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I am always wary about steroids for gout patients. I have to admit, I do not fully understand the interactions, but I have long considered that, personally, I believe the risks of side-effects outweigh the benefits (at least, for me, who has no issues with ibuprofen).
I’ve looked into this a bit further in order to respond effectively, but I still feel I need to understand the exact details. Here is what I’ve got so far:
Prednisone and prednisolone are the common steroids, with occasional methylprednisolone. I have seen the terms ‘glucocorticoids’ and ‘corticosteroids’ used as descriptions of these drugs. I need to research the exact definitions and differences more carefully, but for now, I am working on the assumption that they are interchangeable – i.e. have similar side effects.
Most drugs have side-effects, so it is a question of balancing the risks of one drug against another. There are several studies comparing steroids with NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). The recommendations vary between these studies, so I will need to do a systematic review of results. However, on some studies, the results raise controversy in the medical press, so it is clear this is a very complex comparison.
The biggest consideration seems to surround the long-term use of steroids, so the analysis is again complicated by considering length of treatment and dosage. My biggest specific concerns used to concern complications with septic arthritis, but today’s preliminary research reveals another major concern.
First, septic arthritis. This can be confused with gout, but both conditions can co-exist. It is my belief that steroids should be avoided if septic arthritis has not been ruled out. Feyrouz Al-Ashkar for Cleveland Clinic writes:
It is best to consider steroids in the absence of concomitant infection. In the case of systemic infections or septic arthritis, steroids should be avoided if possible.
and goes on to say:
Oral corticosteroids can be used in the form of a methylprednisolone pack or prednisone starting at 40 mg or less, with a gradually tapering dose. Systemic steroids are the preferred agents in patients with renal failure in whom NSAIDs and colchicine are contraindicated. Local steroid injections may be the best alternative route of administration in patients who are unable to tolerate systemic therapy with steroids, NSAIDs, or colchicine. Steroids, however, are not usually the first line of therapy because of their potential adverse effects such as hyperglycemia, gastrointestinal diseases, weight gain and fluid retention, muscle weakness, immune suppression, and long-term effects such as those on bone resorption. The potential adverse effects need to be considered when making the decision of treating acute gout.
There are no specific references for why steroids are bad for septic arthritis. I have found one report from JAMA in 1957: SEPTIC ARTHRITIS AS A COMPLICATION OF ORALLY GIVEN STEROID THERAPY, which describes 2 bad cases of septic arthritis on steroids.
Moving on to my newly found second concern. I was alerted to “Does prolonged systemic glucocorticoid use increase risk of tophus formation among gouty arthritis patients?”
This study is a statistical analysis of gout patient records, and concludes:Patients with equivalent prednisone intake of at least 15 mg/week for > or = 3 months is associated with tophi formation. In the presence of hypertension, renal impairment, and elevated serum creatinine level, use of steroids confounds the individual risk that each factor carries.
Returning to the controversy I mentioned earlier, “Should prednisolone be first-line therapy for acute gout?” is a response in the Lancet to a study that favorably compares prednisolone with naproxen.
Well known adverse effects of glucocorticoids include hypertension and diabetes mellitus; these are frequent disorders in patients with gout. […]
Clinical experience has taught us that oral corticosteroids for gout expose patients to the risk of rebound attacks and possible drug dependency. Additionally, experimental data suggest that steroid treatment could favour tophus formationSo, thank you Beyondken, for prompting me to look into this a little deeper. I realize this is far from a comprehensive review, but the alarm bells re side-effects are ringing even louder for me now. As ever, the best action is to lower uric acid to safe levels – then you do not need the pain relief.
1. Sweating removes so little uric acid it is usually immeasurable or classed as near to zero as makes no difference. It will not harm you if you keep hydrated. Search for sauna in the box at the top of the screen for more details.
2. The perfect diagnostic routine starts with a uric acid excretion test, as this gives you the extra choice of uricosurics such as probenecid to promote uric acid excretion if it is low. Because allopurinol and febuxostat are so effective, they will reduce uric acid production to the point where excretion rates are not important. Missing the urine test is not crucial. If febuxostat or allopurinol fail, probenecid might be relevant, but not worth worrying about now.
3. Yes, it is time for a blood test. I have absolutely zero medical knowledge, and even if I had, it is wiser to discuss test requirements with your doctor. The only blood tests that I know to be relevant to gout, are uric acid liver function and kidney function. The first is a minimum once a year test for anyone who has had a gout attack or has had gout in the family. The function tests are for gout patients on febuxostat or allopurinol. If anyone knows of other tests that are relevant to gout sufferers, please share your knowledge in such a way as to be understandable to untrained people such as I.
