Help Gout in my Knees for two weeks

[Raj Barua]

Hi
I have had gout for almost eighteen years (am 37 now), for last three years it has been under control. But this year I have had several attacks, I have countered them by NASID and colchicine. Every once in three years I get a bad attack on my knees.

I started with an attack on my right knee almost two weeks ago, as soon as it started I started with brufen(made the mistake of not starting colchicine), then the attack worsened after two days, I then started with acroxia 120 mg, and that did not help then started with Naproxen 500 mg two times a day for a day, then on the fourth day started with colchicine and voveran for three days. It helped a bit. But then my doc put me on indo methacin for a day which made my knee joint very stiff as inflamation reduced but the crystal deposits hardened. Then i again switched to voveran for three more days.

Now it is almost more than two weeks, the acute stage is over, I have stopped all NASIDS and colchicine(which i used for three days: three pills a day). But the pain and the stiffness is still there when I walk and straighten my leg. The gout also affected multipile areas of the knee joint.

So how do get over the pain and stiffness, it is not so painful for me to either pop NASIDs or a colchicine. I have been taking Bromelian pills thrice a day, having lots of water and foods which are highly alkaline like dried figs and watermelon.

Should i start with Febuxstat or alluprunoil how do i get relief from the stiffness and discomfort. Thanks for your help

[Raj Barua]

Ok another acute flare up in my knees… Had some lentil soup that might have triggered it… Started with allupronoil 100mg, Colchicine and brufen…

[Cujo]

Take colchicine as soon as you feel pain coming, it not gonna do much if pain is already there. That’s my observation with this drug.
Secondly, as i understand you have just started taking allopurinol. It takes time (months) to dissolve uric acid crystals in your joints so be patient. Also very often things get worse before they get better with allopurinol.
If you want to know more, please take time and read posts on this forum. Many cases very similar to yours and a LOT of useful information.

[Keith Taylor (GoutPal Admin)]

Again, I second @cujo’s helpful comments, and I’d like to add my own about gout being “under control”

With gout, under control does not mean free from pain. Under control means uric acid lower than 5mg/dL. This is crucial, because higher uric acid levels give an increasing risk of uric acid crystals forming. These crystals interfere with your natural joint-healing processes. This leads to joint damage before it leads to gout flares. By the time you experience a gout attack, your tendons, cartilage, and even bone, will be damaged.

In practical terms, you must increase your allopurinol dose to get uric acid below 5mg/dL (0.30 mmol/L). As @cujo says, it will take months to dissolve uric acid deposits. During that time, you need pain relief. The best pain relief is colchicine at the first twinge, or as a daily preventative for a few months. Support colchicine with anti-inflammatory medicine if necessary.

[Raj Barua]

Keith & Cujo,

Thanks for your comments. The acute flare up and pain is over, the knee continues to hurt and is still somehow stiff. Sometimes at night the pain increases, and it does go down when I gulp down some baking poweder or eat an apple. I have noticed that if there is increase in acidity then the pain tends to increase.

My last uric acid level was 4.4 yesterday and about 5.4 about four days ago. I am still on allouprunoil 300 mg a day. I have stopped coclchicine and NASID’s. My liver function test were not good SGPT, SGOT and GGTP were on the higher side.

I just hope that allouprunoil does not cause any further damage to my liver.

Should I continue with 300 mg of allouprunoil or should i lessen the dosage to about 200 mg since my serum levels are down.

Have I injuried any tendon or cartillage in my knee becuase of which it still hurts and is sore or is it my crystals disolving.

I also beleive that baking soda helps to neutralize the acidity, that is a key aspect.

Thanks

[Cujo]

I don’t know about reducing allopurinol dose when you hit right UA level. I guess it’s safe when you are closely monitoring your blood but don’t take my word for it. I guess Keith gonna be more knowledgeable in this matter.

One thing i learned about allopurinol is this: once it gets in your system, stabilize itself there and you reached proper UA level, you can forget about those things like baking soda, apple cider vinegar, lemons, cherries. I think if they’re helpful at all it’s very little help and difference in your UA. Big game changer is allopurinol itself. It reminds me of a conversation with my rheumatologist. At the beginning of my visits with her i asked her if i have gout then maybe i should eat the cherries. She said: “if you like them, why not?” 😉

[Keith Taylor (GoutPal Admin)]

You do yourself an injustice @cujo. You seem to know all the right things to say, and you say them in a few lines instead of going on and on for paragraph after paragraph.

I don’t believe you should ever think about reducing allopurinol until you have gone at least six months with all the following:

• No gout flare
• No visible tophi
• Uric acid never higher than 5

Having said that, I’d get a rheumatologist’s advice on the liver function results. The thing about knowlede is “a man’s gotta know his limitations”

[Raj Barua]

Thanks, I m continuing with allupronoil, but have had another attack on the knee again from last night. I m at my wits end because my serum level is 4.4. I had some tofu with black bean sauce, could that have possibly triggered it.

