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Jon,
I have had bouts with neck pain as I presume most people have. Not the TMJ type but the type that makes it painful to turn my head too far in one direction or the other. Alternately I have suffered the kind slightly lower down that seems to radiate down one arm or the other.
I have always attributed this to “wear and tear” on the joints and had it confirmed by X-ray as an “awful lot of arthritis and compressed cervical discs.”
I would not be surprised if there was a gouty element to the situation but neither would I be surprised if there weren't. I just don't know. There are lots of people with TMJ and cervical arthritis who have never had a moment of foot pain.
A good test to tie gout in or out of your TMJ tyype pain might be to take something like 6 colchicine in a day (one an hour) and see if there is SIGNIGFICANT pain relief. One would expect relief from gout but not from osteoarthritis.
For me, when my neck acts up I move the computer monitor from the left side of my desk to the right or vice versa, that often does the trick for about 3 months. Another thing I have fouund to be a super NO-NO: NEVER hold your phone between your head and your shoulder without using your hands; might as well proceed directly to a guillotine.
Gout Sufferer,
Don't be afraid of allopurinol. Millions of people have taken BILLIONS of doses with no long term problems. It is among the most innocuous of drugs while being among the most effective.
If you'd like to get off colchicine earlier, why not up your allopurinol to 300 mg. and stop the colchicine in a couple weeks. I doubt that a single colchicine a day is doing you much good anyway.
Just a couple thoughts:
1. A major side effect of prednisone is swelling/fluid rettention/edema casusd by sodium retention. So don't be surprised if the swelling doesn't go down with pain relief.
2. Synthetic steroids cause the body to shut down its own production, so wean VERY slowly especially as you get to lower doses. I think weans from 20 to zero should go in increments of 2.5 mg. if one has been dosing for a couple months.
I think a doctor who prefers prednisone to colchicne for gout treatment to 1 pill a day should not be treating gout. Has diarrhea become the new PLAGUE? Also, as many find out, despite the risks of prednisone, it doesn't work particularly well. Colchicine stops an attack, prednisone masks it. In fact weaning from prednisone often makes the pain worse than it would have been ABSENT the drug.
Maybe it's a faulty definition for me, but I consider any drug that must be weaned off of to be an addictive substance…if prednisone FELT good, the government would probably ban it.
Be patient with the allopurinol (and if prednisone is not stopping pain and swelling, then take something that will.)
A couple months on prednisone should not be too long, jon, but I think, as you do that beginning the move to 17.5 mg. now is appropriatte.
You might find this helpful:
http://www.sarcinfo.com/weaning.htm
Just curious, why has your Doctor Hippocrates decided that one colchicine a day is appropriate dosing? Did he say? Maybe he'd like to write up his novel theories for THE LANCET.
Lynda,
Allopurinol is often prescribed to HELP ailing kidneys…and I'd like to see you get up to 300 mg. ASAP becasue with a 10.4 there is almost no hope that 100 mg. will do anything but aggravate your gout.
Knees are tough to diagnose. If months of allopurinol (and a consistent uric acid below 6.0) tends to make the knee feel better then a gouty knee is suspect. But there are just SO many conditions and injuries that cause knee pain it is often very hard to diagnose.
Celery:
Anecdotally celery was used to treat any disease resulting in swelliing, thus osteoarthritis, rheumatoid arthritis, and gout. The swelling is reduced becasue celery is a light diuretic. Yes, swelling decreases when water and salt are dumped by the kidneys.
But it is pretty well documented that ANY diuretic has a ugly side effect: it retains uric acid by the kidneys. So, given that a decrease in swelling is NOT proper treatment of gout, one should rethink celery as a gout tonic. Decreasing swelling while increasing uric acid might be a quicker qway to get GP informative tombsone all for one's own use.
So many of these old saws come from the days of the charlatans selling their nostrums from buckboards topeople with aching backs…lumbago. Celery is no exception:
In the early days of soda pops, celery seed was a widely used ingredient in refreshing drinks. Since ancient times, celery has been used as a medicinal herb, with properties as a relaxant.
Dr. Brown's Celery Tonic was first served in 1869 and has been bottled and sold since at least 1886. Legend has it that Dr. Brown first created his celery tonic for immigrant children on the Lower East Side of Manhattan, but there is little information about whether he even existed.
I believe it was called Cel-Ray. Bad information is hard to lose, like a bad penny and generations keep repeating the same nonsense.
Celery is good in stews…and sticking out of a spicy Bloody Mary.
