Where did you get pain after taking Allopurinol?

[deano]

Pain after taking Allopurinol?

Hi,
I am new to this forum and new to gout. I am 47 years old and had bunion surgery about 8 weeks ago; the surgeon and I were surprised that he found a lot of uric acid crystals in my foot. He said this is a positive identification of tophaceous gout and put me on 300 mg/day allopurinol and gave me a prescription for indomethacin for flare-ups after starting the treatment, this started 6 weeks ago.

Incidentally, the surgeon showed me a photo of the gout and the crystals were not only in the joint, but all along the bone also. He showed me permanent damage to the toe joint and said I may have to have a joint replacement in the future because of the gout damage. For these reasons, I will not stop taking allopurinol.

About 3 weeks after starting allopurinol, I had a major flare-up at the toe I had surgery on and took 3 indomethacin a day for 3 days and have continued with 2/day since. Since the first major flare-up after surgery, I have had pain increase in many parts of my body and would like to know if this is caused by my gout crystals dissolving? I have pain at times in both feet and it runs up the back of my leg about 6 inches, in both knees, my hands and elbows; I would expect all of these.

I also have pain in my lower back and once or twice in my shoulders, these I am unsure if it is gout related. I had a major flare-up at week 5 after starting allopurinol and had major pain at all of the joints listed above. I have had more pain at my big toe in the past but with it being localized to one area (say a 7 out of 10 on the pain scale), the pain in multiple locations (say 5 out of 10 on the pain scale in many locations) was worse because of all the different places that hurt.

This leads me to a few questions for those who have more experience with gout:
1. can pain in the lower back and shoulders be from gout?
2. is it normal to have pain at many locations after starting allopurinol?
3. any idea how long the pain will last?

My uric acid # was 7.9 at the start of allopurinol and I have not had it checked since.
Thanks in advance for your replies and help,
Dean

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Are you careful when Starting Allopurinol?

[healeyguy]

Hello and welcome.

I first started treating my gout about 12 months ago. I had/have tophi on the helix of my ear. I started with 200mg of Allopurinol and now am taking 400mg. When first taking the Allopurinol, I was caught off guard by the extent and severity of the flare-ups. I experienced flare-ups in my heals, elbows, fingers, toes and wrists. I don’t recall feeling pain in my back or neck. I’m 53 and it felt like i had aged 20 years in a short period. The worst pain for me was in the tendons in both my arms. It was debilitating to a point that I had a hard time lifting a cup of coffee.

Indomethicin is a Godsend. However, I was/am very conscious about the impact of longterm use on the kidneys and monitor my Creatine frequently. I also took colchicine daily during the bouts.

With respect to how long the body will take to “flush” the crystals, that’s the magic question and one your not likely to get a satisfactory answer to. After 12 months, the severity of my pain is much diminished but, I still have nagging irritations in my fingers and occasionally in my elbows. I’ve recently started taking magnesium and have gone gluton free to see if perhaps this will help. I’m very conscious of my diet (no red meat, seafood and beer)

My UA levels were never stratospheric and are currently well under 3 and have been for quite some time. I’m surprised that I still have some joint pain. Like you, I never knew I had gout and found out when i had a big pain in my toe. I’d had this pain before for many years and thought it was an old injury from the past.

So, the long and short of it is, it does get better with time but, I don’t think anybody is going to be able to give you a definitive answer as to when the pain stops. Until that time, the cure is worse than the actual disease.

Good luck

[hansinnm]

Dean
Healyguy answered some of your questions.

Ad 1: That possibility does exist; however, it is very unlikely. Neck, shoulder, upper, middle, lower back pain can generally have multiple causes; I would not even venture to guess their origin. More later on.
Ad 2: Basically, YES, however, difficult to predict, depending on a person’s life style and gout and health history.
Ad 3: Same as #2.
Your UA level is too high. You MUST get down to or below 5 mg/dL Forget about diet, exercise and all those recommended money-sucking health pills, powders, liquids & juices. Live normally, don’t eat and drink in excess. You MUST, however, take a prescription drug which reduces and keeps your UA level around 5 mg/dL. At the present, only Allopurinol and Uloric are readily available (to my knowledge.) There are other drugs which flush out excess UA, e.g. Probenecid, but it’s smarter to eliminate the cause rather than treat the symptoms. Chances are that you may have to take the drug for lifetime; however again, this is not written in stone, except when you get to 60/70 and had gout for 20-30 years to build up in your entire body.
My advice: 1) Get an experienced rheumatologist who will work with and for you, not the other way around, as many doctors want their patients to behave. 2) Have your UA level reduced to 5 mg/dL or below. 3) Have regular blood tests done. While you have the blood tests done, make sure that a ?Comprehensive Metabolic Panel” test is also done. This will assure the doctor and you that your liver and kidneys are healthy. (Those organs can be adversely affected by the medications.) 4) Do take Colchicine (to fight inflammation) and Indomethacin, or Naproxen, or Aleve (to fight severe pain) only as much (1-2/day) as is necessary. The time period may be 6 to 10 to 14 days, depending on the goutie’s history and the severity of the attack. 5) Enjoy the goodies of life, but not in excess of anything.

