Gout attack for 2 months – help!

[algout]

Hi all, hoping someone can help me.  I've been a gout sufferer for about 10 years, taking 300mg allopurinol per day.  A few months ago I fell out of the routine of taking my allopurinol and had an attack.  I went back to my doctor and he said start retaking allopurinol immediately.  I've been taking everyday with diclofenac anti-inflammatories for 2 months but the gout attack has not subsided.  I have pain in my left big toe, top of my right foot and in left ankle, to the point where I am limping and today cannot put weight on my left ankle.  After 6 weeks I went back to the doctor but he said carry on and come back in 2 weeks.  Should it take this long for the allopurinol to bring my uric acid levels down?  I understand the allopurinol may have caused initial attacks as it was begun again so close to my first attack, but I expected the attack to have calmed down by now.  Has anyone had a continual gout attack for 2 months?  I haven't been able to walk properly for 2 months, any ideas what to do?  I intend to go back to my doctor this week.

Any help much appreciated.

[zip2play]

No, I haven't ever had anything approaching such an attack, but then I would never consider the folly of stopping my allopurinol (wink!) I guess you won't either. Once on allopurinol, one must be committed to it and our doctors should be cautioning us of the dangers of going off it.

You have to stop this attack and diclofenac is clearly NOT doing the trick, nor is waiting for it to stop on its own.

Do the zip regimen (and all good doctors' regimen a couple decades ago.) Take 2 colchicine tablets first thing in the morning and then 1 every hour until one of the following occurs:

1. Your pain stops

2. Extreme diarrhea begins

3. You reach a total colchicine count of 16.

 Alas, you will need an Rx from your doctor for the colchicine…be insistent. All the while continue the allopurinol.

Question: How long had you stopped the allopurinol before the onset of this attack? Had it been doing a good job of controlling your uric acid levels and stopping acute attacks?

[algout]

Thanks for the advice zip. 

Yes the allopurinol had been doing a good job.  Also in the past if I had an attack, diclofenac would have cleared it quickly.  I've been surprised that this attack has not got better at all, in fact the pain has spread to both feet (big toes, top of foot toe joints and ball of feet) and my ankle, and has got increasingly worse to the point where I cannot walk today. I achy in other areas too, e.g. top of thigh joints. 

Also, something different on this occasion is that I am taking a medication called depakote for another ailment.  I am wondering if this medication can inhibit diclofenac or allopurinol working, anyone ever come across this?

Thanks

[zip2play]

Depakote can have a  unintended consequences though not commonly pain (except abdominal)but it's possible your diffuse pain is not gout or at least not ALL gout. It's not usual for gout to be so widespread.

Depakot and diclofenac can both cause unusual bleeding but I don't think there's any interaction with allopurinol.

With gout it is quite common to have an analgesic that USED to work well stop working. It's just an indication that your gout has likely gotten worse.

Can you stop the depakote for a week or two  without getting in harm's way. Have you been on it long.

Make sure that if you do a run with colchicine your doctor signs off on any  interactions with the depakote. I doubt there are any but it's probably not a combo that is encountered very often. Maybe the intestinal consequences might be more severe?

[sirlimpsalot]

Algout,

your issues sound similar to mine. Moving all around the feet from one to another and then even in both. Balls of feet achilles tendon big to and top of foot. I have wondered if mine was not gout too but I think it can act very differently in individuals. Mine has been mostly in attack mode since August of this year with a few better days (meaning I still limp but can wear shoes). Hang in there. It is difficult. These guys on here are great and provide a real service. The have helped me keep my sanity dealing with all the pain and the unknown. Much more help than my doctors have provided. The colchicine method zip refers to is the route I took. I demanded it from my doctor. He seemed to think it was a somewhat medieval approach – but I found it does work fairly well. I only made it to 9 or 10 before great sickness, but after the sickness was relief. For me, I was also throwing up too. Not fun, but I didn't have pain at all for a few days. You can find out what works for you. I think the key is riding out the next month or so and making sure to ALWAYS TAKE THE ALLOPURINOL. 

Don't lose hope 🙂

[Keith Taylor (GoutPal Admin)]

There is something seriously missing from this thread.

I've already mentioned elsewhere that it does not make a great song but…..

Allopurinol and uric acid numbers
Aloopurinol and uric acid numbers
Go together like a horse and carriage.

Told you it wouldn't work, but I hope the message isn't lost in the tomfoolery.

Allopurinol ONLY helps gout if you use it to lower uric acid levels below 6mg/dL

What are your numbers, algout?

---

Oops! On second thoughts, this does not quite work.

You can have one without the other.

Uric acid test without allopurinol is perfectly OK, depending on your management plan.

Allopurinol without uric acid test is definitely not OK.

You MUST know your numbers, especially if you are taking meds or making lifestyle changes to reduce uric acid.

[algout]

Hi All

Thanks again for replies – thought I'd come back on to update you as I've been on a journey to various doctors!

I had my serum urate level checked and it came out, to everyone's surprise at 0.30 mmol/L – within healthy range so not gout this time.  The doctors did further blood tests, highlights were eGFR=60 ml/minute, ESR=25, RF negative and serum creatinine=128. 

I was referred to a rheumatologist and have been diagnosed with psoriatic arthritis – I do suffer with psoriasis but as the pain was so similar to gout I never assumed this was related.

Have any other gout sufferers here also been diagnosed with psoriatic arthritis??  The treatment – methothrexate – seems severe so I'm looking for alternative treatments etc. 

Thanks in advance…

[sirlimpsalot]

Hi Algout,

So is it occurring in the tips of you fingers or your toes…I bilieve that is the most common area for psoriatic arthritis to attack. I am still puzzled, but hope you are doing well. As for me, I have followed the advice that I have gotten on this site religiously and it has turned my life around. My feet feel NORMAL today, save a small twinge in my Achilles tendon at the base. I hope you get back to where you were before November soon.

Take care 🙂 

[mecandelaria]

Hi Algout,

I have been dealing with gout for two years now. Have you tried Bitter Melon Tea? I am a Martial Artist. and because of gout I stop training for a while. My doctor has me taking Allopurinol 300mg a day and colchicine when I have a had bad flare ups. I have one friend in Hawaii that turn me on to this Bitter Melon tea. I use 3 tea bags  gal hot let it sit till cools down. I drink this tea all day long.

It has help me alot. Keep a clean gout diet you will do fine. Super Bowl Sunday a had a few beers.

Wrong answer, my gout flared up. I soak my foot in 2 cups Apple cider vinegar and drank only tea and water.and in 3 days I was able to walk again.

[zip2play]

Algout,

I think we have a case here for Dr. House.

Tell me how they came up with the original gout diagnosis?

Tell me how your rheumatologist decided your pain was now from psoriatic arthritis…other than the fact that you have psoriasis.

I have no clue how they do a differential diagnosis. If purely on the basis of SUA then it should be measured after being off allopurinol for several weeks?

Are their specific markers for psoriatic arthritis?

Is there any indication you suffer from BOTH conditions?

Poor zip is very confused here…and not completely unskeptical.

Elsevier has a differential diagnosis between the two but they want a FORTUNE to read it.

[Author]

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