There is no direct connection between cholesterol and uric acid. However, elevation of those, together with elevated blood pressure and risk of diabetes are common statistically across groups of overweight people. I.e. it is a statistical connection with no known medical link. Best to focus on one thing at a time. Where positive advice, such as more exercise, matches high cholesterol, and high uric acid, then it becomes a priority.
Exercise is also recommended for psychological problems such as depression associated with stress or trauma. Anyone want to join me on my daily walk? Springtime in Yorkshire is a great healer.
I know you cannot help associating food and beer with gout, as that is all that medics talk about when they do not understand gout. It can be a factor, but gout is almost always secondary to genetic faults in uric acid metabolism, or problems from side-effects of meds for other health problems, or exposure to too much iron, lead or other toxins.
Restrict your worrying about diet to what is healthy. General rules about healthy nutrition warn about too much meat, and too much alcohol. These are fair warnings, but you have to avoid getting hung up on specific items in your diet. If your diet is bad by normal nutritional standards, then improve it, but do not expect that to have much effect on your gout. The effect is too small to worry about, especially when you do not have a confirmed diagnosis.
You cannot diagnose gout by comparing your experience of pain with other gout sufferers. It is different for everyone. I have even seen one case where gout was not suspected until the patient exhibited uric acid crystals in the eyeball
! Ignore anyone who claims they can diagnose gout from pain symptoms.If there is doubt about the diagnosis, there is one best solution, and one fairly good alternative.
The best solution is to have joint fluid analysed by an experienced rheumatologist who has direct access to polarizing microscopy equipment. Experienced rheumatologists have the best track record for testing joint fluid, and you need to avoid any delay between drawing the fluid and examining it. Make sure it will be tested as soon as it is drawn – crystals soon degrade outside the body, and you risk a false negative.
The fairly good alternative is to assume that your condition is gout, and follow a properly managed uric acid reduction program. This involves a 24 hour urine test to assess uric acid excretion, appropriate uric acid lowering meds to bring uric acid below 5, with regular monitoring of uric acid. Can you maintain low levels, and see that the painful flares get less frequent, and less intense, until they stop completely after several months? If so, then you do have gout, but it is controlled, which is as good as it gets. If not, you’ve only wasted a few months, but at least you will know it is not gout, and can work with a rheumatologist to find what it really is.
In denial? No, or you would not be asking such good questions. You are too new here, Wisescarab, for me to joke about my Egyptian friend who was happily in denial for years. Maybe later.
It does not matter what time of day you take it. As per my prescription, I take mine “with plenty of water, with or after food”
The water is good for helping the kidneys excrete unused allopurinol (for the purists, it turns to oxypurinol before it is excreted). I presume that the food aspect is to avoid potential upset from taking it on an empty stomach, but empty stomach is not something I am familiar with
There is no point in worrying – just be determined to know your uric acid number. It is OK to loose track of your age, the current month, names and birthdates of loved ones etc, but ALWAYS KNOW YOUR URIC ACID NUMBER. If it’s above 5, do something about it.
pen said
… I was reading this site it said not to stop using allopurinol so I didn?t. I don?t know what is going on. Nothing seems to be working cherries, diets etc. …
That point about allopurinol – not stopping allopurinol once you start it – is almost the most important thing about it.
The absolutely vital point about allopurinol is – It is only any good if it keeps uric acid level to 5mg/dL or below. If not, it is a waste of time, effort, and money. If you do not set a safe target for uric acid levels, chances are you will experience worse pain (often in new places), a week of serious pain, 4 weeks and more of weak, sore, stiff, and hot tendons, limping when you walk, etc.
Exercise and a healthy diet are excellent – but only when they support good treatment. Good treatment means always knowing what your uric acid level is, and never let it rise above 5mg/dL (0.30mmol/L). You are doing everything right except the uric acid control – I think your doctor has to share responsibility for that.
Having said that, I am only assuming your uric acid level is too high despite the allopurinol. Your symptoms are similar to the common issues associated with acute gout flares from dissolving uric acid crystals.
pen, please can you post your uric acid test results, so I can decide if this should be filed under bad allopurinol dose or avoiding pain during first few weeks of uric acid lowering treatment.
