests might be appropriate in your situation.
But everyone should get standard liver function tests. There are a few of these and you might as well get them all but the most useful in order to observe the effect of febuxostat are called ALT and AST. If you have no other illness which is affecting these values, they are a bit easier to interpret than the kidney test but it would still be best if you had access to older test results for comparison. There is also a test called bilirubin which is not standard everywhere and may be relevant as well but I don’t think there’s much point in insisting on it as long as your ALT and AST values are OK.
Long story short, best arrange the blood test with a doctor! Febuxostat is not such a common drug so doctors can not be expected to know all about it, but any doctor surely is familiar with standard blood tests so you can simply ask for liver function tests and they’ll know what to do.

[Hasan Mahmud]

Ohh.. Creatinine. I did this test before taking drug. The test result was good. 71 umol/L. Besides this I also did Hemogram/CBC and glucose test. All test results were good according to the doctor. Should I need to test ALT and AST?

[nobody]

Yes, I think everyone should get ALT and AST tested at least once after starting febuxostat.
The liver is of course a vital organ and it’s common enough for febuxostat to cause liver problems that preventing damage is well worth the cost of testing. Liver stress isn’t painful so it can get quite bad before you notice it. This is why people are told to be very careful with common painkillers using paracetamol: excessive doses or prolonged use can cause liver damage and by the time people realize they are getting seriously ill, sometimes it’s too late to save them.

[Hasan Mahmud]

You are really great. I didn’t expect such a cordial response from here. Really this site is awesome. I am quite happy with you.

[nobody]

Give a little money to a beggar or a charity on my behalf and we’ll call it even. 🙂

[Hasan Mahmud]

Okay. I will do that.

[Hasan Mahmud]

Hi,

According to your advise I have done the following tests, whose results are as below;

June 20, 2018
Creatinine 66.70
Uric Acid 207
ALT (SGPT) 30.70
AST (SGOT) 26.90

My previous test result was as below:

May 2, 2018
Creatinine 71.00
Uric Acid 398.90
Glucose 3.97

During this period I took febuxostat. But I wonder despite the improvement in uric acid level, my pain is not improving. Sometimes, it seems to me that the pain is rather increasing. Is it like that the pain will be relieved gradually?

Would you please advise what should I do?

[nobody]

Assuming we use the same units, all your values are great. If febuxostat caused even a little stress to your liver, your ALT should become much greater than your AST which is obviously not happening so as far as I can tell you’ll be able to keep taking this drug without concern for a very long time.

If your problem is indeed gout as your doctor suspects, you’ll have to be patient.
But in the meantime there are drugs you can take to suppress gout symptoms such as colchicine and ibuprofen. You should discuss that with your doctor. Based on your blood test, there is no reason for you to avoid taking more than one drug at the same time (but of course your doctor may be aware of other reasons for you to be especially careful… all I’ve seen is a few numbers!).
If the pain is increasing a lot or your see something wrong with the painful part of your body besides the redness and swelling you can expect to get from gout, do see a doctor just to make sure you aren’t neglecting a completely different problem.

Gout pain should be relieved gradually after starting febuxostat, but that process doesn’t start immediately. What you might notice at this stage is shorter but more frequent painful episodes as well as pain in locations which were rarely painful before you started febuxostat.
Since the blood test confirms the drug is working very well, you can be confident that the cause of gout is being removed from your body. And as long as you keep taking 40mg daily, you can eat whatever you like.
If your pain finally goes away, I recommend waiting a few more months before lowering the amount of febuxostat you take. If on the other hand your pain does not improve by the end of the year, you’ll have to ask your doctor to investigate other disorders.

[Hasan Mahmud]

Thank you very much for your reply and giving your valuable time.

The units were as below;

Creatinine umol/L
Uric Acid umol/L
ALT (SGPT) U/L
AST (SGOT) U/L

Just to be confirmed-I had a belief that after starting febuxostat, gout pain will be relieved gradually in directly proportion to the level of uric acid be decreased. Now it seems wrong. Uric acid may be decreased immediately, but the pain take time to be relieved. Is it like that?