Damn, I.E. killed a wordy ppost:
To summariily recapitulate:
1) bad flare up when went from 100-200, and 200-300
2) since been on 300, have had a lot of “wannabe” flare ups where my knees wil swel, but at a lot lesser level than before
That's why I HATE starting with 100 mg. It casues more problems than it cures. Would a doctor say “It usually takes 1000 mg. penicillin/day to stop a strep attack so I'm going to prescribe 100 for a week and then 200 a week later, etc.?”
Im just really curious about others success with allipurinol, and their time frame,
Over a couple years I had about 5 attacks that lasted 3 days each (on crutches) and went away spontaneously with no consequence.
Finally got attack from Hell, bedridden in screetching pain for 9 days. Took 22 cochicine in one day and pain stopped iinstantly and completely. Started allopurinol 400mg. a week later and have not had an attack in over 20 years. So, for me, colchicne-allopurinol provided INSTANT remission.
If you have lingering pain, give colchicine a try.
but the actual limp feels like it comes from not having the normal ability to fully straighten the leg while walking.
That sounds like a torn meniscus (cartilege.) WHat happpens is that the floating part of the cartilege slips into the joint and interferes with straightening. The cure is usually to cut off the offending piece of cartilege. Mine is very rarely IN the joint anymore but I used to be able to wiggle it artound just under the skin on the inside of my knee. THe injury was 40 years ago and I never did anything about it and now the “lockup” occurs only a couple times a year and lasts only a couple minutes before slipping back out.
Doctor back a million years ago (high school) callled it a “mouse on the knee.” Just fingering around now and I don;t know if I can even find it anymore…perhaps it reattached or simply wore away to nothingness.
I'd have had it removed long ago but for the fact that a dear college friend of mine had it done…and he died a day later, at age 29.
jon,
Before that “Baker's Cyst” ruptured, were you aware of HAVING it? It is a rather prominent swelling at he back of the knee. A Baker's cyst is usually caused by mangled cartilege or osteoarthritis but CAN be caused by gout. Conjecturing that one has a ruptured Baker's Cyst without ever having diagnosed the cyst is bad medicine.
Have another UA run, maybe even another ANA….good he ruled out the horrors like lupus, RA, scleroderma, Sjoergen's, etc.
If you are still taking allopurinol, 300 mg., continue it if it is helping your foot problems. There is no medical law that says you cannot have gout AND osteoarthritc knees with blown cartileges, a couple blown spinal discs and torn rotator cuffs….I've got them all. Maybe the knee will eventually resolve. There's also no law that you cannot go to 400 mg. allopurinol. Perhaps getting your SUA below 5.0 might yield more information.
How about an MRI of the knee to see what the joint looks like. Beware though, if an orthopedic surgeon does it you WILL get surgery because that's all they do…like mindless automatons. Certainly have an aspiration to look for crystals with the next swelling episode.
(Have a check for Lyme Disease antibodies…there's more of it around than most people imagine.)
Do you limp because of the PAIN or because something feels “stuck” in the knee?
Uhhhh,
http://www.theannals.com/cgi/c…..40/12/2101
CONCLUSIONS: Use of oral corticosteroids in patients on long-term warfarin therapy may result in a clinically significant interaction, which requires close INR monitoring and possible warfarin dose reduction.
This reaction with warfarin is no different from what would expect with warfarin-allopurinol
“Not bad enough for febuxostat????” The only reason it could be deemed “not bad enough” is if this “doctor” will stick his neck out and say that your husband does not have gout. If that is the case, then what is he prescribing long term prednisone for?
Get a new doctor, this one is an asshole.
P.S. Is there any way to cure this “microtype” when it pops up?
,
I don;t trust the diagnosis.
Firstly gout is not diagnosed by ruling out other arthritic diseases. Secondly, a UA of 6.2 does not support a gout diagnosis. Thirdly, with myriad incidents of doctors probing your knee swelling an easy thing would have been to take joint fluid and look for crystals of uric acid in the fluid.
I presume they left you with a diagnosis of chondromalacia? That's “jumper's knee” or patellar tendonitis. A couple guys at my gym get good results with a tight band placed right under the kneecap. Give it a try.
If you want more evidence about gout, you can try some relatively high dose colchine. If it doesn't help a lot, then you get even further from a gout diagnosis.
I do not think your doctors are the sharpest knives in the kitchen drawer and for this reason, I'd go very slowly into any prospects of surgery. Exploratory surgery went out with high button shoes…it;s for doctors who have never heard of an MRI/
(Early in the disease, when a gout attack subsides, relief is usually complete and fast.)
So for lots of reasons, I think your knee pain is NOT gout.
Hi Mr. Ed,
I guess you are one of my neighbors (NYC area.)