Ad 1: MSM (Methylsulfonylmethane) has proven itself to reduce joint pains considerably. I am living proof. I have taken it for nearly 3 years now and have practically eliminated all, and I mean ALL, joint pains. I started with 1 gram. Increased it to 5 grams after ~2 weeks, and for the last month I have taken 10 grams each day without any side effects. I am on medication to control Prostate cancer and fight metastasized bone cancer. Do check out MSM on the Internet. The best (most inexpensive) source, I found, is: AllStarHealth.com, 1-800-875-8989. I recommend MSM straight, not mixed with anything else.

Good luck with your fight and control of your gout. You do know, once you got GOUT, you got it for LIFE.

[Tavery]

@Deano
You have uric crystal everywhere, not just the places it shows/hurts. So as those crystals dissolve back into liquid uric acid you will experience flares and pain in many location. That said, that phase is normally measured in days so if its not getting better then there may be more.

More?

Yeah, depends on what else is going on you didn’t mention. Frequently people who are diagnosed with gout will make several changes at once. Their diet changes, they start exercising more, weight begins to drop off, they started some other medications for other conditions diagnosed at the same time and other things that would all play a factor.

Additionally, you didn’t state your dose. A 7.9 to me would warrant a dose of 300 or less once per day. I started off at 100mg daily before ramping up to 300 after a year or so. A big dose right out of the gate can cause a large amount of change in your uric acid levels.

Spend the money on the home kit. Its worth it. Test once a week at first in the morning after your shower (or at least make sure your hands are real clean), but before eating. This should give you a consistent sample to compare to other test results.

One last thought – pain in your lower back and shoulders could very well be from changing the way you walk because of the pain in your big toe. My back hurt like hell because I was trying to keep pressure off my foot when standing.

[deano]

Thanks everyone for the responses, they are helpful and will change my treatment plan…I am setting up for another doctor visit to get my uric acid levels checked along with kidney and liver function, I will give my general practioner a chance at this because she explains things well and listens to me. I plan on being on allopurinol for the rest of my life unless there are complications.
I have heard of Colchicine, can I take it along with Indomethacin and can I take it daily? What are your suggestions around this? I am currently taking 2 indomethacin a day, I tried to back off on this last week and had a severe attack.
I intentionally stopped limping today and the lower back pain is much less so I believe you are correct (Tavery) and I will check on a home UA meter.
Thanks again, it is just nice to have someone to discuss this with!
Dean

[Richard]

Hi,I suffered a bout of gout and was prescribed allopurinol,I was perhaps a little haphazard in taking allopurinol regularly.i suffered another attack.i was then prescribed anti inflammatorys to deal with the swelling,ever since taking allopurinol I have suffered with severe pain in both elbows,I was treated for tennis elbow,the pain was affecting my work etc My doctor prescribed me exactly the same anti inflammatorys for my elbow????? I realised that the two problems were connected,I stopped my allopurinol and hey ho,my elbows are pain free. I am taking my anti inflammatorys at the moment but I am expecting the gout to flare up in the future.Back to the drawing board,at least I’m able to lift a cup without pain!

[Keith Taylor]

Richard, I hope you realize, you’re dicing with death. Lifting a cup without pain is good, but allowing excess uric acid to destroy your body isn’t. When tennis elbow is caused by tennis, it’s an indication that you need to exercise differently. When tennis elbow is caused by gout, it’s an indication you’re in serious trouble.

Watch the Allopurinol for Gout video to see the dangers of stopping allopurinol without a good alternative plan.

I highly recommend that you start a new topic about tennis elbow and gout. Then work towards a proper treatment plan before gout ruins your life.

