Mild Gout Symptoms

[GoutPal Victim]

Hello all, about a year and a half ago I had my first gout attack and since then I have had a further two attacks. All three were within 6 months of one another, in my ankles, and were excruciatingly painful. I haven’t had an attack in 12 months.

Yesterday I noticed a dull ache in my left ankle and today it has become more painful, I would describe it as being similar to the second or third day of an acute attack after the most severe pain has subsided.

Though this feels like gout it is different from my previous attacks, specifically in that I have not had the usual mind-blowing pain. So I am curious, is this likely gout? Can you have a ‘mild’ attack that doesn’t deliver the usual ‘glass in the joint’ pain that we all know?

It might seem a pointless question but any feedback would be appreciated.
Chris

[GoutPal Victim]

Well turns out I was wrong, the mild pain was simply a prelude to the main event. Oh dear, here we go again…

[Keith Taylor]

Oh dear Chris. I was going to suggest that might be the case. It does not always happen, but is quite common. Sometimes our immune system copes at the dull ache stage. Other times, it can’t cope. Then, inflammatory agony occurs as our immune system calls for reinforcements.

If you learn to recognize it, early pain treatment is always best for gout pain control. If you need help formulating an effective gout pain control strategy, please ask.

You need uric acid control asap. Talk to your doctor. Then, as for clarification/affirmation here as you need it.

[Patrick]

Oh brother Chris, do I feel for ya man. I was there also. Pay attention to the advice given on this site and the remedies. They work.

If you haven’t already, go get your Uric Acid checked. Like immediately. The sooner you know where you are at your levels, the sooner you can get working on lowering it. If you have had Gout diagnosed, are you taking medication?

Keith has some great plans on the right side menus. Visit “Personal Gout Diaries” or “Structured Gout Help”. The can be very helpful.

Like you, when I started to feel a gout attack coming on, I never assumed it was going to be either mild or severe, I treated it as a Gout Attack, period. I would hit it hard immediately with a 6 day Methylprednisone pack (I keep a prescription handy from my Rheumotologist) and 0.6MG of Colchicine twice a day. This should really cut the pain down to near zero pretty quick.

But Chris, the attacks will keep coming and they will become more frequent and more severe if you don’t get your Uric Acid under control immediately. It starts with medication and a few lifestyle changes. Once you get the Uric Acid under control, you can tweak the lifestyle changes a little. But remember, it won’t happen overnight brother. Good luck buddy, all of us can relate to what you’re going through.

[GoutPal Victim]

Early signs of a gout attack for long-term sufferers

I am on Uloric and still have gout attacks once a year or so. I have noticed on two occasions that in the weeks before an attack I get mildish aches in my left foot which travel from point to point. I.e. the first day it may be on the left side of my foot and the next day in my ankle and so on. Never in the same spot twice. Eventually, it ends up in my big toe and that is when it becomes a full-blown attack. I noticed when it was in my ankle that my ankle is noticeably swollen. Nest time I will start the colchicine as soon as the pain begins anywhere. Has anybody else experienced this? My doctor says this is coincidence and a gout attack always comes on without warning.

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If you’ve had gout a long time, can you tell if a gout attack is about to start? Yes, but you should not get attacks. Uloric should get uric acid safe.

[Patrick]

My doctor says this is coincidence and a gout attack always comes on without warnng

I’d say your doctor is nuts. Early on, my Gout attacks would occur without warning. But as I have dealt with this for several years now, I know what to look for and, more importantly, what to feel for.

Fabian, as soon as you start to get “mildish aches” hit that quickly with Colchicine and Naproxen, preferably pharmacutical grade, but over the counter will work. Take max doses. That should help squash it.

For further information, look up in the right hand box of this web page to “The Gout Search” and type in “2 hour Gout Relief” or however you want to phrase it, and Keith has some great tips on how to kill that Gout Attack quickly. It sounds very similiar to what I just advised you.

[d q]

Hi Fabian, that was the case with my second gout attack. Pain started at base of the foot after a few long walks and took about 3 days to strike full blown (prior to starting allopurinol). After start allopurinol attacks would hit within hours during the day and last days or weeks and the last attack even lasted 2 months. What I have noticed however is as this last attack subsided the pain has moved from location to location on my foot. I guess it’s part of the whole UA clearance process.

The real question here is why are you still getting attacks after starting Uloric? Ideally you should be attack free if you’ve been on Uloric long enough to remove all accumulated deposits. How long have you been on Uloric and what are your current UA levels?