The way the body seems to handle long term gout is to isolate most of the urate in a sealed pouch slightly outside a joint and isolated from the bloodstream. If this is COMPLETE it has no more effect on the body than would an impacted stone. With no experience of surgical tophus removal but some idea of how bizarrely they can be shaped my guess is that no surgwon could get all of it out without gross overcutting. So I would expect the surgery to result in a lot of temporary re-migration of whatever was left in on a near microscopic level. A nicety is that since the body dopes such a nice job in moving the tophi bulk OUT of the joint, surgical removal of the tophus can be done without manging the joint…and thus a quick return to real life.
In English I think you will have more pain rather than less on a temporary level.
I also think that if you had one BIG one removed, you have dozens of smaller ones hiding 'round.
Tell us about your allopurinol use. (I think you are goiing to need it now more than ever.)
lioness,
It isn't that allopurinol is not useable with warfarin, just that allopurinol INCREASES the anti-clotting effect of warfarin requiring an adjustment downwards of warfaring dosage with allopurinol use. Perhaps this isn't a BAD thing but a doctor has to stay on top of your hysbands clotting (as he should do with JUST warfarin.)
Febuxostat is a good substitute for allopurinol and it seem to have no interaction with warfarin…but be triply sure of this. Downside is that it costs a fortune and is new but the cost depends on who is picking up the bill…like a lot of things in likfe, eh?
What is your husband taking the warfarin for? Bloood clots in leg, heart arrhythmia? Is it likely he will need it for a long time?
Heart FAILURE is a slow deterioration of the heart, usually the left ventricle which pumps blkood to the body. Coronary artery disease causing heart attacks has a great deal to do with cholesterol and deposited blood fats and causes heart attacks killing part of the heart muscle and this is the MAJOR casue of heart failure which, if you are not killed instantly, begins the process of heart weakening, aka failure.
But your hear can go into failure for other reasons, like infections (endocarditis, pericarditis,) defective valves from disease or heredity, rheumatic fever, rampant hypertension causing unending pressure on the left ventricle, pulmonary hypertension (distension and weakening ofn the RIGHT ventricle becasue of lung problems) and even just inheriting a “weak heart” and now it seems untreated hyperuricemia. There are so many more, even cancer, emphysema, kidney disease, auto-immmune diseases like Lupus, and on and on.
There are many things that can transform a tight, hard little POWERFUL muscle into a flabby bag beating irregularlynot able to do the one job it must…pump blood well.
Limpy,
Here's as good an assay of the effectiveness as I've found:
Zyloprim was the original patented name for allopurinol when it was discovered while searching for agents to treat cancer. Prometheus and Smiith Kline continue to market it under a couple brand names.
This advertised joint sells
“generic Zyloprim” which is a misnomer because it is either BRAND NAME Zyloprim, or the generic, allopurinol. That's like saying “generic Bayer aspirin.”It also costs exactly 10 times as much as I pay (at Target Pharmacy) for 90 x 300mg. (I pay $10…they want $99.99.)
It's glucosamine-chondroitin, the latest in a LONG string of artthritis pain relievers.
I used the combo for amost a year…it did nothing for joint pain (bad knee cartileges, bad rotator cuffs.) If you want to try for yourself, you can get the combo in large bottles in any big retailer like Walmart or Puritan Pride for a LOT less than this branded product.
Typical starting dose is 1500 mg. glucosamine + 1200 mg. chondroitin or 3 a day of this Cosamin.
Can't hurt…but don't look for any gout relief.
Personally, I think if you wait a while, you will see glucosamine-chondroitin exposed as just another scam, like copper bracelets.
Arthritis is the most amazing disease. In spite of being cured on a monthly basis for the last 100 years, it's still with us just as it was when Sloan's Linament was peddled from farm to farm via buckboard:
At some point in the brothers' venture, someone applied the liniment to his back, discovering that it relieved his own discomfort, as well. Thereafter, the Sloan brothers began selling even more of the liniment advertising it as “good for man and beast”.
nokka,
God bless us every one.
I presented with 8 years of angina (since 1992) and EVENTUALLY found a 99% blocked right coronary artery. I had it opened with angioplasty and stent. On the basis of this study I might go up to 400 mg. allopurinol.