I spotted a friend in Albuquerque:
View Hans In Albuquerque in a larger mapClick the + button to zoom in, and the ‘view larger map’ link for more details.
hansinnm said
Keith, I sure hope I wasn’t a contributor to your depression. No goutie needs that. But let me tell you that because of your forum and the contributions of the sincere gouties I did receive a gift from the partner of a goutie who had died. I’d like to help here. You have my email address. Would you be so kind to pass it on to Delboy so that we can get together when he gets here? I’d find ways to pass his gift on to other gouties.
Absolutely not, Hans – now that I understand your humor, you only bring me joy (I’ll send her back when I’m done
). The depression is a post-traumatic stress issue from last year’s accident. I thought I’d licked it, but I’m getting a few flashbacks and crap this year. I’ll deal with it, but the anonymous a-holes that post meaningless, impolite criticism about a free resource are getting to me, along with other annoying people sending rude private messages. It is definitely not from any active members of this forum, though I’ve deleted one or two in a fit of insomnia-induced rage. I will soon return to my old self, and return to heckling them ferociously.I will pass your email to delboy, using your gmail address, as I believe this is your current one. I love that you’re enjoying life as a drug-runner
I work on a rough rule that you should allow a month for every year of untreated gout to get rid of the old uric acid deposits. You might do it quicker if you get uric acid well below 5mg/dL (300 μmol/L) for several months.
300 is the upper limit, so I hope you get below that – please let us know, Frank, when you get your test results.
Search for ‘lower quicker’ or ‘Uric Acid Crystals: Time To Dissolve’ for more (copy to search box above, without the quotes)
driftwood said
[…]
I don’t know why it’s so strong and not going away.
[…]Gout is not an eating disorder, it is a uric acid imbalance. Diet changes can make a small difference, as can a teaspoon in a flooded boat, but the small change is not enough.
Each day your uric acid rises above the crystallization point, is another day of more uric acid crystals deposited in and around your joints. In my humble opinion, prednisone, and in fact any pain relief, will make this worse, because they are masking the symptoms, not treating the cause. As soon as the relief stops, you said it, KABOOOOOOOM. Pain relief is good as support for a few months whilst allopurinol does it’s job, otherwise it is a joint wrecker.
Or in other words, make that x4
All seems OK.
Even MSIE is working OK now. There are still some minor issues, but nothing to wreck the discussion – unless you want to post images.
It is time for a major rethink about direction, and how the forums will be used in future. I am working on this.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.
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 problem with ice is, whilst it will relieve swelling, cold also lowers temperature, thus causing uric acid crystals to form more easily.
If ice was the only alternative, then it would be acceptable, but there are lots of other ways to relieve gout pain.
When you want to control gout, you must start with the intention to lower uric acid – the only way to stop gout long-term is to get uric acid safe. Short term gout pain relief is completely different – just because something stops the pain today, does not mean that it cannot make it worse next week.I write as a man who has experienced sore joints throughout my body – each year getting worse.
Gout pain feels like a broken bone, but unlike a broken bone that will heal itself once set correctly, untreated gout simply gets worse. Every day that you fail to bring uric acid down to a safe level is another day you build up more uric acid crystals. Most days you do not even notice this, but every few weeks you get a sharp reminder in the form of a gout attack.
Many gout sufferers try to man-up, take the pain meds, and wait for another battle. You cannot win. Each time, as Erik is experiencing, the pain gets worse, more joints get affected, and even the strongest, bravest man will fail eventually. All the time this is happening, uric acid crystals are eating into your tendons, cartilage, and bones. The acute flare fades after a few days, but the deposits carry on building, and carry on destroying your joints.
I do not think you cannot afford a doctor, Erik. I think you cannot afford to continue without one.
Hi prorec, you really should get your neck checked by a doctor.
Gout can cause permanent joint damage if it is not treated properly. This means getting uric acid under control – lack of pain is not a good measure of gout control. This is because uric acid crystals can accumulate slowly in the neck, and other joints. You might not get a gout flare immediately, but the buid-up of crystals can erode the discs between spinal joints, and also the bone as well.Gout In Neck
This gout in neck discussion is now closed. I have summarized the main points, with additional material in
Neck Pain With Gout. There is also information about neck problems with gout in the Gout Symptoms guidelines.If you still have questions about gout neck pain, please start a new discussion.
Merago said:
Now comes what could be the hard part ? convincing my GP to prescribe me allopurinol?
