New to gout – need some generic advice

[Ted Pimentel]

New to gout, new to this forum, have some basic questions:

1. As a new member, I could not register for an account, had to log in using one of my other accounts (facebook). Is there a way to anonymize my name in this forum so that people searching me in google don’t see all this private medical info about me?

2. My flare up is a couple of days old already. I went to the urgent care and was prescribed prednisone (60mg daily for 5 days). It seems to work ok as the brutal throbbing pains largely go away during the day but at night, they come back with a vengeance. I have seen in the interwebs that after stopping prednisone, one can have rebound. Is this the case? If so, what is the pain management strategy then?

3. My doc did not prescribe alluprinol. Presumably, it would be good to get a confirmation that my issue is in fact gouty arthritis. I did have blood test that showed 7.5 mg/dL uric acid levels but I understand that high levels of UA doesn’t mean gout and that normal levels does not mean no gout. I’d really rather get on top of this sooner rather than later – what are the right steps to take to determine if alluprinol or some other uric acid reducing medication is appropriate?

4. Are primary care docs generally ok for gout or do I need a rheumatologist to get best guidance? My experience with other chronic conditions (insomnia, tinnitus) is that primary care docs don’t want to or know how to give advice that is long term. Usually, they want to treat the acute symptoms today but the conversation around long term management is lacking. Is that true for gout also as it relates to primary care docs?

Some of my specs:

51 yo
obese
family history of high blood pressure and gout
Meat eater
Very rarely consume alcohol

[nobody]

I was waiting for an answer to 1) but on second thoughts, there’s a matter which can’t wait: what to do about pain that comes back?
Pain isn’t the most pressing issue actually. You should get the inflammation causing the pain looked after without delay. A GP can take care of that. Taking more steroids or non-steroidal anti-inflammatories are the main options. Which (if any) is more appropriate is up to your doctors but what’s up to you is making it very clear this is bad. Don’t allow them to let inflammation fester without a damn good reason!
You can also take pain killers while waiting for the inflammation to come down but don’t use painkillers to live with inflammation unless you’ve made damn sure the doctors did all they could to stop it.
And be sure to drink plenty of water if your kidneys can handle it!

[Ted Pimentel]

Thanks for your reply.

As to #1, its not a deal breaker but if the forum has the feature, I want to take advantage. I’m sure this isn’t going to be the last time I post here (sadly). If you have other useful tips, please go ahead.

I have been to a GP (family medicine person so not a specialist). My diagnosis was “clinical” which I suppose means based on what they saw and what I told them during my visit. They did do a blood draw but I am not sure if those results definitively point to gout, only that the uric acid levels are higher than the “standard” range. Blood test results showed 7.5 mg/dL uric acid levels.

I’m kind of used to taking charge of these chronic issues – family doctors carry huge case loads so I can’t imagine they want to do more than get patients in and out. Is what I have from my family doctor sufficient or do I need to ask them to stick a needle in the joint for a more definitive diagnosis?

Also, what is this thing about East Asians and allopurinol? I am Filipino. Do I need to do some extra due-diligence before going with allopurinol? My dad has gout and says he was prescribed allopurinol without too much fuss.

[nobody]

Taking charge of serious inflammation on your own might result in a bad reaction to a drug. Even if the doctor only recommends what you already knew, you may be treated differently if you need emergency care because you followed a doctor’s advice as opposed to self-medicating.

Unfortunately the needle in the joint isn’t always definitive. Imagery could provide clues.
Otherwise formal diagnosis tools rely on some specifics about the symptoms as well as on the symptoms coming back after stopping completely several times. They also rely on the amount of uric acid in the blood of course (which looks high enough for gout in your case but which should be repeated before jumping to conclusions to make sure it wasn’t some kind of outlier).
It’s not necessary to wait for symptoms to come back if you trust the experience and discernment of a doctor who claims to be able to recognize gout, especially if they’ve used an MRI or ultrasound. No one can tell you over the web if a particular doctor is trustworthy but I’d definitely see a specialist if it was practical (not too far away, too expensive and so forth).

In any case, don’t start allopurinol without careful consideration and planning. It’s a long haul drug which treats a slow disease. What matters is not to let the disease fester for years if you have it. But it’s well worth delaying such a treatment a few weeks to do things properly.
Yes, there is an extra risk with some East Asian ancestries. Both febuxostat and the genetic test have only become available relatively recently, allowing people to take fewer risks. I don’t know what the risk is for any of the ethnic groups of the Philippines but I expect many islanders would have some “foreign” ancestry anyway. So consider going with febuxostat instead of allopurinol if you can’t get a genetic test to rule out this risk. But this is premature, and only one of the matters to consider before starting such a drug… you’ll hopefully be able to talk about this in good time with a specialist.

[Ted Pimentel]

Thanks for the reply. By taking charge, what I mean is being more insistent in certain things such as seeing a rheumatologist or insisting on a test that gives more definitive answers.

[nobody]

Sorry for the misunderstanding. Doctors can be so expensive that I often want to be my own doctor…

[Author]

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