If it is gout, coclchicine will show very good results. That statement may not be 100% correct but it's pretty close. Back in the old days before blood tests, MRI's, X-rays, specialists, if you had foot pain they gave your colchicine (made from crocuses.) If it worked you got your gout diagnosis. If not, they called it rheumatism. 🙂
The medical term for the ANA test is ANTI-NUCLEAR ANTIBODY test. It can point to many auto-immine diseases, many of which can cause joint and muscle pain. Tied to CRP (C-reactive protein) and several other tests, more light might be shed on inflammatory disease. There are a lot of false positives with some of these tests, so dont get frightened by any one
Here's a good link
http://arthritis.about.com/od/…../a/ana.htm
(I once got a 1:320 ANA and got white with fear thinking I might have Lupus (becasue I had a couple other markers also…retest showed a completely normal ANA)
Ask for your records ekes, any good doctor should have tested your ANA level in a RA workup…you are entitled to all your lab results.
I don't like taking pills on an empty stomach so I wait until breakfast a couple hours after arising. Sometimes breakfast doesn't happen and sometime around dinner time it's “Did I take my allopurinol and my Lasix today at lunch????”
I hope I get better than a 50-50 right guess.
The good thing is that oxypurinol, the first metabolite which is also very effective, has a very long half life and the occasional missed pill or double dose doesn't have much of an effect either way.
I guess if the doubt occurs too often one could take a HALF pill.
ekes,
Pain in shoulder, knees, throat (weird), wrist, fingers and hands MAY be gout, but with a 6.6 mg/dL SUA my guess is that you should consider it NON gout until you get some toe, foot, ankle involvement oe some higher uric acid numbers. Colchicine not working definitely points AWAY from gout.
From what I see I would nay-say a gout diagnosis.
Have an arthritis panel run definitely including an ANA. Probably not conclusive unless a LOT of testing is done. Generalized pain is hard to diagnose that's why so many charlatans are getting rich selling fibromyalgia and leaky gut “cures.” Look towards osteoarthritis, rheumatoid arthritis or Lupus…none of them easy to diagnose.
How about upping the Naproxen to something like a divided 1000 mg./day if you are in a country where it is OTC?
There are stronger narcotic pain meds like oxyxodone, hydrocodone, codeine. Talk to your doctor about more potent pain relievers if the pain is brutal.
I have never known anyone who had tophi removed surgically, although I DID remove a small bean sized tophus from my own thumb with “self-surgery.” It did not grow back.
But don't do what I did, have a surgeon do it so that you don't infect anything. Make sure you go to someone with a track record…our hands are too valuable to f%$k with.
Here's my take on it: With a high uric acid your body will wall off urate into a tophus. But the “walliing off” means the body cannot see it, reduce it, etc. IF sometime later, one has controlled his serum uric acid, I see no reason why a removed tophus should grow back because there is no excess uric acid to grow it.
I have a lentil sized tophus on my little finger which is unnoticeable unless I point it out…I've decided to let it be.
My thumb over the years caused the occasional dull ache, nothing more. Little finger bugger, nothing at all.
Soleranz,
For the gout, my guess is that you are not taking enough allopurinol (Zyloprim.) If you take enough, perhaps 300 mg., you will stop having attacks or at least have far fewer of them.
But the weight loss is significant. It isn't likely related to gout or allopurinols except for the fact that fast weight loss can trigger attacks. But, such a large loss so quickly IF you have not been restricting food is cause for concern. Like odo says, have your doctor do a solid physical on you with the goal of finding out the reason for the 22 pound weight loss.
What is your sex and height?
I delved a little this morning and calculated my GFR from a couple of the Internet formulae. Seems for preciision you need to find out whether your creatine was tested using IDMS or nor…and I haven't a clue what that means. Anyhoo, WITH IDMS, my GFR would be 70mL/min/1.73 square meters. WITHOUT IDMS, the value would 74. Anything over 60 seems to be acceptable for someone of my age. (My blood creatine was 1.07 last year and 1.00, back in 2003…and also 1.0 back in 1982 {I keep my blood results})
Kidneys seem normal and I've taken an average of 300 mg. allopurinol every day for over 20 years.
From the formulae it seems inevitable though that our kidneys are destroyed with age and time. I guess that's why in so many cases of impending death you hear the term “the end is near, his kidneys are shutting down.” I even heard the same comment about my CAT, the sweetest pet that ever lived.
Funny, from all the calcualtions, if I read them right, for any given creatine level blacks have a much higher GFR. I guess that implies the black races have better kidneys? I wonder why that would be?
BTW, Functioning kidneys should allow NO protein to leak into the urine.
zip, I'd be interested in knowing about your “9 day attack of podagra from Hell” if you're willing to share it.
Well it started at 5 AM, a very common time. I found I could barely step on my foot to go to the bathroom (almost “en suite.”) Since this was similar to about 4 earlier attacks, I figured 3 day of pain and I dug out the crutches. For the earlier atttacks in my instep and ankle I had not yet made the gout connection…young and stupid but also not in the most common joint.
