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@nobody @Keith

This has kicked off into a brilliant debate. A great opportunity for us to brainstorm too.

“iron-stomached, steel-livered” – haha 🙂

Yes, from what I understand most of Keith comments were about habitual exercise whereas my findings were more concerned with what getting mobile asap can or can’t do to the acute flare. Despite uric acid forming microscopic crystals that are harmless in themselves the real issue is when they accumulate around the joints. From what I understand over time these crystals can mechanically intervene with the normal movement process of the joints. After all as nobody says there must be some sort of “additional friction or compensation for the foreign body” which I believe can cause some sort of bone erosion.

Whilst I most certainly believe that the real issue is addressing the underlining issue of lowering uric acid I also seem to have had better heating time results resting the joint longer. However on the flip side trying to keep mobile and use the joint during an acute flare caused me to almost become ‘aquatinted’ with the pain so somewhat more pain tolerant which I probably wouldn’t have been lying down resting. I definitely do not condone that as an advantage though. I think in future if an attack does strike I will take the more relaxed approach rather then express mobility.

Finally, I spoke to my rheumatologist about my ongoing pain and he’s response was quite simply you seem to have ongoing low grade inflammation which there is nothing we can really do about until you start febuxostat to begin to dissolving the crystals that are causing your immune response. I insisted and questioned if it could be permanent damage so he offered an ultrasound guided injection to remove the pain and check to see if there was damage but I rejected that route and explained that I would like to have a detailed MRI scan as I felt that they can better indicate damage. He wasn’t too pleased and explained that an injection would relieve the pain and that I could reject the needle at the time of the ultrasound however I said no. I want an MRI to give us CLARITY, ultrasounds are not as accurate. so I am now waiting for the scan date.

What do you think, can we get a clearer picture from that?

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@keith @nobody

I love a good debate. Anyway here is my two pence on this.

I have only ever had 3 attacks since August 2015 so cannot really give much independent experience. On the other hand I have dealt with the gout attacks in 3 different ways. One with no NSAID’s or Colchicine (I never knew about them during my first attack and just went to A+E) and the other 2 with Naproxen alone.

The second attack a year in August 2016 I used a strong course of Naproxen only as I was too worried about the side effects of Colchicine and what impact they may have on my condition. Regardless, the Naproxen helped significantly pain wise.

The third attack this March which has left me with constant residual pain due to commencing Allopurinol was also treated with Naproxen alone for fear of Colchicine however this time the Naproxen did next to nothing in helping me feel better. It may have been making things easier then what things may have been without but I certainly didn’t feel much relief whilst taking it. Maybe because I only took it for 10 days and not through the entire attack duration.

How this relates to mobility is as follows;

The first attack I stayed in bed most of the time with no meds. The recovery time was approximately 12-14 days.

The second attack I took Naproxen thus I had pain relief and was able to walk around the house however the attack lasted 14-18 days. I tried to keep mobile where possible but did not exert force.

The third attack I took Naproxen and despite hardly any pain relief I kept pushing myself to walk around as best I can and although the ‘attack’ has passed residual pain still remains. That attack lasted over 18 days. Pain relief was next to minimal but I wanted to stay mobile.

So from my experience, resting is probably the better/faster option. Now had I not pushed myself when taking the Naproxen during the second attack maybe those 14-18 days would have been reduced by a further 3 or 4 days which would mean pain relief and a reduced length of attack.

Which ultimately begs 2 questions;

1. Can pushing yourself despite pain to get mobile asap actually cause irreversible damage as I am still dealing with residual pain today? Osteoarthritis as a result of a gout attack because of persistence to walk or was it just coincidence?

2. Even if one uses a combined aggressive pain relief course like mixing Colchicine with NSAID’s and Paracetamol to dampen pain who’s to say your joints are not taking a massive beating whilst you enjoy these mobile pain free periods? At the end of the day stopping inflammation is not your only issue when crystals break into synovial fluid or get stuck in soft bone.

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Colchicine for the first time

@keith @nobody

So the swelling has generally come all the way down but the pain still persists after long walks mainly on the base of my foot and around the top of the toe. As you know I’ve discussed this with two separate rheumatologists and have a professor to see in September. Anyway, I finally decided to give Colchicine a try and took my first 0.5mg tablet this morning to see how my body reacts should I need it.

Anyway, 2 hours into taking it everything seems OK actually. I’m not expecting anything in the way of getting my foot back in shape from the one tablet. It was just to see if I can tolerate the stuff in the event of a flareup prior to starting Febux.

Only side effects I’ve noticed is a dry mouth and throat and an increased urge to drink water, I’ve also noticed a slight headache and a very slight loss of voice. Otherwise things seem OK. I was wondering if these side effects are something you guys experienced the very first time you took Colchicine or every time you took it.
If any side effects did occur during your use, how long did they take to settle down?

Thanks guys.

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Rebecca, another thing you should take into careful consideration is in fact stress levels. Although it may not directly effect your gout (some may differ) it will however disturb the way you live your life which can and will result in a life led by gout and not general wellbeing. Gout is a chronic condition however life isn’t, it’s temporary. You’ll never outrun gout but gout can outrun you.

