another flareup.

[jba66ihc]

I have had gout for almost 6 months now. I am currently on 300mg allop. I have been enduring an attack for a month now. I have been eating right and going to the gym. Although I havn’t been able to work out for the last month. Indocin wasn’t helping. So I was given Percocets to kill the pain. I work on concrete for 10 hrs a day as a mechanic. I don’t know what else to do. I figured with the meds and proper diet and all would be good. I even tried a supliment but I haven’t had it enough to know if its going to work. Im on the verge of losing my job because of this. Any and all advice would be great. Thanks

[limpy]

Man thats tough. Colchicine will stop most attacks but the price is a killer. Took one .6 mgs pill twice a day for 18 months and it really helped with the pain and swelling. But when I bumped my dose of allop up from 200mgs to 300mgs I got off them with in a month. What is your acid level now since your on Allop? If I were you i’d try and get it down in the 5 range. Good luck. Limpy

[thetempguy]

you said, “I work on concrete for 10 hrs a day….. “
Do you let your feet get cold, like ice cold to the touch? I wear sweaters and keep my home thermostat really low and I used to walk around barefoot all the time. Cold feet did not bother me, in fact I kind of liked it. Then i read something about cold feet triggering gout flare-ups and started to wear slippers and socks; gout attacks stopped pretty much after that. Beer & dehydration are the remaining enemies now…. 🙂

[jba66ihc]

No,I can’t stand to let my feet get cold. I live in North Carolina so it isnt a big deal. lol If my feet or hands are cold I am cold. Beer would be my enemy but I haven’t had one in quite a bit. I would love to be abe to drink it again though. Maybe once I get it all under control I will be able to have a few beers from time to time. I did buy a heating pad and tortured myself with apple cider vinager last night and my foot was much better today and was able to work today.

[Beyndken]

jba66ihc said

Any and all advice would be great. Thanks

Have you tried prednisone? I have found the pain to be noticeably lower only an hour after taking it. It also seems to halt attacks if taken early enough.

[Keith Taylor]

I am always wary about steroids for gout patients. I have to admit, I do not fully understand the interactions, but I have long considered that, personally, I believe the risks of side-effects outweigh the benefits (at least, for me, who has no issues with ibuprofen).

I’ve looked into this a bit further in order to respond effectively, but I still feel I need to understand the exact details. Here is what I’ve got so far:

Prednisone and prednisolone are the common steroids, with occasional methylprednisolone. I have seen the terms ‘glucocorticoids’ and ‘corticosteroids’ used as descriptions of these drugs. I need to research the exact definitions and differences more carefully, but for now, I am working on the assumption that they are interchangeable – i.e. have similar side effects.

Most drugs have side-effects, so it is a question of balancing the risks of one drug against another. There are several studies comparing steroids with NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). The recommendations vary between these studies, so I will need to do a systematic review of results. However, on some studies, the results raise controversy in the medical press, so it is clear this is a very complex comparison.

The biggest consideration seems to surround the long-term use of steroids, so the analysis is again complicated by considering length of treatment and dosage. My biggest specific concerns used to concern complications with septic arthritis, but today’s preliminary research reveals another major concern.

First, septic arthritis. This can be confused with gout, but both conditions can co-exist. It is my belief that steroids should be avoided if septic arthritis has not been ruled out. Feyrouz Al-Ashkar for Cleveland Clinic writes:

It is best to consider steroids in the absence of concomitant infection. In the case of systemic infections or septic arthritis, steroids should be avoided if possible.

and goes on to say:

Oral corticosteroids can be used in the form of a methylprednisolone pack or prednisone starting at 40 mg or less, with a gradually tapering dose. Systemic steroids are the preferred agents in patients with renal failure in whom NSAIDs and colchicine are contraindicated. Local steroid injections may be the best alternative route of administration in patients who are unable to tolerate systemic therapy with steroids, NSAIDs, or colchicine. Steroids, however, are not usually the first line of therapy because of their potential adverse effects such as hyperglycemia, gastrointestinal diseases, weight gain and fluid retention, muscle weakness, immune suppression, and long-term effects such as those on bone resorption. The potential adverse effects need to be considered when making the decision of treating acute gout.

There are no specific references for why steroids are bad for septic arthritis. I have found one report from JAMA in 1957: SEPTIC ARTHRITIS AS A COMPLICATION OF ORALLY GIVEN STEROID THERAPY, which describes 2 bad cases of septic arthritis on steroids.

Moving on to my newly found second concern. I was alerted to “Does prolonged systemic glucocorticoid use increase risk of tophus formation among gouty arthritis patients?”
This study is a statistical analysis of gout patient records, and concludes:

Patients with equivalent prednisone intake of at least 15 mg/week for > or = 3 months is associated with tophi formation. In the presence of hypertension, renal impairment, and elevated serum creatinine level, use of steroids confounds the individual risk that each factor carries.

Returning to the controversy I mentioned earlier, “Should prednisolone be first-line therapy for acute gout?” is a response in the Lancet to a study that favorably compares prednisolone with naproxen.

Well known adverse effects of glucocorticoids include hypertension and diabetes mellitus; these are frequent disorders in patients with gout. […]
Clinical experience has taught us that oral corticosteroids for gout expose patients to the risk of rebound attacks and possible drug dependency. Additionally, experimental data suggest that steroid treatment could favour tophus formation

So, thank you Beyondken, for prompting me to look into this a little deeper. I realize this is far from a comprehensive review, but the alarm bells re side-effects are ringing even louder for me now. As ever, the best action is to lower uric acid to safe levels – then you do not need the pain relief.

[Author]

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