[mathman]

Well, I have an update, and it looks like it might be my final one.   I got a work-in appointment with the chief of rheumatology at a local hospital today.  He told me after a thorough examination of my foot, considering that I have pain in about 6 joints, that it's NOT gout.  He's thinking reactive arthritis or ankylosing spondylitis, since I have back problems.  He says that the multiple joint involvement like mine and the fact that my SUA is only 6.5 is strongly indicative that it is NOT gout.  Unfortunately now, my treatment cycle is going to be much harder.  He's trying Celebrex for three weeks, but thinks it's likely going to require methotrexate or a drug that controls rheumatoid arthritis.

Thank you for all your help and encouragement – this is the nicest online community I've been involved with – very kind and helpful.

Take care,

MM

[mathman]

One other question about colchicine … will it still work even though I have been in a state of flare up for a LONG time?  I mean, I've heard it works best when an attack just starts.  Will it still work in these circumstances?

Also, how long will the diarrhea from colchicine last?  What I'm getting at is that I have work this week.  Would it be best to wait until Friday?

Anecdotally, I have found that eat a full pound of strawberries helps significantly.  But if I don't do it every day, the pain comes back.  I've experimented on and off with them … I find this very odd.  It's not a 100% cure, but it helps.

Thanks again,

MM

[mathman]

To answer the questions posed above:

1.  No, I haven't had the joint aspirated.  It's my third toe joint that's the primary culprit, and both doctors have said that those joints are too small to aspirate.  They said it would be painful and that they would not be able to get any fluid out of it due to its small size.  So they say that I have all the clinical presentations of gout, and that through my bloodwork, they've eliminated septic arthritis, cellulitis, rheumatoid, and reactive arthritis.  They say that it has to be gout, even though my highest SUA reading has been 6.5 during this whole time.  Also, it seems to me moving from joint to joint in my toes.  There are days when I have very nearly no pain, and there are days when its excruciating.

2.  Doctor says that colchicine is dangerous.  I think I'll be okay with it, because I'm 6'4″ and weigh 270 lbs.  I don't think that 1 .6 mg pills of colchicine will kill me, but I don't know.  He says that the “doing regime” that colchicine has is dangerous and could land me in the hospital.  I don't know … honestly, he's kind o fscared me into not wanting it because of the danger of overdose.  I'm really conflicted on it.

Thanks agains\ folks, you've been a real lifesaver.  I don't have anybody else in my life to talk to about this, and you folks have been really understanding.

MM

[mathman]

Unfortunately, I don't usually have routine blood tests.  I'm 32, and didn't really do any of this until about a year ago, so I don't have a history of results.

Also, the doctor will not prescribe colchicine because he said there's no proof that they're any better than NSAIDs in the long term.  He also said that colchicine is dangerous because of the quantity of deaths and hospitalizations from overdose.  So I'm stuck with naproxen 3 times a day.

Doctor AND a rheumatologist I've been to say that this is one attack that keeps flaring up – but I've had it for almost 2 months.

This is frustrating.

Thanks,

MM

[mathman]

OK, I have an update.  I got my labs back today.  Now, my foot felt 80% or so better when I had this lab test two days ago, and I have a SUA of 6.4.  So here's the summary:

1st test during horrible attack: 4.6

2nd test during attack (about two weeks later): 5.9

3rd test two days ago (during a very brief period of relief): 6.4

Unfortunately, I'm back in horrific pain again.  That's what this will do – it subsides for a little while and then comes right back.  My doctor is hesitant to put me on allopurinol.  But with a SUA of 6.4, plus all my symptoms, is this enough to say gout for sure and that I need to be on a uric acid lowering drug?

What do you folks think?

MM

[mathman]

1.  The only issue that I have with colchicine is its toxicity … I've heard of people dying from a dose as low as 6.0 mg.  My tablets are in .6 mg form.  16 sounds like it could be a fatal overdose, and I don't want that.  Honestly, with as much as my GP scared me about taking it, I'm kind of afraid to take colchicine …

2.  Everything's changed in the last two days … I have no problem walking.  The last (minor, but still annoying) pain I have is the middle of my 3rd and 4th toe joint are swollen, red, and painful.  The MTP joints are no longer inflamed, and are not really too stiff (they are a little still).  Can gout “migrate” like this?

Thanks!

[mathman]

I've tried baking soda and it doesn't really do much for me.  The only successful therapy I've found is oral or injected steroids.  The rheumatologist I have right now doesn't want to really do anything else.  Couple more questions:

1.  This is my first attack.  How common is a multijoint first attack?  I have it in my 3rd and 4th toe at the joint and at the tip.  Also, my 5th toe at the joint is affected.  My foot is HUGELY swollen.

2.  Colchicine seems to help others – didn't do anything for me.  Any ideas why?

3.  My uric acid level is 5.9 currently … is this high enough for an attack?

4.  Most importantly – what should I do?  Natural remedies don't work, and only steroids give me relief.  Can't be on those for long …

MM

[mathman]

Thanks for replying.  Let me answer your questions:

1.  The rash is red, like prickly heat.  It is directly in the center of my foot – not ON the joint, but close enough.

2.  Unfortunately, I'm a teacher, so I'm on my feet all the day.  Can't take off … but I'm worried because this has been going on for almost two months.  I said in my previous post that I was concerned about the length of the attack … and I'm suspicious overall that it is gout at all because of the fact that my SUA is only 5.9.

3.  Colchicine doesn't do anything.  I took 3 pills a day for three days and got no relief at all.

I really do appreciate the input.  Although I'm not happy there are others, it is nice to have the support.  This has been the most miserable month of my life. 🙁

[Author]

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