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Five months ago I contracted gout in the right great toe together with a severe infection which became gangrenous. Subsequently I had three debridement operations and the resulting wound is still being treated.Since the initial event I have consistently been experiencing got pains (twitching around the toe area together with the top of the foot, together with occasional throbbing). Over the last two weeks I have had a further two bad attacks accompanied with stiffness and soreness of all major joints ( I am arthritic) together with shivering.
Despite being careful with my diet my uric acid level is around 8 mg/dL and I feel that it is time to commence taking alloprurinol. However I have read that it is not a good idea to commence with allopurinol until gout has abated. I intend therefore to request a prescriptionn of colchicine to allow the gout to settle down before commencing with the allopurinol.
Comments from those with experience would be appreciated. Many thanks
Yes, alyboy, that is a good approach.
I find colchicine supported by an anti-inflammatory is the quickest answer, as colchicine slows the increase in inflammation but does not provide pain-relief. A week, or even two or three days, on such a combo should ensure that gout pain is gone, or very much reduced.
Once inflammation has subsided, you can stop the anti-inflammatory, but continue with colchicine for around two weeks. If you have a change in allopurinol dose, it is good to go back on one or two colchicine for one or two weeks which will reduce the chance and severity of more attacks. If you do get an attack, return to the colchicine plus anti-inflammatory to fix it.
Good luck with getting your uric acid down to 5mg/dL. I am down to 3mg/dL for a few months to speed up dissolving old crystals. I THINK it is working, but early days yet – I'll report back in a couple of months, when I'm hoping the tophi shrinking will be noticeable.
Yes, alyboy, that is a good approach.
I find colchicine supported by an anti-inflammatory is the quickest answer, as colchicine slows the increase in inflammation but does not provide pain-relief. A week, or even two or three days, on such a combo should ensure that gout pain is gone, or very much reduced.
Once inflammation has subsided, you can stop the anti-inflammatory, but continue with colchicine for around two weeks. If you have a change in allopurinol dose, it is good to go back on one or two colchicine for one or two weeks which will reduce the chance and severity of more attacks. If you do get an attack, return to the colchicine plus anti-inflammatory to fix it.
Good luck with getting your uric acid down to 5mg/dL. I am down to 3mg/dL for a few months to speed up dissolving old crystals. I THINK it is working, but early days yet ? I’ll report back in a couple of months, when I’m hoping the tophi shrinking will be noticeable.
Keith (Gout Admin) said:
Yes, alyboy, that is a good approach.
(1) I find colchicine supported by an anti-inflammatory is the quickest answer, as colchicine slows the increase in inflammation but does not provide pain-relief.
(2) ?stop the anti-inflammatory, but continue with colchicine for around two weeks. If you have a change in allopurinol dose, it is good to go back on one or two colchicine for one or two weeks which will reduce the chance and severity of more attacks.
(3) If you do get an attack, return to the colchicine plus anti-inflammatory to fix it?.
Keith, I think you are confusing the facts and the guy.
?(1) Colchicine IS the anti-inflammatory. You said yourself: ?”???
as colchicine slows the increase in inflammation but does not provide pain-relief?.” and you probably meant to say: “??
supported by a pain-relief medication. like Naproxen or Aleve is the quickest answer
?”
(2) I think you meant to say: ” ?stop the pain relief med, but continue with colchicine for around two weeks?.”
(3) Don't you want to say: “If you do get an attack, return to the colchicine plus a pain-relief medication to fix it?.” ?
alyboy,
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Given your history it sounds like you are very much into the chronic gout stage, unending discomfort, considerable tophaceous deposits requiring debvridement.
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I think it is unwise for you to put off starting extreme anti-uric acid formation?measures (like allopurinol.) Perhaps even WITH a uricosuric like probenicid.
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With chronic gout, awaiting a time when you are symptom free may simply delay treatment for an extremely long time while gout goes on causing more and more damage.
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I think a proper serum urate goal for you might be under 4.0 mg./dL. (Don't bother with 100 mg. dosing with allopurinol…it will serve no purpose other than to cause you more pain.)