[Keith Taylor]

Hi Fabian ( @fabian-israelstam ),

d_q has already asked the most pertinent questions: “How long have you been on Uloric and what are your current UA levels?”. Because the only reason for taking Uloric, or any other uric acid lowering therapy, is to make uric acid too low to get gout attacks. If your dose is not high enough to get uric acid safe, it is a complete waste of money. Also, you are extending the time you are at risk of serious health problems.

On your particular question, I think your doctor is confusing gout diagnosis and gout management. Because painful swelling without notice is a diagnostic indicator for gout. But that’s only because new gout sufferers have no experience of gout. So, they disregard those early signs. However, once you’ve had a few attacks, it’s often easy to spot the first signs. In fact, your symptoms are very familiar to me.

But, you should not be having any gout attacks. So please post a bit more relevant history as soon as you can. Then we can save you from continuing gout, save you from fatal consequences of badly managed excess uric acid, and save you from a doctor who loves to spend your money with no real purpose.

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Which is your febuxostat (Feburic / Uloric) dose?

[CraigieBlur (Old Forum)]

How long does “mild gout” last?

Dear all,

Firstly, I am a complete newbie to this gout game and have researched the web high and low since having my first attack earlier this year. I have to say that I personally feel that this site is the best out there and am so glad I found it!!

Anyway, back to my story……….

My “Gout” life started back in early July this year (2010). I play (well used to before my gout attack!) 7-a-side football once a week. I played on the usual Tuesday night and everything seemed fine (I do get a few twinges/bruises every time I play) but on the following Friday morning I woke up, stepped out of bed and my big-toe on my right foot hurt when I walked on it. Strange I thought but must be “football” related – How wrong I was…….

I gave it a week (missed playing football and haven’t actually been able to play again since) and then went to see my Doctor. The first doctor I saw said it was a “hairline fracture” and to rest it. Off I went.

3 weeks passed and it was still no better. Well to be truthful, it seemed to be “ok” one day then go back again the next?? It if was a bone healing then why would it “keep” going backward every other day? Back to my Doctor, I went.

My Doctor sent me for an X-ray at a hospital. Waited a week and called them up. It looks like a “dislocation” I was told and to come back to get it “fixed”. Went back to the hospital. Oppps, they had made a mistake and looked at my X-ray incorrectly??? They tried to say all of my other toes were “bent” so they were dislocated. Basically, at my X-ray, they had told me to “bend” my other toes so they could get a clear picture of my big toe. So they took another X-ray at the hospital and they said it was definitely not a fracture or a dislocation.

Off I went with a special boot they gave me to walk on and the Doctor at the hospital put it down to “bad internal bruising” and to just be patient.

3 weeks passed. Still no better. This is getting silly now. After looking at advice on the internet after Google “Bad big toe” I came across someone saying the word GOUT. I didn’t even know what this was?? [hint: See What Is Gout.]

Anyway, after looking into further and also viewing images of Gout on the big-toe/foot, I realized that it was exactly the same as mine. So I went back to my Doctors and demanded to see another GP. This new GP confirmed it looked like Gout but I didn’t fit the “profile” of a candidate for it (I turned 30 years old in July and this is around the exact time I got this first attack). I rarely drink (although I binge drink once every 2/3 months). I eat healthy foods, exercise, and drink loads and load and loads of water!! I told my doctor it could be hereditary. He agreed it could be but sent me for a blood test. I was also given Dicloflex 50mg tablets (3 a day).

I also ordered 3 x bottles of CherryActive concentrate juice and have been drinking 2 x tablespoons a day since. It is also worth saying that my left knee had now also swollen and my 2nd biggest toe on my right foot had also swollen.

10 days later and my results were in. “Normal” I was told. I still wanted to discuss with my GP as my foot was still not right. 4 days later (after being on Diclofex for 2 weeks) I saw my GP again who had sent me for my blood test. Although it was “normal” I was 4.1. My doctor said if it was 4.2 I was it “Gout” territory. As I was still having “symptoms” my Uric Acid level could be artificially low as my body had “dumped” some in my swollen joints. It is Gout.

I said that I had researched Allopurinol and wanted to go on it as soon as possible. He said that I could get “further” attacks when I initially go on the tablet but I said I would rather take this risk and to go on the Allopurinol as soon as possible (I want to get my Uric Acid levels down and it makes absolutely perfect sense to go on it now after my first known attack).

