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Hi
I’m not a gout sufferer myself, but my husband is!!! He had his first attack almost 8 years ago after a week away on a course from work with mates, and the typical binge drinking each night that tends to accompany these occasions. He was given diclofenac to resolve this attack, and then told to take it as and when he needed to. Since then he has not had many attacks, but the ones he has had tend to flare up about 10-14 days following a binge drinking session. This may just be a coincidence, but it does seem to follow the same pattern each time.
From this, rightly, or wrongly, I make the assumption that his gout is triggered by binge drinking. He has been a heavy drinker prior to, and immediately following the first gout attack, but has now decreased it substantially to within normal limits within a normal week – and usually drinks red wine. He does, however, still tend to binge on nights out occasionally and on holidays for the week.
Just over a year ago he was prescribed allopurinol 100mg by his gp following a severe gout attack, which incidentally, occurred in January after a couple of weeks holiday drinking over christmas and new year of bitter, red wine and sherry. During the first few months of taking the allopurinol he did get a few gout attacks, which then seemed to calm down after a few months. Then in October, he got another attack in the usual big toe joint, which was followed by one in the ankle of the same foot. This got so bad, it resulted in a trip to hospital on a Sunday afternoon, where numerous tests were run and he was told he had an infection and given antibiotics to clear it, which was successful. This last attack did actually follow the death of his father at the end of August, my 50th birthday celebrations, and a weeks cruise. He was then clear of attacks for a few weeks. However, then along came a works christmas do, then the christmas period, followed by a weekend away of 3 nights out – and into February along comes another ankle problem like the last one. We’re now into March, and still it continues. On visiting his doctor a couple of weeks ago and again earlier this week, it is suggested that he has achilles tendonitis. I make it my business to learn what I can about gout, and have discovered that this can be diagnosed by mistake – when the gout pain is mistaken for achilles tendonitis as gout becomes a chronic condition instead of the acute condition that we all know.
What does anyone else think? Has anyone else had any similar experience?Hi marud,
There is a lot of nonsense talked about gout, both inside and outside the medical profession. It is not a drinking disorder or an eating disorder, it is simply an excess of uric acid.
There are many reasons for excess uric acid, some of which may involve food and drink, but that is not the point.If you visit the dentist with a cavity, he does not say, that is from too much sugar in your diet, so cut out the sweet stuff and all will be well. He fixes the problem, and if you are lucky, you get advice on how to prevent it in future. So it is with gout – fix the excess uric acid problem as a priority, then look at possible causes and see if they can be avoided in future.
It speaks volumes to me that you have not mentioned your husbands uric acid level, but this is the most important thing. It has to be 5mg/dL (0.30mmol/L) or below. Many doctors do not understand this, so they suggest other things. Tendonitis is a possibility, but if it exists it is almost certainly caused by your husband’s gout.
There are very few cases where 100mg allopurinol is sufficient to lower uric acid to a safe level. It is vital that you find the latest test result value, and insist on dose increases and retests until uric acid is down to 5 or below. There is always the risk of further attacks until your husband has had several months at a safe level, so use colchicine supported with an anti-inflammatory such as naproxen or ibuprofen. This can be daily as a preventative for a few weeks, then as required.
A gout attack in an ankle is a VERY common early acute attack site. In fact my second attack was right there, even before the big toe.
Of coursee I believe that NOBODY will get any relief from 100 mg. allopurinol. I do hope your husband is not still on that dosage. The thought of someone on 100 mg. allopurinol for a year sends shivers up my spine.
A doctor’s guesstimate of “Achilles tendonitis” is just that. And acually an acute gout attack in the Achilles tendon is very much TENDONITIS, an inflamed tendon.
Get his blood tested and see if he is getting the desired low uric acid, below 5.0 mg./dL. On 100 mg. allopurinol, I very much doubt it.
(Consider a new doctor. Mr. Achilles Tendonitis sounds dubious.)
