Secondary Gout Sufferer Archive

[Junior GoutPal]

Secondary Gout Sufferer Archive is a collection of comments about Secondary Gout Sufferers. It includes:

• Comments from lapsed GoutPal members.
• Remarks from anonymous GoutPal visitors.
• Other replies that do not justify their own topic.

Secondary Gout Sufferer Archive Audience

Secondary Gout Sufferer Archive is aimed at gout sufferers who have gout caused by something that is not genetic. If you do not know about different types of GoutPal Gout Sufferer, please read Questions for Gout Sufferers.

Secondary Gout Sufferer Archive Overview

Secondary gout means gout that is caused by another disease. You should consult your doctor to identify which gout-related disease you have. Then, we can discuss how you might cure that disease to cure your gout. There are many diseases, and environmental factors, that can cause gout. Including:

• Obesity.
• Surgery.
• Sleep Apnea.
• Bad choice of Blood Pressure medications.

I will add to that list as we have more Secondary Gout Discussions. Please use that link to find current discussions about Secondary Gout.

You can post here if you want to reply to a specific comment. However, I strongly recommend you find a current discussion from the list above. Or, better still, start your own topic about secondary gout.

Do you know what’s causing your Secondary Gout?

[Dave]

Just to note: After taking BPpill ( diuretic) for about 14 days I developed a gout like symptom in one big toe which was broken many years ago.

Pain would come & go at 45 second intervals day & night. So I stopped the BPpill and pain faded away to nothing over the next 24 hours

Are there other medications to stay away from?

[Keith Taylor]

Hi Dave,
Thanks for sharing your experiences about your gout with diuretics for high blood pressure.

I can’t say I agree with just stopping blood pressure meds. We’ve had lots of discussions about blood pressure and gout over the years. Recently, one GoutPal member reported that his gout was cured after changing from one BP pill, to a different one.

That’s the right thing to do – changing, not stopping. We know that there are some BP meds that increase uric acid for some people. Others decrease uric acid for some people, and there are also some that have no effect on uric acid.

Your doctor prescribes blood pressure pills for a reason, so simply stopping them isn’t wise. Dave, I really hope that you can discuss this with your doctor. Hopefully, you will become one of the people who cures gout completely, just by getting better blood pressure pills. The main thing is to be safe, and if I can help with that in any way, all you have to do is ask.

As for other meds, the same safety rules apply. If you cannot avoid a drug that raises uric acid, it is very easy to balance the effects with allopurinol. It is vital that you discuss these issues with your doctor. For a starting point about some of the meds that can cause gout, please see Beware Gout Cures You Do Not Need. The opposite of that are medicines for other diseases that help gout.

[Jason Fritz]

[emailed via Gout Forum Update Service]

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in regards to ‘other health issues’:

in my experience- any diuretic(s) be it medication or herbal (such as Gokshura a.k.a goat’s head or Caltrops) are terrible for gout sufferers because they increase the concentration of uric acid in the bloodstream.

Hydration is your friend, diuretics are not.

There are studies that show that coffee in moderation is helpful (i’m not sure why) but every time that I have used any diuretic I have immediately had gout symptoms……hope that helps.

[Keith Taylor]

Thanks Jason,

I like “Hydration is your friend, diuretics are not.” You can be sure I’ll be using that phrase!

Coffee helps by lowering uric acid. I haven’t seen any conclusions about the mechanism. There have been suggestions that it might reduce uric acid production, like allopurinol. Or, it might increase uric acid excretion, like probenecid. It might even do both. Any way, coffee is good for gout. There have been suggestions from certain unreliable sources that diuretic qualities of coffee make it bad for gout. That is wrong, as studies have shown that the slight diuretic effect is insignificant compared to the volume of water used to make coffee.

[Junior GoutPal]

Original Secondary Gout post from Whitney:

Is this gout? (Yeah, I know it probably is)

So, I am pretty sure I am at the end of my first (may it be my last) gout attack. I am a 41 year old woman. Seldom drink, red meat 1x week, maybe. I have been on a diet and have lost 25 lbs over 4 months. I have read that rapid weight loss can trigger an attack. My pain started with feeling like I had a bruise on the bottom of my foot at the classic gout toe joint. It progressed to very painful within 24 hours. I though I had a bone bruise or stress fracture from
Pilates (feet in straps connected to your body weight and some extra resistance w/ springs). Well, they took X-ray in urgent care, said no fracture and “doubted it was gout” because area was not swollen and red. My the next morning, after a night of tears, I couldn’t walk, so I ended up in ER. NP says, yes, it gout. Gives my Rx for the anti-inflammatory (I forget what it’s called, super NSAID) took Uric acid level. 3.7. Med starts working that evening after second dose. That was last night. I can walk again, with discomfort. Noticed swelling yesterday, still visible when you hold both feet sole to sole with the sides showing. Now, when I walk, I feel like the ball of my foot at the toe joint is tender and bruised again. I know you can still have gout without a high Uric acid level. So, now the things that I have read that I did not experience: I was able to tolerate touch and my sock on my food. I could point my toes with out a problem, but it was painful to flex. Sorry about the rambling. It sure sounds like gout. I have an appointment with my doctor on Monday, but it seems like if I am better it makes more sense to go in in two weeks to get levels drawn again, yes? Thank you for any info.