In my present situation, should I continue febuxostat? If so, how long?

Thank you in advance.

[nobody]

Yes, you’ve understood correctly.
People who have deformed hands and feet because of uric acid should see an immediate improvement as uric acid is removed from their body in proportion to the decrease of the level in their blood.
Uric acid should also be in the process of being removed from your body but the amounts are much smaller in your case. Even a very small amount can cause a lot of pain so you may not notice much difference until most of the uric acid has been eliminated. Also, small amounts can be isolated from the blood and persist for a long time. So in your situation the improvement is more in proportion to the duration of the treatment than to the level in the blood.

So far as I know, there is no reason for you to stop febuxostat so yes, keep taking it! Gout patients normally keep taking it for the rest of their lives.
The dosage seems too strong for you so what you might want to do is to switch your dose to 20mg. But the latest recommendations for gout I’ve read say it’s OK to have uric acid that low for a year or so I recommend waiting until the pain has gone away before lowering your dose.
Of course if your doctor ends up finding a completely different problem and decides you never had gout, they’ll tell you to stop taking febuxostat. If you want to quit the drug for any other reason, you should first look into other ways to prevent the amount of uric acid in your blood from going back to 400 or so after you stop taking it.

[Hasan Mahmud]

Gout patients normally keep taking it for the rest of their lives. Omg!!

Doesn’t it have any side effects? Moreover, if I keep taking it for long time, wouldn’t it lower uric acid level to near zero? If so, would it be good?

One more thing to be mentioned that I am feeling more pain than before. Is it normal?

Thank you again.

[nobody]

All drugs have side effects but they do not always affect everybody. It’s a relatively new drug but some people have been taking febuxostat for many years. Based on your blood test, you seem to be having no problems. Did you notice anything unusual?
You do not want your uric acid to fall to zero but it should not fall much lower anyway. Since it’s very low already, you shouldn’t keep taking so much febuxstat for several years. If you were to take 20mg for instance, it would probably rise to a more normal value while remaining low enough to ward off gout.

The pain should vary so it should sometimes become stronger.
But pain is difficult to explain in writing. I don’t know exactly what you feel so I can’t rightly guarantee you it’s normal. If you feel something very different from what you’ve experienced these past years, best see a doctor just in case this unusual pain is caused by something else requiring a different treament such as antibiotics.

[Hasan Mahmud]

I understood.

Somehow I came to know that after taking febuxstat, pain could be increased. That’s why I have asked whether it is normal.

However, you have given a lot of advises, which seem to me vary rational. I am greatly indebted to you for your consultation. I don’t know where are you from. In my country, doctors are not so co-operative, with few exceptions. They don’t like to hear from patient very much. They provide treatment on traditional way, thinking all patients’ cases are similar. They don’t to think that some cases might be different. I have visited about dozen of doctors during last couple of years due to this pain. None of them treated me properly. Even one doctor, who is a professor of the best medical college of my country, told me to change my shoe, which he believed was cause of my pain, nevertheless, uric acid level was 390+. How funny! I have changed several pairs of shoes, but no improvement. My last doctor seemed to be a good doctor. He advised me to x-ray the joint and gave some tests. After seeing the report, he identified that it is gout arthritis. See, after six years and visiting dozen of doctors I came to know that it is gout. There are many examples of malpractices done by doctors in our country. If you interested, I will tell you one by one. Therefore, I don’t have much trust on doctors of my country. Sorry, told you a lot of negative about my country’s health sector.

[nobody]

Pain often becomes more frequent after starting febuxostat. That would be normal. But if your pain actually became more intense, that’s not so normal. It’s not a big surprise but it’s not typical.
You are a special case anyway. The way you reduced uric acid is definitely not normal. Most people take a more gentle drug than 40mg febuxostat to begin with. And most gout patients start with more uric acid so they never go as low as 200. This must have created a unusually strong chemical imbalance in many parts of your body. There is research showing that when uric acid is lowered gradually (the opposite of what you did), there is less pain.

