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Hello all,
This is my very first post, so please bear with me ;-).?
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My doctor put me on allopurinol about 4 months ago.? I went from an average reading of about 9 (sometimes several points higher) to an average of just below six.? I developed some ankle foot problems a couple weeks ago that my doctor thinks was gout, but?diagnosis is based on the fact that my foot was painful and swollen, nothing more.? The highest uric acid level I've seen in weeks is 6.1. (several lab tests, and i do have a meter at home).?
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So, here's what I'm thinking:? I wonder how many times that other medical conditions? (e.g. pseudo gout, or some other?form/type of arthritis).???I think many/most of my past flare ups (over the years) truly were gout.? But, this one just felt, acted different.
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Besides,?I know of NO reason a person couldn't have both gout and pseudo gout, Psoriatic, RA, or some other condition.??
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From my understanding the only way you would know for certain is to extract crystals (if there were any) and examine them (or, is that incorrect)??
Yes, it is true that multiple arthritic conditions can, and frequently do, affect the same joints.
The joint fluid analysis test is the only common way to be almost certain about what is causing inflammation. I say “almost” because it is not 100% certain. The common pitfalls are inexperienced testers, leaving fluid too long between extraction and analysis, and insufficient volume to perform adequate testing.
The only certain way is advanced scanning techniques ? search for DECT in the box at the top of the page to see more information and discussions about it. Unfortunately these test facilities are very rare (and my attempts to glean more information from Siemens about active locations have fallen on deaf ears ? or blind eyes)
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For all practical purposes, a commonsense approach is best. If six months on uric acid lowering meds, at sufficient dose to maintain uric acid below 5mg/dL, do not produce a significant improvement in symptoms, then investigate for something else.
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I just realized that six months of pain is ridiculous. Gout pain should go away in a week or less. If it does not, then investigate for something else, but the lower level of uric acid is important. 6.1 should be good enough, but it does not allow enough margin for natural fluctuations. 5 is the new standard, and I am slowly changing all my references to safe levels from 6 to 5.
Over the past few years, I've had at least 9/10 episodes that were diagnosed as gout (by four different doctors, including one rheumatologist).? Some of these episodes lingered as long as 2-3 months.!
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After one or two painful events, I jumped on the Internet and started reading everything I could about gout (including visits to this site
).? The more I read, the more I considered possibilities other than gout.??
I find it absolutely amazing (and disappointing) that two of the four diagnoses were based on visual appearance only!? I mean, that is probably prudent, if it?s the patient rarely has an episode/problem.? But, I would have thought that before placing a patient on ANY long term, gout medication the an attempt to positively identify the condition would be attempted.???
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So, here I am, after nearly a dozen episodes (attacks, injuries, whatever), and after visiting 4 doctors, without any reliable diagnosis (at least, as far as I?m concerned).? Heck, they haven?t even x-rayed the foot (for all I know, I could have a fracture).? The only diagnostics that have ever been performed is serum uric acid (which was always on the high side?but, not always above upper norm limit).?
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Since, this last?episode?(again, for lack of a better term), the doctor is talking about switching me from allopurinol, to uloric??
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It?s pretty darn frustrating to know I might be popping gout medication for the rest of my life,?and?it may not end my pain (I may not have gout)
. ??laerley said:
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Since, this last episode (again, for lack of a better term), the doctor is talking about switching me from allopurinol, to uloric?
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Don't let a pill pusher switch you to a $5 pill. The only sane reason to go from Allopurinol to Uloric is severe allergy to Allo. NOTHING ELSE! There is a 40-50 year proven history that Allo WILL control your gout, IF YOU HAVE GOUT.
hansinnm said:
laerley said:
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Since, this last episode (again, for lack of a better term), the doctor is talking about switching me from allopurinol, to uloric?
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Don't let a pill pusher switch you to a $5 pill. The only sane reason to go from Allopurinol to Uloric is severe allergy to Allo. NOTHING ELSE! There is a 40-50 year proven history that Allo WILL control your gout, IF YOU HAVE GOUT.
I think at least some of the event's I experienced were most likely gout flares.? However, my feeling is that not all were gout.?
I'm not afraid to tell me doctor “no.”?;-)? And, I have simply refused some medications and/or medical diagnostics/procedures.??I told him the other day that I didn't understand why I should switch from allopurinol to uloric.? Especially when considering that I'm only taking 150 mg?(yes, I cut one pill in half).? After reading Keith's post above, I think I will increase the dosage a little, in an attempt to get my UA down to 5.?
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