I will second that..i had my first attack in my left ankle….then my right ankle …and i didnt know what it was until 5 years later ( 1 month ago) uric acid 10 and i go back for an update on tuesday..then i will TELL the doctor what dose of Allopurinol i should be on. By the was t that Colcochine is brilliant for stopping an attack..i have had two “early morning wake up calls” and popped a couple of them and then one an hour later and the pain dies away…fabulous..
I’ll add my voice to the “gout is common in the ankle” call. Unluckily for me, the first doctor I saw, all those years ago, ruled out gout because it hit my ankle, and I never had a toe problem.
Only a theory, but I put this down to a lot of driving at the time, with my ankles being the lowest part of my body for hours a day. In the end, it doesn’t much matter – as jasper65 says – you have to insist on a high enough dose of allopurinol.
Hi Keith
Many thanks for your reply, it has been very enlightening. We have a uric acid meter at home, as my husband’s uric acid level doesnt seem to get checked by his doctor very often. But it also means that we can keep a check on this level. Most of the time his level is between 5 and 5.5, though we do get lower readings at times. However it does appear to be teetering on the edge of what it needs to be below, so maybe it does seem that he needs a larger does of allopurinol. He has also had some high readings – these have generally followed a night out ( it was 9.7 the day after a works Christmas do, and took a while to settle again), or on return from holiday. The reason I associated it with drinking alcohol was because each attack that occurs tends to be 10 -14 days after heavy drinking sessions. The previous attack in his ankle in November was put down as being an infection in his blood? He was given antibiotics and it cleared up. This current ankle problem appears to be very similar to the last one, but much more severe and long lasting, and again, occurred a couple of weeks after several heavy drinking sessions. My husband has got antibiotics again, but they don’t seem to be having much of an effect this time. He’s also got 30/500 cocodamol which are not helping the pain, and he’s resorting to using a stick to aid his mobility. Do you have any suggestions that may help?In my personal experience, and from reading several studies, the biggest problem from alcohol is a tendency to forget the pills. If allopurinol is forgotten for one day, this is not a big problem, but if it happens on consecutive days, or more than two or three times a week, then the dose might become ineffective.
Your doctor has a professional responsibility to run blood tests for patients on any uric acid lowering treatment. Uric acid is important, but so are liver and kidney function. Maybe you need to remind him of this responsibility – no need to start a war at first, but be firm, because this is serious.
I have used home uric acid testers in the past, but no longer use mine as I have given the responsibility back to the doctor. When I did use it, I was careful to compare my readings with “official” results. It is too easy to get into bad testing habits with insufficient blood drop size leading to results being understated.
My biggest worry is the blood infection and antibiotics. Gout can be mistaken for septic arthritis, but it can also occur at the same time. It is vital to get this treated properly, by a rheumatologist. I am concerned that, if antibiotics were not effective (or have been missed??), then the infection will get stronger. I’d recommend a visit to a rheumatologist with some urgency.
The main issue here is dealing with the ankle pain that might be gout, might be septic arthritis, or might be a combination of both. However, marud has raised the subject of alcohol, so I may as well mention some thoughts that have occured to me.
Firstly, alcohol, though a mood lifter in moderation, has a tendency to promote depression when taken in high volumes. This makes the managment of gout difficult, becuase without a clear head, and a determined plan, it is hard to fight gout, or any other pain-related condition. There is a tendency amongst some drinkers, myself included, to over-indulge when the pain gets bad. Unfortunately, the temporary relief of a good drink session does not last, and there is another more important aspect.
I have noticed that prolonged drinking promotes aching joints. This is personal research, and I have not investigated published medical literature. I have found it to be repeatable, and noticeable. During busy social periods, I have noticed my walking was impaired by stiff joints. After a couple of days without a drink, the stiffness disappeared. I do believe this was something other than gout, and friends have mentioned similar experiences after several days partying.
As I said, it is better to keep this thread to ankle related problems, but just search for alcohol in the search box at the top of the screen for more relevant discussions.
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