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First time gout flare up - lots of questions

Posted , 4 users are following.

ross86462
ross86462

Hello everyone,

Last Wednesday, I had my first severe and debilitating gout flare up behind my left toe. I had to call in to work for a couple of days, and I saw my GP for a blood test. He started me on indomethacin, but it feels like it didn't help with the pain, or inflammation.  I returned to the doctor today, and he is referring me to a rheumatologist, and switching the medication to prednisone. I haven't been formally diagnosed, but he said that "it sure looks like gout". My uric acid level was 9.4mg/dl on the first day of the flare up, and it dropped to 8.7 two days later. 4 months ago, my UA was 8.3mg/dl.

Hopefully, the rheumatologist will take some time to discuss this with me, but I still can't quite wrap my head around why this is affecting me. I'm relatively young, don't drink, don't smoke, don't have diabetes, and I don't have an extreme diet. I'm not in perfect shape, but I'm not obese. I don't currently exercise regularly, but I walk regularly with my job. I am however guilty of eating food with preservatives, or easy to cook food.

I know that some people just get bad luck, but I question if something else is going on that could have caused the gout. Could gout be caused by a kidney problem? Should I ask the doctor for any additional tests to determine if any other conditions might have caused it?

The doc wants to put me on allopurinol once this attack is over.  I think I recall reading that some people suggest alternative treatment methods before jumping on allopurinol for the first time. Can anyone explain this logic?

Finally, is it normal for the bruising to migrate away from the joint? I'm on day 5, and I noticed a new bruising/red skin on the outside of where the metatarsus is. It almost follows the bone. It's hard to see in normal lighting, and I can see it better when the lights are dim. See the attached pics. The dark line running along the contour of the arch is not a shadow - it is a red bruise.

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  • ross86462
    ross86462

    Posted

    Thanks for all of the responses! A quick update - 

    I gave in, and asked the rheumatologist to send me to a podiatrist since he didn't seem too confident in doing an injection. The podiatrist did an amazing job getting me better. It was extremely painful, but it instantly reversed the gout flare up. He was a skilled doctor, and had confidence that he could attempt to pull fluid, and inject steroid in the joint. He also seemed to know more about gout than the Rheumatologist. He said that in a true gout attack, the inflammation gets worse when the limb is lower than your heart. (I was starting to worry that it was septic arthritis)

    All in all, the gout flare up lasted a month before the injection turned it around. 2 months later, and the joint is still very swollen, and gets red/black and blue when I'm standing. It isn't inflamed, but it feels hard from the trophi. Hopefully this will go away on it's own as I continue to take allopurinol. 

    I've been taking allopurinol for almost a month now, and haven't noticed any major changes. Still a vegetarian with the occasional exception for salmon. No high fructose corn syrup whatsoever, and I've completely given up on alcohol even though I rarely drank it in the first place.  I was originally 225, and now I'm down to 210, and exercising. Hope to knock this one out for good.

    • alex247
      alex247 ross86462

      Posted

      Hi, Ross. Glad to see you're on the mend and have taken positive steps to changing your lifestyle to help. My last attack in April has almost gone. after a day of standing on my feet, my affected foot feels a little more tired and swollen than the other but im hoping this will get better with time. Out of interests what age group do you fit in? (trying not to be specific here)

    • alex247
      alex247 ross86462

      Posted

      Im curious as to why the doc stuck you on Allopurinol after one attack. its usually if you have two.
    • ross86462
      ross86462 alex247

      Posted

      I honestly don't think that my GP is very knowledgeable about gout. The podiatrist got me fixed up, and from my experience is the "go to" specialist for gout, not the rheumatologist. I think he made a judgement call based on the severity. I'm not fighting it personally because I don't ever want to experience it again. People speak about allopurinol like it has some nasty effects. Why are so many people against it? 

      Just another update - the joint in my right foot now has a sharp pain when I'm walking, but it has not become inflamed yet. The joint in the left foot still looks swollen and bruised, but it is not tender like inflammation. I've experienced a new peculiar abnormality. A week after I started the allopurinol, my right index finger got red at the edge of the nail and it filled with yellowish white pus. (similar to a hang nail) It healed in a week or two. Never had anything like it. Now, my right toe has the same thing going on - just like a bad hang nail. Could this possibly be due to the medication, or uric acid buildup? I read that Paronychia can be a symptom of diabetes, so I hope that is not the case. Maybe I should have my A1C tested again. A few months before the gout struck, I tested my blood sugar for the first time, and it was 101 mg/dL (normal:70 - 99 mg/dL). I had an A1C test after that, and it was 5.6 % (normal: 4.5 - 5.7 %)

    • rustygecko
      rustygecko ross86462

      Posted

      GPs are given a very short training on gout while at university; unless they do specialist trading in rheumatology they don't get much more.

      As for why allopurinol has such bad press - I don't know. Most people get on with it okay. There is one very serious side effect which will kill you (all you skin drops off), but it's very rare unless you are Han Chinese Thai or Korean. This is the reason we start on 100 mg for a couple of weeks. 

      There is an association between gout and diabetes - and the combination is bad. Losing weight and cutting out all sugar and esp. HFCS and reducing alcohol will help both. 

    • alex247
      alex247 ross86462

      Posted

      Interesting point an the podiatrist. I presume you can see a podiatrist without federal unlike a rheumatologist. 
  • rustygecko
    rustygecko ross86462

    Posted

    This is true - I thought the same. My guess (for what its worth) is: 

    a) very high reading of blood urate even though taken during an attack (when it will have reduced from the real reading);

    b) the attack was so awful.

    • rustygecko
      rustygecko alex247

      Posted

      Depends on where you are. In the UK i think its two in 12 months. But the doctor of course has some leeway for clinical judgment. In this case - terrible pain and very high bloods.
    • alex247
      alex247 rustygecko

      Posted

      Explains there reluctance to put me on them. Ive not had an episode since April. Im due back in two months for a check. By which point ill have lost 2 stone (one to go) and be out of the obese BMI category. Will see if lifestyle does effect it. 

       

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