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This is my first post here and I would be grateful for some expert advice.
I had my first (mild) gout attack about 3 years ago when I was 52. I cured this with Ibruprofen. Just over 6 weeks ago I started another attack – same big toe as the first one but with my whole foot hot and swollen. I'd say this was more painful than the first time – I needed sleeping tablets to get to sleep on two nights.
I treated this attack with Ibruprofen for 3 weeks which eased the pain quite a bit but did nothing for the swelling on the toe or the foot generally. My doctor proscribed Diclofenac which I took for 2 weeks plus tapering the dosage as instructed finishing the course of treatment last Saturday. This reduced the swelling and ended the pain although my toe and the foot remained red coloured and warm.
Today 3 days after finishing the Diclofenac the gout is back and worse than it was 6 weeks ago. I'm seeing my doctor on Friday and would be grateful for some help on what sort of treatment to ask for.
Should I request a further course of Diclofenac? Or is 6 weeks long enough on NSAIDS treatment and so it needs something differen?
Just to complete the picture I'm on Amitryptalene for a long term (18 months) neuropathological problem with my knees.
Thanks for reading all this! Any help gratefully received!
John.
There is more than a little evidence that diclofenac is singularly bad for gout use because it causes the kidneys to retain uric acid.
I think treating a gout attack for weeks with one of the gazillion NSAIDS is the wrong tack when there is a drug which is gout specific, cheap and works very quickly. That drug is, of course, the tried and true COLCHICINE!
John,
Why not ask your doctor for an Rx for it. It's only, but significant, side effect is diarrhea.
Thanks Zip2play – I will.
Just as aside the doctor I'm scheduled to see is a nice guy – he saw me when I first had an attack
3 years ago – but he came from Iran and his English wasn't too good. I was completely baffled by his initial advice to “goggle goat” until I worked out he was trying to say “google gout”!
Yeah- Watch the goats..the deserts' big and lonely
I find Colc. helps- but would hesitate to take more than 8 tabs/day for a few days myself.
A body can get used to painkillers after a while – so it's not a long term solution to rely on these.
I generally use Co-Codamol [Effervescent] but am aware that Codeine is habit forming long term.
Colchicine work best if it's used immediately upon the inceprion of an attack. The most acceptable scenario for a gout attack is that crystals form in a joint and the body attacks them as foreign. THis attack causes inflammation which creates an acid environment in the joint. So what was a saturated or supersaturated uric acid status in the joint (or else there would not have been crystallization in the first place) becomes, in acid medium, a much less soluble environment for uric acid…massive crystallization and massive immune response and massive inflammation with even MORE acidity.
Colchicine alkalyzes this joint quickly stopping the cascade. So you can see why it works so much better at the inception of an attack and why it is less effective taken on a day to day basis.
When you learn to recognize the first twinges, you can often stop the attack with only 2 tiny pills. Once the attack gets going full steam, you need one and hour for as long as it takes to a max of 16…stay home and close to a toilet for this kind of dosing.
Before you discuss pain relief with the doctor, ask him about uric acid lowering. This is the most important treatment to stop future attacks.
During the first few months, you will also need pain relief. As zip2play says, colchicine is probably the best. NSAIDs are not good for long term use, but if you take ibuprofen to cover a few days gout attack, be sure to discuss the right dose with your doctor. For severe gout attacks (and I wouldn’t take anything for less than severe attacks) the standard over-the-counter dose may not be sufficient.
Don’t forget your free gout pain relief guide.
Thanks for all the advice/help gentlemen.
I saw the doctor this morning and we discussed gout prevention. In view of my medical history he felt a change of diet and weight loss would be better than medication. He gave me a diet sheet.
For the current attack – 6 weeks and counting but low/medium pain – he said that since NSAIDs hadn't solved the problem he would bring in “the big guns” and he gave me a steriod injection and said that it should make a substantial improvement after about 24 hours.
Well its been 12 hours since the injection and although the pain isn't any worse it's not too much better either. in fact the heat in my foot has increased a great deal – very warm indeed now and pretty uncomfortable in fact.
Is this a normal reaction to a steroid injection?
Thanks again. John.
Hmmm, NSAIDS and steroids.?
If you have a pair of gloves, take them into his office, smack him in the face and tell him he's fired.
Then go to someone who inderstands gout.
The correct drugs are colchicine and allopurinol, not NSAIDS and steroids!
zip2play said:
If you have a pair of gloves, take them into his office, smack him in the face and tell him he’s fired.
Gloves!:eek: Have you gone soft:wink:
Well see…
I have this big pair of chain mail gloves that often works WONDERS!
If that doesn't work, then it's pistols behind the church at dawn!
Yikes! I am rather shocked he would give you a steriod injection. I admit none of us are doctors, but the treatment for gout has been fairly standard for decades now.
Steroids are great treatment for a million different problems….but gout isn't one of them.
Well it's been 10days since my steroid injection and I'd say thing have improved about 50% – less pain but my toe is still red and sore especially if I try to walk.
I'm leaving it another couple of days then it's back to the quack's for more inappropriate treatment.
Steroid injections usually do bring pretty quick relief, but they inhibit the bodies own natural production of steroids, so should always be seen as something of a last resort.
I believe there is a limit to the number of shots that can be given, so it is particularly bad to rely on steroids if there is no plan in place to get uric acid down.
You really have to get on allopurinol, or some other uric acid lowering therapy as soon as you can. This leaves a few months of potential gout attacks which will get less intense and less frequent.
You probably need something to help handle the pain, but colchicine is usually more effective than anything else. Yes, it can lead to diarrhoea, but if it clears the pain that’s a small price to pay (be sure to drink plenty to replace lost fluids).
NSAIDs are the next choice, and there are many to choose from. You do not say in your original post what ibuprofen dose you were on. It is often more appropriate to increase the dose under medical supervision, but never more than 3200mg per day. This should be limited to as short a time as possible, and as low a dose as possible to cope with the pain.
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