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I've just started taking Allopurinol, and I was curious how you treat minor “level 1-2” attacks/discomfort while taking AP.? When a low level attack occurs, do you stop the AP and start Colchicine or do you take something else.? I have an arsenal of pills I can take (Colchicine, Naproxen, Vicodin, Ibuprofen 800mg, etc…), but I wasn't sure what is best for low level attacks.
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As for mid/high attacks (6+), it sounds like I should stop taking AP and do a Colchicine regimen and then restart AP a week after the attack goes away, right?
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Since attacks can happen anytime, I want to make sure “I'm ready…”.? Nothing worse than traveling and be unprepared for an attack.
How about these micro gout attacks?
I recently switched from Uloric to Allopurinol. Regardless I have been on one of those, with colchicine, for almost four months now. The attacks have been coming nonstop and always in the little joint of my right big toe.
Here’s the strange part. They sometimes last for less than a day. What’s up with that? This is something I have not experienced in my 13 years of gout attacks.
Yesterday, I woke up at 2am with some raging pain. I took my normal morning mix of colchicine and AP. This time I added a single Indocin to the mix for pain. By 10:30am the pain was GONE. The movement in my joint was back. Here’s the catch. My foot is still reddish/purple and very inflamed. I feel like I could run less than 24 hours after the attack. Of course I won’t because that would be stupid. I’m saving it all for a mountain bike race on Sunday. 😎 These micro attacks come from nowhere and leave just as quickly.
Is this a good sign that my body is getting through the UA crystal removal process? Is there light at the end of the tunnel? This has been the worst four months of my life. There has been the odd 1 week long attack, but recently a lot of them have been in and out strikes.
I had something similar a month back.
I reckon the 2 day event was reactive arthritis due to infected bug bite [very gout like] -which passed off and I then walked the hills with care, only to kick in the kneecap for a week of swelling and pain. My fault for overdoing it. Dr. seemed to agree about the reactive bit- though it is a bit academic as event was over by then, apart from residual swelling.
Never previously had gout above ankle -or for less than a week, initially.
Plus the swelling was away from the severe pain centre in the initial attack, but not the longer second bit at the kneecap, which in any case was puffy [fluidic] tissue, rather than inflamed and firm as in gout.
I suspect having gout made the reaction worse, but it was not a normal response- as for gout.
Arthritis has to be on the table, then.
Still a bit academic, too- as both are from the same stable!
Jeff,
It sounds like some dissolving and reforming is going on with an immune stimulation each time. This is probably resulting in more and more urate being removed each time.
Do these micro attacks always come on after a period of immobility, like several hours sleep?
What serum uric acid readings are you getting?
Consider sleeping with heavy socks to keep your feet warm and urate more soluble. Consider upping your allopurinol and/or your colchicine?
These attacks come at random times. They have not been tracking the characteristic attacks. That’s what makes this so weird. I had what can be considered 1/2 attack yesterday and to day everything feels ok again. Same joint. Always.
Zip- my last SUA test was 9 days ago and it was 3.0
I’ve gone to wearing wool socks in summer and I can not up my cochicine. A person has limits. :frown:
I think it is all part of the lame game we all go through with Gout.
I have been on Allop 300 mg for 9 months now, my SUA always below 5 ( except for couple of occasions) and I seem to be doing fine except my right foot ( point of attack and injury). Lately in last 2 weeks, I have been getting very vague pains and sensations in my both the toes and ankles, even knees at times. There is heat sometimes and some times, they feel tender. Last 2 days, particularly yesterday was scary as I got many painful twinges in the toes the whole day. There was no swelling or any pain on pressing…just more than 50 twinges in the day. I can call it mini micro attack if you would. Got up today morning and everything is cleared.
I did not take any Colchicine or any other pain killer. In the night, I loaded myself with prohibited Veg food – Spinach, Legumes and Cauliflower – did it delibrately…wanted to test if it will flare up — it got cleared up..today, there have been no sensations or twinges till now.
Every 3-4 weeks, I get such sensations and at times they are scary…there is something with this treatment which at times seems uneasy.
I have been on allopurinol since November 2009. My dose has slowly increased over that time, partly as I was overseas and therefore away from my GP for 4 months. I started on 100mg; after a month went up to 150mg and on return home went up to 200mg. My next official blood test is next month and its possible I go up again to 300mg then.
I have had no attack as such during that time, but have had lots of micro attacks. How does this feel ? Well, like there's some tiny little guy following me around with some pins. He sticks me with an assortment of his pins, some of them are only little so not too bad, some of them are much bigger and he jabs me with them. Its a sharp sensation, which lasts only a few moments, but they can be quite frequent at times. I assume they are caused by crystals dissolving and the urate moving around, but its difficult to know for sure. Other times I feel sore in various joints, elbows, knees, feet. Sometimes when these sensations are at their worst, I can feel a bit groggy. Other times I feel perfectly normal.
I have a home tester, which has been showing usually low to mid 5s. I had some problems with the tester when overseas when it gave erratic results, so not too sure whether they are correct. I'll see at my next blood test. Its so difficult to know what to do for the best. I have had not proper attacks sine being on allopurinol, so don't wish to do something which upsets that; while at the same time it would be nice to be rid of the little guy with his armoury of pins.
Based on my experience and what I have seen on this forum, I would categorize the Gout related symptoms( with or without Gout treatment with medicines like Allop) as below:
1. Nano: These are very minor twinges that come up occasionally and disapear. Most of them we simply ignore.
2. Micro: These are twinges or aches that cause slight discomfort and catch attention of the brain. Still no damage. Mostly go away at their own.