Let me know if you ever wish to talk more about the psychological effects.

Get yourself to Turkey and have the best time you can 🙂

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Rebecca, I would have to agree with nobody on this. Try and get your protein from natural sources such as lentils and beans.

Would it not be possible to make yourself a protein rich smoothie for when you are on the go? I’m not much of a fan myself of smoothies and some say they are good and some say their bad but I would assume if you need an occasional mobile protein boost maybe that might be an option for you rather then powders.

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Perfect – well done. 🙂

Turkey! My sister has been to Istanbul and Borsa and says it’s lovely.

I look forward to going one day 🙂

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That’s good news – Well done.

Yes, if you have control of uric acid at lower doses of Allopurinol then you are fine to stay there. Just make sure you monitor your Blood, Kidney and Liver function levels with your regular uric acid tests.

Out of curiosity, what dose of Diclofenac do you take and for how long after the attack do you continue for?

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Thanks – I will have a read.

How often did you get flare ups prior to starting home therapies?

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Yes, indeed you can however try to keep distance between yourself and sick people especially hospitals prior to going and whilst you are there as colchicine reduces your immunity capabilities.

One thing I would like to ask is have your attacks become less intense since starting allopurinol 6 months ago or are they still the same on the pain scale? If they are getting less painful allopurinol is indeed working and your crystals are getting less and less. If they are not however then you are still going through the primary stages of debulking.

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@urankji – I was wondering if you actually tried Malic Acid and if your uric acid levels really dropped, if so how much by? I’m thinking of giving it a try but wanted to know if you had an idea of how the actual mechanism works? Thanks

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Over production of red cells is most definitely one of the causes of gout and quiet possibly the only reason you may be experiencing gout.

When you produce more red blood cells, more red blood cells will go through their usual lifecycle. Once they complete their lifecycle they are recycled and uric acid is released from them (the dead cells). If you have a high rate of production, naturally you will have a higher rate of cell turnover and this itself will cause uric acid to rise.

Do you have your Full Blood Count results to hand? More specifically your haemoglobin as this is a good indication as to why you may be over producing red cells. Check to see if you have your bilirubin results too.

In any case let us know what your haematologist says.

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Hello Eric,

Most will agree that none of us have a crystal ball what can be said is this.

Should I expect a gout attack?

If you have just started Allopurinol and you are not taking preventative treatment (Colchicine) you can expect a gout attack regardless of what you drink or eat. Your body is now dissolving uric acid crystals and you are getting better. It might be a rocky ride till you get better but Colchicine is there to keep any attacks at bay in your early allopurinol days.

Can I take colchicine to ward it off?

Yes. 3 ways you can deal with this:

1. Start Colchicine with Allopurinol for a few weeks / months (get advice from rheumatologist first about dosing and length)

2. Take Colchicine anyway to keep it at bay and mind at rest however if you plan to be out and potentially around sick people or hospitals then this isn’t advised as you will potentially be weakening your immune system for no real reason.

3. If you feel an attack coming, just take it then.

How soon after drinking does one get an attack?

If anyone can reliably and accurately give you answer to this life would be much simpler for anyone who visits this site. 🙂

Finally, I personally don’t drink, but if you are taking Allopurinol you already have a safety net in place when it comes to purine rich content.

Cheers.

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@nobody – How you doing pal.

Question for you, you mention;

I’d be more concerned about the damage inflammation is doing than pain but sometimes, pain relief is indeed what you want.

I wanted to know what you mean by this statement as I remember you mentioning you have had long attacks and after pains for over a month so you may have better experience then me. Does long term inflammation actually cause issues? More specifically, can NSAID’s which reduce this inflammation correct those issues that have developed and reverse the damage (if any) or would they stop it temporary until the dose wears off?

For that matter how did you resolve your long term inflammation, did it just get less and less over time or when starting febuxostat?

Cheers mate.

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@Keith – Good to hear you had a good time. I have USA on my visit list for next year. It’s probably going to be Italy for vacation this year 🙂

I’m extremely keen to read the article about getting mobile as soon as possible as I think I may have found a link to what I might be experiencing. Please let me know as soon as its ready for reading and where to look out for it.

Cheers mate.

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If you’ve been tired since you’ve started allopurinol, you should discuss that with your doctor and make sure your health is being thoroughly monitored. The drug could conceivably be affecting you in a dangerous way.

This is indeed correct. You need to do a Full Blood Count and an Iron Studies and Ferratin blood test and post those figures here. (Ferratin might already be included in a Iron Studies test but check)

We can take advise a little further from there.

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If I thought Tophus Sufferer would read this thread, I’d have brought up pegloticase myself. haha!

So you’ve had gout for 37 years, just out of curiosity, why didn’t you start allopurinol (I know febuxostat wasn’t around) back then?

Did Allopurinol not work for you?

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@Keith – hi mate, thanks for those articles. I’ll get down to reading them and post my findings on a separate thread.

I might give it a try before starting febuxostat 🙂

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