My Doctor said he can put me on Allopurinol but wants me to be “clear” of gout symptoms. Bearing in mind my first “attack” started on around the start of July. It’s been around 3 months now (really, really making me down, to tell the truth as it has just come out of the blue and not being able to walk without a limp is driving me nuts).

Anyway, to get me “clear” of the symptoms he told me to stop the Dicloflex and have a weeks course of Prednisone. I am on day 3 of a weeks course and although the swelling seems to have gone down (my right knee seems fine now and has been for a while anyway) it still hurts to walk properly and my right shoe/trainer still feels very tight.

Anway, after my long-winded story of my Gout, my questions are these:

1) Is it normal to have a “mild” gout attack linger for over 3 months??

2) Should the Prednisone not work by now?? (understand that it does not dissolve the crystals but helps with the pain reduction and rids of the basic symptoms which my doctor wants in order to be able to put me on the Allopurinol).

3) Will the Allopurinol work and, if it does, will my symptoms disappear completely forever ( I hope I have not got any permanent damage in the affected joints)?

So far my prolonged attack has been mild and when I sit down and am off my feet I wouldn’t even notice it was there. But gout hurts when I walk and I just really want to get back to normal again.

Really hope someone can offer me some advice as not too sure if I can trust my doctor’s advice completely

Best regards

Craig

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Will gout pain go away quicker with better walking shoes?

[zip2play (old forum)]

Craig,

A tough case: Even during an attack I would find a 4.2 Uric Acid too low to indicate gout, even given the typical fall as crystals form. Typically the first gout attacks subside untreated after 3 or 4 days.

If it IS gout, then allopurinol will clear your symptoms forever, as long as you keep taking it.

But if I were in your shoes, I would watchfully wait until you have a clearer picture and more certainty that it is gout. Taking an antibiotic for 10 days unnecessarily isn’t serious, but taking a drug for the rest of your life if you don’t need it is a horrific idea, as much as I like allopurinol.

You can get some more evidence by taking colchicine. If it works well that points to gout.

Get a couple more serum uric acid blood tests.

Alas for most of us the confirmatory event is the attack from Hell and very high SUA levels…but then we are sure. In your situation, if you start on a life of allopurinol now, you will always wonder “what if it isn’t gout?” Until you see a SUA of at least over 7.0 don’t begin treatment unless they can isolate crystals from some joint fluid.

[davidk (old forum)]

Craig- I share Zip’s concerns that with low SUA, this may or may not be gout. One thing is clear, you have run into the same challenge as the rest of us in finding competent medical professionals. Please go see a Rheumatologist as soon as possible. they are gout experts and if it is gout, that’s who you need to see. I agree with Zip, you may not want to start Allopurinol yet. I don’t see that you’ve tried colchicine; you may want to consider that-it’s for pain and inflammation for gout and in my experience works better than prednisone- I’ve used both – a lot.

I have the same big toe problem as you and I was months before I could walk without a limp and asked the same questions; why does it not go away even in the midst of a flare up. But, some differences: I had UA levels above 9 and I had frequent major flare ups where the joint turned red and was extremely swelled up and you can’t put any pressure on it at all- no limping. So, you are missing the high UA and major flare ups that are typical of gout.

[A Google User]

Gout and Restless Legs

I’m taking the Allopurinol now (100 mg day until I get a blood test, and GP thinks he’ll increase it). I’m supposed to take the colchicine when the next flare happens. (Along with NSAIDs)

I’m having little bursts of gouty things, left and right foot, ankles (?), toes. Some are super painful, but last 10 seconds. So I don’t know…I’m guessing I’ll wait to start the colchicine when it revs up to a genuine outbreak? I know there are different schools of thought on all of this, and for the newbie, it’s a bit confusing.

Do any of you get sort of a restless legs thing when you have a flare? I can’t explain this exactly, but when it ramps up, my legs just start kind of flipping around, or my feet. It’s almost like restless legs (from what I know). Is this a thing? Buehler?

[nobody]

You’ll have to experiment with colchicine and see what works for you. There are different ways to use it. But it works best if you don’t want until it revs up which is why some of us take colchicine on the first signs an outbreak might be coming rather than when it’s clear a serious outbreak has started.
If you’re planning to take both colchicine and NSAIDs during your next serious outbreak and you have never used colchicine, I recommend trying a pill of two of colchicine without NSAIDs first in order to see see what side effects (if any) you get. A good time to try colchicine might be when you have slight symptoms you figure might be the beginning of a proper outbreak.