I m drinking lots of water not taking Colchicine or NASIDs because of my liver. Just biting my teeth and continuing with 300 mg of allupronoil. This too shall pass

[Raj Barua]

Ok had to bite the bullet, started with Colchicine and Voveran 75 mg. I m still perplexed why another flare up especially when my uric acid is at 4.4 that is below 5.

Is it because my old crystals in the knee are dissolving. It is in the different areas of the knee.

[Keith Taylor (GoutPal Admin)]

Uric acid crystals grow slowly, and often go unnoticed. When they dissolve, it is usually fast. Partially dissolved crystals often trigger gout attacks in areas that have previously been unaffected. The other point is that gout attacks during uric acid lowering treatment are often quite widespread, whereas gout attacks during untreated gout are usually only in one or two joints.

Please stick with it. The gout attacks will get less frequent and less painful. Drinking skim milk might help get rid of uric acid as it dissolves, but all fluid intake helps. Don’t go overboard with fluid intake – 2.5 to 3 liters is OK unless you are sweating a lot. Keeping warm is also recommended.

[Raj Barua]

Yes, my attacks have been spreading from one area to anohter area in the same knee. Keith, thanks for your support. I am continuing with alluprunoil and colchicine. I am not taking any NASID’s as the pain is bearable. However once in four to five days it really falres up that’s when I gulp a voveran tablet.

But should I continue with NASID’s since it will act as an anti inflamatory, none of the NASID’s (brufen, naproxen) are working. I am scared that NASID’s may affect my kidneys.
And I am alergic to the cox inhibitors which I presume does not have a FDA clearence in the US.

[Keith Taylor (GoutPal Admin)]

I’m not sure about NSAIDs effects on kidneys. Remember, I’m not a doctor. I see my role as helping you understand what your doctor tells you, and also helping you to know what questions to ask your doctor.

Therefore, ask your doctor if your kidneys are at risk. Also, ask why colchicine has not been prescribed on a preventative basis for a few months until you get uric acid stabilized. At one tablet per day, with an extra tablet, if you experience an attack, it is the best way to control gout attacks during the early stages of uric acid lowering treatment. Colchicine is safe at up to two tablets per day. Except for the USA, where it is sold as Colcrys, it is also very cheap.

Anyone who is suffering should read my gout pain freedom article. In this day and age, the only reason for enduring gout pain is medical neglect. 👿

[Raj Barua]

Keith, Colchicine was prescribed but the doctor has asked me to stop taking it as it not very nephro friendly. So with the NASID’s.

I have been asked to discontinue alluprunoil and shift to febuxstat (which according to him is more nephro friendly)and my current uric acid readings as of yesterday is 3.9.

But there is still pain whn i try to walk or bend my knee, and general knee immobility. But there is no acute pain.

My doc has reccomended that because of my LFT and Kidney test I have no choice but to wear the gout out.

Yes I have started drinking skimmed milk. But why have you reccomended that I keep my fluid (water) intake only to 2.5-3 lts. I always though that more the intake the better it is to flush out uric acid.

Best
RB

[Keith Taylor (GoutPal Admin)]

Sorry, I didn’t realize you have kidney disease. That really complicates gout. Best to consult a rheumatologist, but choose one that has experience of managing gout in a patient with kidney problems. Many gout treatments can help diseased kidneys, but this has to be managed on a case-by-case basis, as the cause of kidney disease will be very important.

When you get a good rheumatologist, they can also guide you on fluid intake. Around 3 liters is for people with normal kidney function. I’m not qualified to give medical advice, but I do know what works for most people. I’ve assumed you are a regular gout sufferer, and I never thought about complications from kidney disorders until now. My bad for assuming regular gout. Your bad for not mentioning your kidney problems in the original post. Please let me know what your rheumatologist advises so I can give better help to other kidney impaired gout sufferers in future.

[Raj Barua]

Keith, thanks for your advice. My LFT is a bit abnormal as of now. So the doc has adviced me not to have NASID’s(only SOS). Although the knee has cleared up, within two days of the knee clearing up I had an attack on my left toe. I am continuing wiith alluprunoil and had colchicine for initial day or two of this flare up.

Two days ago there was a lot of swelling on the toe, although the swelling has reduced there is pain. Its been almost seven days since this flare up

[Keith Taylor (GoutPal Admin)]

Thanks for the update, @sidbarua. I think it’s best to focus on controlling uric acid from now on. About 3 weeks ago, your uric acid was below 5. That is the only way to control gout, but it can take several months to get rid of old crystals. The lower you get uric acid, the quicker that happens. It also depends how long you have had gout.

Have you been able to keep uric acid below 5? If so, it’s just a matter of patience. Attacks get less as weeks pass. I hope, like me, you wake up one day, and realize you haven’t had a gout flare for months.

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