This should not be too hard, particularly in the UK, where the British Rheumatologists (both major professional bodies jointly) recommend up to 900mg per day allopurinol to maintain uric acid below 300?mol/L (5mg/dL 0.30mmol/L).
Do not let your Braveheart genes let you underplay the pain you have been in. Even strong Aberdonians cry. How much longer can you cope with constant time off work, and a life of abject misery? Save your best girlie scream for him. Actually, better not, as if he thinks you have a gout flare now, he might delay the allopurinol. Anyway, you get the picture – you can't bear the pain, or the thought of more of it.
I am not sure about the risk of flares being increased with allopurinol. If anyone has trial data on this, I would be pleased to see it.
My saying is “There is risk of a gout flare when you lower uric acid. There is certainty of a gout flare when you do nothing.”
The flares are certainly different, in my experience. Much shorter duration ? one or two days compared to 5 to 7 days averrage pre-allopurinol. Also much more random. Pre-allopurinol, I recall periods of one joint being affected by a series of flares over a few months, then a different joint – now it is a different joint each time.
For anyone contemplating allopurinol (or other uric acid lowering treatment) I would say, prepare for gout flares ? do not expect them.
My doctor prescribed colchicine, with the recommendation that I took 2 a day for two weeks when starting allopurinol, when increasing the dose, and whenever I experienced a flare. I learned that colchicine slows or prevents inflammation spreading, but does not directly reduce pain, so I occasionally supported it with ibuprofen. I may not have totally fixed the gout yet, but I have beaten the pain. It is good to be in control, and whilst I am still prepared for gout flares, I do not worry about them.
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Prepare for a flare. If not there, don't care.
For a gout sufferer on uric acid lowering treatment 2.9mg/dL(0.17mmol/L) means the meds are working, your level is safe, and six to twelve months should see an end to all old uric acid crystals (depending on how long you have had gout)
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Low is meaningless in medical terms, but in statistical terms I think it is either one or two standard deviations below the mean, but not something I care to investigate at the moment.
zip2play said:
In all seriousness Limpy,
I don't think there is a legal basis for patenting allopurinol.
Yeah, but 3 years ago, did you expect to see colchicine protected as it is now?
I have not figured out how they will make profits, but no company spends this amount of money without good expectation of a return.
limpy said:
So you guys are saying the FDA is going to let them do to Allopurinol what they did to Colchicine? Raising the price x 10. Limpy
Unless you fight it Limpy, they will do that (in my opinion). Give Ardea a ring, and see what they are up to.
You are spot on re the patent issue, zip2play, and I have not worked out exactly what is going on. I just know that something is happening, so I started a little scaremongering [sorry]
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It may end up being something helpful, like an allopurinol combo that has more benefits for gout sufferers. If that is so, then fair play, and good luck to them.
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My problem is the “fair play” angle.
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There is clearly something happening that is not being explained here. Every pharma company complains about the high cost of clinical trials, yet?Ardea are clearly investing massively in the current allopurinol trials. I know that marketing companies get really rich on the back of patented drugs, but this is the first time I have seen a marketing company being used to push clinical trials. They are spending massively on Facebook, and they are spending massively on general Internet advertising. No doubt I have only seen the tip of the iceberg, and there will be many more $millions on marketing in medical facilities and pharmacies. An in-depth study is beyond my means, but for on-line spend, they are certainly in the same league as Takeda who are promoting Uloric now it has patent protection.
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A clear statement of intent from Ardea would be nice, but I will not hold my breath.
bakabakakun said:
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So, I'm not sure if I should wait longer, and try to cut more stuff out (such as fructose), or just get on allopurinol. Even if I never get another attack, 9.2 is no good, right?
Cut out excess fructose for your general health. The links to gout are tenuous at best, though absolutely nobody says fructose improves gout.
9.2 with no attacks is fine. The general advice with high uric acid and no gout attacks is do not treat, because this appears to be the highest risk group for adverse reactions. At the moment, nobody knows exactly why this is, but the culprit is probably genetic. I.e. if something in your genes allows high uric acid without gout flares, then that seems to link with poor toleration of allopurinol and febuxostat.
I will not speak for others, but my personal view is that you have the right to determine what meds you take, or at least the right to a proper explanation why your doctor will not do it. If he is refusing because of what I said above, then I believe he is within his rights to lower your risk of adverse reaction, by waiting for a more compelling situation. If he is just trotting out some inexplicable mantra, then he is a bastard.