3. Mini: These are more than twinges, some low level pain, sometimes swelling and enough to make a person scared. Generally an indication, gout attack is possible. Preventive tretment like Colchicine may help. Some people can get through them without much damage, some do not.
4. Macro: This is real attack. Pain, swelling, heat, redness…all classic gout symptoms. Pain killers / Colchicine etc. are required, earlier the better. Walking and other effected joint movement is very painful and better avoided. Remindes a person – life can be unfair to some.
5. Major: Well, this is worst attack like Zip said in many posts – attack from the hell. This is where shit hits the fan. A gunshot is probably less painful. Walking around – forget it. I donot wish it even to my enemies.I assume Allop is supposed to get a person from Major / Macro category to Micro / Nano. And it takes time to do that and in the process, invokes different categories of attacks depending upon how much urate it encounters during the cleansing process.
This is just my thought. Being a person in management consulting field, I love to categorize items based on severity:smile::smile:
Utubelite said:
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This is just my thought. Being a person in management consulting field, I love to categorize items based on severity
Nice job, Utubelite. One item missing: A nice picture representing each category.
Here’s a good news update for you. After almost five months of constant pain, I appear to have turned the corner. No alcohol for 11 months, and a combination of uloric, probenecid, AP, colchicine, indomethacin, and ibuprofin for 6 months made the difference.
I really saw improvements when I went on 300mg AP and .6mg 2/day colchicine. Keep the faith that there is an end to difficult times and STAY ON THE MEDS! That second item was my biggest problem for 13 years.
I just finished a race peak that included 4 mountain bike races and two triathlons. There was never more than a twinge in any of my joints and the tophi blob on the end of my big toe is not 1/4 the size it was 6 months ago. None of this would have been possible if I had accepted my gout future as written in stone or if I had not religiously taken my drugs.
Keep on keeping on and know that this pain is temporary. Do the right things to make yourself better.
Jeff B said:
No alcohol for 11 months, and a combination of uloric, probenecid, AP, colchicine, indomethacin, and ibuprofin for 6 months made the difference.
You taking all of them together daily? Is that really wise or healthy?
You sound like a human version of a lab test tube 
Hi Jeff,
I’ve found that micro attacks are normal in the beginning cleansing process. I’ve now been on 300mg AP for approx. 9 months.I had micro attacks in knees, both feet and elbows daily for about the first 6 months (note: except for mt right big toe, I never had any pain in these joints prior to AP). There would even be some redness and swolleness at times. These attacks would last anywhere from a couple minutes to a couple days or more. Fortunately for me, they never turned into a full blown attack. Anyways, my point is that for me the turning point was about the 6-7 month mark. After that I still got these micro attacks (and still do a few times a day), but they are very minor. I can eat and drink whatever I want as well as work up a good sweat at the gym. Everybody has their own “turning point” after starting AP. I started AP after my first attack that last nearly 2 months so maybe I had less urate to clear out than others who have gone decades longer untreated. Just give AP time and patience. it WILL work if you’re on the correct dose!
Just my thoughts.
vegetarianGuy said:
You taking all of them together daily? Is that really wise or healthy?
You sound like a human version of a lab test tube
I should have been clearer. Through the last six months I have been on at least one of those drugs. They never crossed over. The 300mg of AP and .6mg colchicine 2/day seems to be the sweet spot. Probenecid didn’t do much for me and I think the Uloric might have started the cleansing. Ap is my goto drug right now since it has continued the cleansing and is MUCH cheaper than Uloric.
SUA level was a 4.2 last week and a 3.0 last month. All is right with the world.
I have to say though. Popping multiple blood vessels in my eyes while on Indocin was quite scary. I guess I shouldn’t have been attacking hills with my road bike while I was on that though. You can’t fix stoopit!
Jeff, sounds good.
Probaly soon you will be able to keep the colchicine just for emergencies while you conmtinue with the allopurinol, 300.
Yep indocin is notorious for bleeds. I would never bike with it because it makes me quite dizzy and the dizziness is quick and sporadic…just enough to have me careen into a tree.
Eye bleeds are SO scary.
zhunter said:
…? When a low level attack occurs, do you stop the AP and start Colchicine or do you take something else.? …
You take something else. You take to this forum and read all about Allopurinol and attacks.
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As for mid/high attacks (6+), it sounds like I should stop taking AP and do a Colchicine regimen and then restart AP a week after the attack goes away, right?
Wrong!?
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Since attacks can happen anytime, I want to make sure “I'm ready…”.? Nothing worse than traveling and be unprepared for an attack.
I am sure “you're not ready…”.?
Hans said it nicely in blue. Let me add
Do not stop taking allopurinol once you have started it.
There are some exceptions, but I do not want to cloud the issue. If you stop and start allopurinol randomly you will cause many problems.
Thanks for the replies guys, very helpful to know.? I'll remember the advice and make sure I keep a few pills of Colchicine & Naproxen in my travel bag, and remeber to always take my daily dose of AP.? Since my last attack happened while I was in the mountains, I want make sure I don't travel unprepared again.
When you are on allopurinol and still feel an attack, take 1 or 2 colchicnes immediately. If pain persists for an hour, do it again. As Keith said DO NOT STOP ALLOPURINOL.
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I think Naproxen is a TERRIFIC drug, but I have yet to use it for any foot pains, so I cannot give any personal anecdotal info on it re gout. For my knee and shoulder pains and even minor low back discomfort?it works very well.
(For BIG backaches it's SOMA plus my TENS unit.)
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