I wouldn’t fault the doctors you’ve seen too much. Typically people who have gout test higher than you did. Many doctors around the world would not consider gout when uric acid is under 450.
My uric acid used to be higher and many doctors still wouldn’t consider gout because my uric acid was “normal”. I’ve seen so many mostly clueless and non-cooperative doctors from different countries (all of them Christian countries though) and have been given so many explanations for my joint problems over the years! I was told my shoes were the problem, sure. But I also apparently have several different bone deformations not to mention nervous problems. Even my veins/arteries were supposed to be diseased at one point.
I don’t doubt that medical malpractice is a problem in your country. But when it comes to gout, medical malpractice is everywhere.

[Jyothish Nair]

Gout attack lasting more than 2 months!

I am 40 years old male with height of 178 cm & weight of 77 Kg. When I woke up on 19th May 2018, I had a severe pain in the back side of my left ankle which made it literally impossible for me to get out of the bed. After 4 days, still limping severely, I had been to the GP who ordered blood tests and the result shown Uric acid level of 8.9 mg/dL. I was prescribed allopurinol 100 mg X 3 times a day. The pain flares up and reduces(but never stopped) since then and I have been limping for these duration due to the continuous pain. I used to consume alcoholic drinks once in 2 months (a maximum of 60 ml). But since the pain, I have kept away from any form of alcohol.I consume Chicken & seafood once a week. Rest of the days I am on a vegetarian diet.
Can anyone please tell me whether Gout attack will last this long & do I need to take another medicine? (even as of today, I have severe pain in my ankle (back side).

[nobody]

Hi!

If allopurinol is the only medicine you take, yes you should be taking another medicine.
You shouldn’t quit allopurinol. Typically, people take allopurinol their whole life. It takes care of the cause of gout but curing gout takes a long time.
In the meantime, there are many medicines that can help with the pain, swelling and so forth. The most common are a class of fast-acting anti-inflammatory drugs called NSAIDs which includes ibuprofen.

Gout attacks do not typically last this long but it is not unheard of.
When people start taking allopurinol especially, they often get frequent attacks. Frequent attacks could of course feel like a single attack of varying intensity if the location of the pain doesn’t change.

Finally, you didn’t ask about that but it would be prudent to get another blood test done if you haven’t had one since starting allopurinol. First, you need to make sure your body tolerates allopurinol well (typically, liver and kindney function are checked). Second, the efficacy of allopurinol should be verified because it varies between individuals (some people take a higher dose than you do while others take a smaller dose).

Goof luck!

[Darline Smith]

10th day of painful big toe gout attack. Thought attacks did not last this long
Oh

[Sandy Guevara]

Gouty foot still hurting 2 weeks after allopurinol

Hello,

I’m 58 year old female who just got diagnosed with gout. I have other autoimmune issues. Also, I have Raynauds, Sjogrens. After reading several of the posts on here and reading people’s symptoms, I think I have had gout for at least 3 years. 3 months ago I went to see Rheumatologist for pain in my lower ankle. Dr told me I had gout and Uric acid tests came back at 6.2, but I was denial. Took another test and that test came back at 5.8. Fast-forward to March and my knees are in so much pain and joints are either sore or stiff. Same ankle is tender and finger joint hurts at times. I’m miserable. Dr. rolls in ultrasound machine and shows me the crystals in my knees. Puts me on colchicine and Allopurinol. I don’t drink and might eat red meat once a month. But I’m about 30 pounds overweight.

2 weeks later and feeling much better all over. I can’t believe it. But my foot still hurts. Not sure if I just over do it and don’t let my foot rest. I do LIGHT exercises such as going to gym, walking, and bike riding, about 2x per week and don’t over do it.

I am so thankful for this forum. Because I have learned so much from all of you.

[Author]

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