As the first and second days progressed it was clear that nothing could be put on my right foot and swinging the foot with crutches was too painful so I took to my bed the second day (if memory serves.) I took everything in the medicine chest including ibuprofen, acetomenophen with codeine, aspirin (later fouind to be a big no-no,) phenobarbitol, librium. Nothing worked. I could not bear anything but the lightest sheet covering my foot and just changing position was horrible. To go to the bathroom I had to crawl on my hands and knees, keeping my right foot elevated behing me, VERY careful not to bump it. That was so difficult that I switched to a hospital style pee bottle…and tried to hold the rest in until I HAD to make the hallway crawl.
My right bunion joint was purple and the front half of my foot badly swollen with the skin so stretched it looked like it might burst.
My bed partner became an ancient 1400 page volume of the PRINCIPLES OF INTERNAL MEDICINE with a good long chapter on gout (Al Gore hadn't invented the internet yet.) I diagnosed myself with gout. THe book talked about the HUGE excretion of urate with 6 grams of aspirin daily (like 19 a day) for a week. I made it 2 days before my stomach told me NO MORE ASPIRIN!
But I also found the OTHER cure, colchicine, 2 to start and one an hour til pain relief or severe diiarrhea. So I called my doctor and TOLD him I wanted him to call in an Rx for 60 colchicine. Friend went for the Rx and the next morning I started before dawn. I took a total of 22 pillls on day 9 (no mention the daily UPPER limit is 16.)
At pill 22, all Hell broke loose and I sat and shat for 45 minutes nonstop/ I would drink a large glass of water (I knew to avoid dehydration) and it would immedicately spill though within a minute…I worried whether I was going to find my eyeballs in the toilet. At the end of the 45 minutes the pain in my foot was gone…a couple hours later all signs of swelling were gone and I arose, Lazarus-like and went for a walk…the first time out of the house in 9 days. That week I went to the doctor and got an Rx for 400 mg. allopurinol per day, a year later I dropped it to 300 and have not had an attack in the last 24 years. When I tried 200 mg + lasix + losartan for a few months, I started getting some little twinges and ran a 6.7 SUA…quickly went back to 300 mg.
I have NO dietary restraints and like meat, even liver, shellfish, and wine and beer (perhaps TOO much.
)CAUTION: Do NOT take 22 colchicine. I'm 6' 2 inches and over 200 pounds so MAYBE for me it wasn't QUITE an overdose.
Just to address one point. Every timeI have tried jogging, all goes well for about 3 weeks and then my knees begin to ache. The pain lasts for several weeks after I stop jogging. I have almost no knee problems with using the elliiptical trainer though. I use the professional style Life-Styler that my gym has (about 30 of them.) I've tried the store-bought consumer models and they seem pretty crappy by comaprison…herky-jerky instead of smooth.
Since I've ripped the cartilege in both knees (first one in high school during the Civil War
) I don't know whether I can attribute any of the pain to gout or just rotten knees, best guess is the latter.david (and Nate if you're still here),
What kind of 24 hour urate excretion did they determine for you on any of your 24 hour tests?
Hmmm, here's a good research topic: Does Uloric cause more initial flares than allopurinol? I wonder if anyone has done the study?
Anyway, I went on AP after that bad spell with gout and had not had a flare up until I started jogging.
I would not be quick to dismiss jogging/running as innocuous, especially in the first year of treatment.
Entertain this fact if you will:
We have gout attacks and the body deals with them by walling off the urate with flesh, fat and scar tissue. Some of this urate peeks throrugh to the bloodstream and causes an immune response…pain and inflammation. Some is more successbully walled off and invisible to the immune system for years or decades unless something happens to change the status quo. To me it seems likely that a buried tophus in the ball of the foot, usually the bunion joint is banged pretty furiously with repeated hard footfalls in running. Such battering might readily disturb the covering of the tophus and WHAM the body attacks it again. Ultimately, the resolution might be for the good…but a full blown attack is a high price to pay. So me might ultimately have to choose whether to let sleeping dogs lie or to let them attack with fury. Food for thought?
My opinion is that there are THOUSANDS upon thousands of conditions that can afflict us. If one of them does, we are at an advantage over any GP who must (or SHOULD) learn something about all of them…but that must perforce be a CURSORY something. For us, we need become expert in only ONE of the conditions and it is not too hard to learn almost everything there is to know on such a single condition. We can become as good or BETTER than even the average specialists who still must deal with hundreds of conditions.
If we choose NOT to become expert in our own conditions, we have only ourselves to blame when we follow the designs of someone who is also not an expert.
For our own good, we must ultimately become our own GOOD doctors in the areas where we need care.