The problem with waiting, is that we do not always recognize gout attacks for what they are. The typical big red toe does not always happen, and you might just experience discomfort or medium pain. This is an indication that uric acid deposits are building up slowly, destroying your joints as they grow. It has a good chance of being spotted by a rheumatologists joint fluid analysis.
I do understand the scary nature of the first gout attack. It is not helped by doctors talking rubbish about diet. You clearly have a uric acid imbalance, and the best you can expect through acceptable diet changes is 10% improvement. If you go extreme, you might get a further slight reduction. This means a miserable life ruled by a stringent diet that controls purines, calories, and iron. You also have to emphasize?foods that are known to have uricosuric or xanthine oxidase inhibitions, as long as you can tolerate these foods. Diet for gout is very very difficult above 8mg/dL
Your uric acid imbalance needs monitoring with uric acid tests at least twice a year. You need to be mindful of pains in joints that do not reach the crippling stage – everything down to numbness and tingling are a potential sign of uric acid crystal deposits.
You must have pain relief on hand. The best solution for gout is one or two colchicine per day which should stop inflammation getting worse, combined with anti-inflammatories. NSAIDs, if you can stomach them, such as ibuprofen or naproxen are usually the best. I cannot speak for naproxen, so consult your doctor or pharmacist. For ibuprofen, gout requires the maximum dose of 800mg – the OverTheCounter dose is simply not enough. You can alternate this with other analgesics that are not NSAIDs. Such a package should allow you to stay mobile during gout attacks.
Beating gout is all about getting a personal plan.
Getting a personal plan is all about finding ways to work with your doctor, or in extreme cases move to a new doctor. Working through your fears here in these forums will help enormously. Use the forums to help understand what your doctor has said to you. Use the forums to get advice about what to ask in preparation for your doctors visit. Forget all the rubbish you may have read elsewhere, especially if it relates to gout and diet.
Probenecid is an option, but only really effective if you are an under-excreter of uric acid. A 24-hour urine test can check this, and should have already been ordered – or is your doctor out of ideas? Other uricosurics are available, but probenecid appears to be the most effective for gout.
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I have a feint recall of allopurinol de-sensitization, but can't remember how effective this is. Basically, you start on a low, tolerable dose, then increase in tiny increments. Best consult a rheumatologist about that.
Jeffros, thanks for the link, but I wouldn't bother looking for that enriched milk. Let me tell you why.
First, here are a couple of related links to the source of your article.
The abstract is at : ard.bmj.com/content/early/2012/01/04/annrheumdis-2011-200156.abstract
There is data about the products used at: ard.bmj.com/content/suppl/2012/01/04/annrheumdis-2011-200156.DC1/annrheumdis-2011-200156_ds2.pdf
You can see from these that the investigation is only looking at gout flares. Whilst I accept that we all want fewer gout flares, that is not the basis of a good gout management plan. A good plan should be centered on getting uric acid down to 5mg/dL. 6 is an option, but gives you little safety margin for natural fluctuations in uric acid level and temperature.
The main author of the latest milk and gout report, Nicola Dalbeth, has done earlier work, which I feel is more significant. I covered this in http://www.goutpal.com/1046/where-is-milk-in-your-diet-for-gout/.
That study showed that skim milk in various forms always reduces uric acid in the blood by about 10%. Whether this is enough or not depends on your starting level.
The later study merely shows that by adding an anti-inflammatory supplement, the milk produces less pain, but that is likely to be true of any anti-inflammatory, not just the two used in this study.
You can see from the products information that the test milk was specifically made for the investigation, so you are unlikely to find it commercially available. I guess you could get the ingredients and make your own, but you might as well use ordinary skim milk to lower uric acid, then use black bean broth or some other anti-inflammatory product to lower inflammation.
Welcome, Roger.
It is very frustrating when you do everything right, and you still get gout flares. The 0.3mmol/L (5mg/dL) is the minimum safe level. Like you, I've managed to get down to 0.2mmol/L and I'm pretty certain that my visible tophi are shrinking – slowly.
But yesterday I got hit with noticable knee swelling and today the pain is almost keeping me away from the pub. (calm down, I said almost). Only positive mental attitude can help here, though I did see a report in the news yesterday claiming that swearing helps lower pain. I'll spare you the details, as I don't think typing it helps, but if you live anywhere near the Yorkshire area of England, best keep your ears covered.
I feel positive because I know things will get better, but I'm prepared for the long haul. I am not expecting my 16 years of gout to go in anything less than six months, and if it takes 16 months to match the years, I'll be happy. If it takes longer, I'll be less positive, but if necessary, I'll get another boost by trying the allopurinol/probenecid combo.