I don’t know what’s up with your “restless legs” but it sounds like a nerve might be involved. Powerful pain for a few seconds for no obvious reason also sounds like a nerve thing.
Back when I was lowering the amount of uric acid in my blood through diet, I had strange nerve problems which seemed to involve a particular joint for a while and was sent to a neurologist who didn’t detect enough damage to explain the symptoms. I suspect inflammation might have been interferring with my nerves, for instance by creating pressure at some locations. Or maybe it was something else entierely…
See what your doctor thinks.

Unrelated: you probably are aware of this but it seems there is an interaction between levothyroxine and milk (and possibly dairy more generally). It’s apparently recommended not to eat or drink dairy for several hours when you take levothyroxine. It’s not a big deal but might result in inconsistent effectiveness of the drug, as if you were randomly lowering the dose.

[Steve Bateson]

Mood swings before a gout attack?

Hello all,

Really pleased to have found Goutpal and learned a lot from what is here, both the site and the forum.

First the history

After 9 years of occaisional and repeated pain that numerous medics could not identify, this time last year I had the mother of all attacks and after much to and fro got a referral to a rheumatologist. One large array of blood tests later and I was given the diagnosis, pretty much along the lines of ‘it’s obviously gout’. Sadly not that obvious to the previous 6 or so medics that were happy to dispense Naproxen and not dig any deeper. Probably my fault for getting it in the achilles, the knees, the ankle in the ball of the foot etc, and not presenting with a throbbing big toe.

At diagnosis my urate level was 492. Not horrendously high but high enough.
10 months late after a steadyish drop the last reading was 312. We’re aiming for sub 300, so subject to variation its almost there.

This has been achieved by (in my rank of effectiveness):-
Allopurinol 200mg
Increased hydration
10kg weight loss
More exercise, mostly indoor rower
Vit C supplement 1000mg
Cherry concentrate capsules.

I’ve also been using Colchicine. 500ug daily at first, reducing to ‘on demand’ now.

Obviously I’m not in the clear by a long way, and had to hit the Colchicine again last night but it seems to have worked its magic.

Now the question.
I have noticed, retrospectively I must say, that recent attacks have been preceded by a couple of days of unexplained bad moods. Nothing specific, just a general grumpiness and malaise. If I was your puppy you’d be fetching your own stick, that kind of thing. As a result, I find myself wondering about cause and effect.
Is there something causing the change in mood that is also triggering an attack or is an impending attack from trigger(s) unknown causing the change in mood?

Does anyone else experience this sensation? I am also wondering if I could use it as an early indicator to take up the Colchicine again.

Regards

Steve

[nobody]

Hi!

I haven’t noticed such mood swings but see if you can spot other changes happening at the same time like lack of sleep, abnormal sweating, constipation or water loss (very rapid weight loss). I guess one’s diet (and salt in particular) could also trigger both mood swings and attacks.

It’s not the end of the world if you don’t quite reach 300. If the coldest joints of your body (toes, fingers) never developped uric acid deposits for some reason, a slightly higher value might be fine.

As more uric acid gets flushed out of your body, the average attack should get progressively shorter.
Maybe it’s too soon for you to risk it but at some point you might want to try not taking any colchicine when you normally would because the “magic” might not be in the colchicine pill.

[Steve Bateson]

Thanks Nobody,

I’m going to look up salt and mood as it never occurred to me there could be a correlation, however I think you hit the nail when you mentioned tiredness. I believe that is behind the grumpiness.

I have also just been reading Keith’s article from the current sidebar about gout triggers, and am thinking that the effort of mustering further white cells to tackle dissolving crystals may be draining my resources, so to to speak. That being the case, as I fully subscribe to the ‘lower faster’ mantra, I could be in for a painful 9 months or so based on the one month per year of build-up rule of thumb.

The 312 reading was just over a month ago and as I’ve stuck with the regime I expect the downward trend will of continued, but guess it will have to level out sometime. Is it normal to be able to reduce the allopurinol dose to a management level in time?

Steve

[nobody]

I’m not sure what you meant with that last question but the latest guidelines I’ve read do speak of reducing the dose after symptoms have disappeared when the initial target has been set at 300.

Considering your uric acid has never tested all that high, I very much doubt you’re in for 9 painful months. It may indeed take 9 months or more for your symptoms to go away entierly but, after a few months, your symptoms will hopefully become quite mild.

[Author]

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