@alyboy – Was your second post a mistake? Should I delete it?
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@hansinnm – Do you want moderator rights so you can correct my posts? (Thank you for clarification)?
@zip2play – Is it not worth a short period on 100mg just to rule out hypersensitivity? I know it is rare, but the consequences seem pretty dire to me. How would you handle the risk?Keith (Gout Admin) said:
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@hansinnm – Do you want moderator rights so you can correct my posts? (Thank you for clarification)?…
Hell NO,?Keith !!!
I can hardly moderate my own life
, let alone YOU and your website
.I thought you might appreciate not having incorrect statements of yours tainting your otherwise excellent gout forum.
This is only for your eyes, Keith: I would have PM'd you instead of exposing it to the general public if we still had that feature.
Keith, I have changed my mind. I'll take on the moderator job and and save you time and energy so that you can keep the forum and me straight and I'll deal with the scam artists. Mother Nature has given me lately so many adrenaline shots on the lake, I've got to get rid of some of that energy.
Hans, you saved my life – or at least my short vacation.
You now have special powers in the form of a little spanner next to the profile button on the line above the message. Edit or delete as you think fit. I'm sure you'll be kind to those who make genuine mistakes and ruthless with those who are trying to abuse us.
I am back at the weekend, but will be checking my emails daily.
Gotta go now before I start making declarations of undying love
Keith (Gout Admin) said:
Hans, you saved my life – or at least my short vacation.
You now have special powers in the form of a little spanner next to the profile button on the line above the message. Edit or delete as you think fit. I'm sure you'll be kind to those who make genuine mistakes and ruthless with those who are trying to abuse us.
I am back at the weekend, but will be checking my emails daily.
Gotta go now before I start making declarations of undying love
Thank you, Keith, for your vote of confidence. Enjoy whatever is left of your vacation. You need not worry about ??
“making declarations of undying love“. You aught to know, there is NO “undying love”. It dies with you the moment you take your last breath. I'll be content and satisfied with declarations of just plain love.And you may RIP that I will/shall NOT tamper with any gouties' posts/comments.
hansinnm said:
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And you may RIP that I will/shall NOT tamper with any gouties' posts/comments.
Good to hear Hans. If I was coming to this forum for the first time (in pain) I don't think I'd be too impressed with threats of censorship and editing if my enquiry or spelling & punctuation wasn't up to scratch.
Aaaaaah, that's better.? Better go & take a smileypurinol now, just in case
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Dear Keith,?
Sorry for the late response but thanks for your advice, Yep, I was a little confused but understood that what you were saying was that the medication should be colchicine supported by an NSAID. This recommendation is fine, but of course one has to have the support of the medical profession to have it prescribed. I interviewed my GP yesterday and he has agreed to prescribe colchicine and dicofenac. I am taking both twice daily and find the most benefit from the latter,
Concerning Zip2play's comments I had come to the conclusion that the best course of action would be to commence allopurinol as soon as possible and this has now been agreed with the GP, although on the minimum dosage of 100mg
I don't fully appreciate Hansinn's comments as I understand that naproxen is also an NSAID, ie an anti-inflammatory.
I am new to these games, both forums and gout, and it is my understanding that the pain of gout comes from the build up of uric acid crystals (tophi) in the joints which the body sees as an invader the result of which causes inflammation and eventual pain, and getting rid of the inflammation, gets rid of the pain.
My previous understanding was that to get rid of the gout one's UA should be below 6.0mg/dL but from your posts I see that you indicate that it should be below 4 or 5!! Recommendations as to how this can best be achieved would be appreciated.
I have found it difficult to find useful and genuine information on this subject and it was a relief to stumble upon 'GoutPal'. It is an excellent and informative site covering a much neglected subject. Thank you all for your interactions. I note that my original post has generated a lot of correspondence outside of the main subject and trust that this has not been a problem.
Yes, Keith, my second post was in error. My DELL decide to go its own way! Please delete it Keith.
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