I have seen a number of studies that measure urate removal in months, if not years, though nothing comprehensive to give a firm timescale. All you can ever do is get your uric acid as low as possible, as it is clear that uric acid crystals dissolve quicker when uric acid levels are lower.
On completely unrelated health issues, the good thoughts and kind contributions from people here have helped me enormously. My day is devoted to continuous positive thoughts for Roger and Zip2play. Together we can make it better.
limpy said:
He said that?I seemed to have an idea what was best for me. Thats where we left it. LIMPY?
That's the best way to train your doctor. Go prepared with a few relevant facts, but don't show off. Just convince them that you know exactly what you want, and why you want it. Once they realize you know what you are talking about, they soon come on side.
I'm not trying to start a Doctors Appreciation Society, but I have spoken to one or two doctors as friends or acquaintances – they get really pissed when patients start spouting loads of stuff they've read on the Internet, without any thought about what it really means, or how it affects their particular case.
Thank you for mentioning this site, limpy.
hansinnm said:
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Thank you, Keith J. This is one of the best, most useful recent news on our forum.
Or the death of it.
Do we know anything about this company? Are they reliable and trustworthy? I never trust people who use help forums as free advertising to promte their wares without asking.
The company that have successfully provided the UAsure meters for several years have done so with good aftersales support, and the small commissions they have paid me help keep the servers running. If that revenue stream dries up, this time-consuming forum ends.
I wonder if Utubelite has consented to his words being used as testimonials on the website. I certainly have not.
It is very easy for dodgy companies with some working capital to destroy existing markets and then put their prices up.
Anyone tempted to deal with a company with such lack of principles needs to think about the consequences of their actions.
In my opinion, it is time to start a gout management plan. It is too
early, without the information I described in my final sentence to know
what specific action to take. Allopurinol (correctly dosed and manged),
supported by colchicine during the early weeks or months, is undoubtedly
the best program for most gout sufferers. However, it always works best when it is planned properly, with clear goals, and a review of other options to ensure that both gout patient and doctor are fully aware of their responsibilities and requirements and expectations.Welcome John,
I'm almost tempted to say read what I said to ctrlkeys recently, when he could not stop gout pain, but I think you deserve a bit more.
You are my hero to accept that allopurinol gives you your own gout freedom. Well you would be if you had not let it run out. Get a grip, John. Make me a promise that you will never go more than one day without it. More importantly, make me a promise that you will get tested for uric acid every 4 weeks until you get uric acid below 0.3 mmol.L (5mg/dL). After that you can relax testing up to once a year, but you must always know your number. It is the key to telling your doctor how much allopurinol you need, and it is the key to a pain-free life.
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But for now, we have to deal with the pain. Look at the calendar – we are in the 21st century, and nobody has to endure pain. Work with your doctor (or, better still, a pharmacist) and find the combination that suits you. Here are some pointers:
Colchicine is usually very good at preventing gout pain, or stopping it getting worse. 2 tabs a day for 3 to 4 weeks when you start allopurinol, or increase the dose is good. At other times, if you feel a twinge, take one as early as possible. Colchicine will not relieve gout pain once a flare starts, it just stops it spreading, so you have to wait it out, or take something else.
The usual something else is an anti-inflammatory. Ibuprofen does it for me every time, and in worst cases I've alternated this with paracetamol. When the pain is bad, these types of combinations are the best, and the best advisers seem to be hospital medics, who know everything there is to know about stopping pain – at least in my experience they do.
Steroid shots into the affected area bring instant relief. Personally I would not allow steroids anywhere near me, but if you are desperate, they might be an option. I believe there are many better pain-killing choices, but the important thing is to find what works for you.
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Now, can everyone please look away, as I have to share a personal experience with John, and it may shock you.
This is not a recommendation, John, but something that works for me. At 35 to 40 pints a week, your session intake is beyond lightweight, so you might tolerate the treatment. If it does not work, you have lost nothing. Stand at, or near the bar. Drink your quota and do not sit down. You should find, after 3 or 4, that movement gets easier. Keep moving as much as you can. Do not sit down until you go home. Make sure you drink water before bed, and if you have to get up through the night, and when you wake in the morning. Back this up with your choice of over-the-counter pain relief at a dose advised by your doctor. This has only failed me if I forgot the water, or did something like a long drive with no breaks to keep moving. Good luck