[Benedict]

Just to add my 2 pence worth…I’m 37 and had a nasty Gout attack last November (I’ve had minor attacks for the last 12 years). After getting it under control I started on Allopurinol 100mg and Colchicine 2 * 50 daily. Initially, my uric acid levels were about 7.7 mg/dl but have now dropped to 3. I increased the Allopurinol to 200mg a month ago and am now on 300mg daily. Every now and then I felt twinges, slight pain at which point I’d have Colchicine 2 * 50 to stop any pending attack. Although now I am wondering with my uric acid levels quite low whether the twinges are crystals dissolving away, or in fact damaged joints (caused by the crystals) – the twinging increases after a lot of walking or exercising. I’m going to try and stop the Colchicine (I’ve been on it daily for a few months now) as it’s not good for my immune system and only take it if I get pain that’s more than twinges.

Anyway sorry, I started waffling. All I would suggest is continue with the Allopurinol (with some colchicine and NSAIDs or paracetamol) and slowly reduce the latter two. Otherwise, a build up of uric acid crystals can cause very serious health issues besides gout. It is a long term strategy so please read case studies and work with your doctor and the knowledge people on this forum to design a plan suitable for you.

[Keith Taylor]

Thanks for your input, Benedict, and for your update.

I think you are right to try and stop colchicine now, though you can always try it later if inflammation gets out of control without it. Exercising is generally good for gout, so I’m hoping the twinges get less as your uric acid crystals continue to dissolve, and your joints start to recover. I don’t think you’re waffling – your experience and attitude are very relevant to Richard.

Also very good advice from you to Richard, especially about working with his doctor, and fellow gout sufferers here, to create a good personal gout management plan.

[Benedict]

Hi All

Just a query and some advice please if available…

As mentioned above I have been on 300mg of Allopurinol for the last 4 weeks, plus colchicine daily which I’m trying to reduce the colchicine from 2 * 50 daily to 1 * 50 to 0. I’ve noticed if I don’t take any at all then I start to get twinges (at the site of my original attack plus other sites, e.g. have felt like mild gout like pain under my ankle for the last few days). Unfortunately, I’ve got a dose of man-flu at the moment with a sore throat etc so I know I shouldn’t be taking colchicine. Also I don’t want to completely stop taking colchicine and risk a flare-up! Currently, I’m trying to survive with a 50 mcg colchicine every two days, plus paracetamol. ( I cannot take ibuprofen as it bothers my kidneys)

So is there a way of knowing if the pain in other sites is the tiny dissolving crystals getting lodged? And will these dissolve further with the allopurinol?

Any thoughts/advice much appreciated!

[Keith Taylor]

Hi Benedict,

Without a DECT scan, there’s no way of knowing for certain if dissolving uric acid crystals is causing the pain in sites not previously affected by gout. If it is the cause, and if your uric acid levels are still below 5, then allopurinol will definitely cause more crystals to dissolve, until the risk of gout flares disappears altogether.

At this stage in your treatment, though we can’t be certain of the cause, we can assume that it is dissolving uric acid crystals. This is part of the waiting game. If you know uric acid is low enough, you can be sure that flares will get less intense and less frequent as time passes. If you are still getting discomfort in six months, then it’s time to investigate other possible causes.

It would be good to record your uric acid test results, and allopurinol dose changes in your profile. That way, it’s easier to see how you are making progress. I’m not certain if the 3.1 you mentioned earlier is before or after you increased your dose. I always recommend blood tests within 2 to 4 weeks of a dose change.

[Benedict]

Hi Keith

Hope you’re well. Thanks for reply. I’ve started updating my profile – its a good place to monitor my progress!

To summarise, my uric acid was at 7.7 a week after my last big attack (november). This reduced to 5.5 with four weeks of diet changes. I started taking 100mg Allopurinol and this dropped to 4. Increased dosage to 300mg and the tests (after being on 300mg for 2 weeks) placed my uric acid level at 3.1 .

So I guess it looks like it is dissolving the crystals. I don’t mind the discomfort as long as I avoid a flare-up (wishful thinking!)

Take care

[Keith Taylor]

Great stuff, Benedict.

I’m confident, from what you’ve said, that your gout will soon be completely under control.

I’m tempted to ask you to make a post every time you have any sign of an attack. But that means that you’ll soon never come here. Why not post every day you have no pain, to encourage other gout sufferers? You’ll soon be here every day! 😀

[Author]

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