[Keith Taylor]

As you say, Whitney, it sure sounds like gout.

Is NP a Nurse Practitioner? In any case, I’ve got to assume if they diagnosed gout, then that is what it is. A rheumatologist might do more tests to get a clearer diagnosis. Let’s assume it’s gout for now, until we have more facts.

Uric acid level of 3.7 (presumably mg/dL) doesn’t support a gout diagnosis. But, 0.37mmol/L does. Could your test results be mmol/L? It’s unusual for USA, as all United States test results I’ve seen have been mg/dL. But, I’ve seen other scales in some USA gout studies, so might things be changing?

For now, I think the best thing is to try get hold of any previous uric acid test results. If you can get them, please post dates and exact numbers with the scale.

Sorry I can’t be more helpful, but that 3.7 is outside my experience. I cannot see any explanation for it. 5.7mg/dL, yes that’s gout. 4.7, maybe. But, 3.7? How!???

[Carolyn Poulter]

Hi Whitney, hope you get to the bottom of the mystery soon. Like Keith says, it sure sounds like it. I have only recently found this wonderful site and I am pleased to discover that the symptoms seem to vary for all of us. Perhaps why the first doc didn’t think it is gout, same thing happened to me I am also interested in your comment about rapid weight loss possibly being a trigger. Though ongrats on the weight loss just the same!

[Junior GoutPal]

Keith, I do not have another Uric acid test to compare. Carolyn, this is what I found on the web,”Rapid weight loss or fasting can cause excess lactic acid buildup, which hinders uric acid excretion by the kidneys thereby triggering a gout attack. Dieting also may cause a loss of potassium, which can increase urate levels in the blood. Some dieters also use diuretics which can deplete the body of potassium and other minerals, triggering a gout attack.” However, I have been loosing weight slowly. .5 to 1.0 lb a week. I drink fluids (I could drink more, but don’t feel I am dehydrated. I was 188 at 5”0″, I am down to 164. Still overweight, 32 BMI vs. 37 and I am moderately muscular. Toe is still swollen today. Shoes are still uncomfortable. I can feel relief from the Indomethacin in about two hours. So, what ever is going on is definitely an inflammatory response. The question is from what? Uric Acid? Something else? I will definitely follow up w/ MD to figure out, as it would be nice for this not to happen again.

[Carolyn Poulter]

Thanks for the extra info. Yes it certainly seems like I have been my own worst enemy with regard to the weight loss not through sensible methods and subsequent plummeting potassium levels and of course the GOUT!! OUCH! I do hope you feel better soon and definitely follow up even if this bout goes away.

Each time my gout gets better some tiny part of my admittedly tiny brain thinks ‘OK it’s gone! That’s that then.’ until it comes back. So now I am diagnosed I am going to keep taking the Allopurinol. I go back for more blood tests (oh joy!) in about 6 weeks. I am so pleased for you regards the weight loss but don’t put too much on the BMI thing, as long as you feel good and feel good about how you feel and look then that’s perfect for you. Now if I could just follow my own advice………………

[Junior GoutPal]

UPDATE: Well, I guess it really is. Here we go with my other toe. Took Anti inflammatory right away and still uncomfortable to walk today. Which sucks when your job is walking back and forth across the hospital to see various patients. :/. Got my blood drawn yesterday at the very beginning when I noticed just the littlest of a twinge. Probably would not have noticed it at all if it wasn’t for my flare a few weeks ago.

[Keith Taylor]

Hi again Whitney,

“Got my blood drawn yesterday ” – does this mean you will have another uric acid blood test result soon? If so, please post the result.

If it helps, you can take a photo of the result and send the picture to me, via the Helpdesk. To send pictures, click the orange Gout Help button, then attach a file with the paperclip button. Or, send them using the “Attach a file” link on the GoutPal Helpdesk new ticket form.

[Loni Ross]

If gout is caused by something like secondary polycythemia, or iron levels, or even hypoxia, will it be resolved once the underlying cause is corrected?

[posted via reply to email update list]

[Keith Taylor]

Loni, if gout is solely caused by a primary disease such as one of those you listed then it will be resolved. But managing secondary gout is not that simple. Because there are 2 great unknowns:

1. Is your primary disease the sole cause, or do you also have gout?

2. How long will it take to correct the underlying cause?

In both those cases, you run the risk of serious harm from excess uric acid. So it makes sense to get uric acid safe now. Then, when you recover from the primary disease you can start a controlled, safe withdrawal from uric acid treatment.

Coincidentally, I wrote about reasons for managing secondary gout today in a different context. I’d appreciate feedback to say which explanation is clearer.

[Author]

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