Lump on big toe joint after gout

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I am 36 yo and had massive gout attack just before New Year, i had 4-5 attacks over the past 5 years but this one was the longest and most painful.

I was taking painkillers and indomethacin and it managed to get rid of it after 2 weeks of pain and misery, however, there is lump left on my big toe joint where attack happened and i can not bend my big toe all the way like i can on my other foot.

I felt pain and gout didn't completely disappear.

I went to dr and he gave me prednisolone to take for 3 days and colchine (which i didnt take btw as there no pain per se) only when i press that bump feels kinda painfull.

I finished with 3 days of prednisolone and while it helped a bit the lump is still there and i can say that my big toe joint doesn't feel as healthy as the other one, its like 80% ok but not quite there and i always feel like it can get nasty

I am a bit worried about this, what can it be? it is definitely not normal compared to my other foot, What can i do to fix this, x-rays, medicine...

Im thinking of going back to my dr and tell him that meds didn't quite fix the problem but i would like to hear from people here who had this issue.

Thanks

I

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  • Posted

    You almost certainly need colchecine - it is not a pain killer - it stops inflammatory response. A few days will probably fix it. Be careful not to take more than the stated dose.

    The bad news is most patients the gout will get worse. If you start to get gout regularly you need to attack the underlying disease: slim to perfect weight, exercise at least 4 x a week, and if you still have attacks - allopurinol. Stop drinking alcohol drink lots of water. Stop all fructose.

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    • Posted

      Pharmacist said its pain killer and to take it till pain is gone away so I thought i might skip it as im not in pain, i had other pain killers. Anyway i just took 1 colchecine now.

      So you think something is sill inflamed, right?

      I have had gout attacks before, once a year or so BUT never had this lump after gout disapeared.

      He also gave me progout to take for 1 month but I hate drugs, I always some side effects and i know if i take something every day it will sabotage some other part of body

       

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    • Posted

      I understand your reticence to take drugs, but gout will destroy your joints and blood vessels and kidney. There's a time for drugs and this is it.

      The more gout attacks you have they tend to get worse.

      The swelling is probably just inflammation. Try 1 colchecine every 12 hours. But drink loads of water.

      It's *possible* you have grown a tophi.

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    • Posted

      If the pharmacist said colchecine is a pain killer, it's a sad reflection on pharmacy training today.

      "Colchicine is used as an anti-inflammatory agent."

      Reducing inflammation will as a side effect reduce pain, but colchecine is not and never has been an analgesic.

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  • Posted

    Hi

    Sounds like Gout Tophi, basically a build up of uric acid around the joint which then turns into a lump, which probably means your uric acid levels have been high for sometime

    I would get your GP to refer you to a Rheumatologist who should recommend having a procedure to remove it, especially as it is giving you some discomfort.

    You can also wait for medication to dissolve it over time, but when i say time i mean 1+ year, after the uric acid level is under control

    Thanks

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    • Posted

      'You can also wait for medication to dissolve it over time,

      but when i say time i mean 1+ year, after the uric acid level

      is under control'

      What medication do you mean, you mean i should be taking some meds for a year?

      It is not big lump but it is still lump on side, no discomfort but its not meant to be there

      I m takin colchecine twice a day and i hope it clears it up

      GPs are useless, he should be checkin my uric acid level, its almost

      Like i have to beg them to do what they supposed to be doing,

      Imo gout is just a symptom of something that is wrong in the system and blood,

      Should i ask him to send me to lab and get all necessary tests done,

      Im more concerned about underlying causes

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    • Posted

      I've been taking Gout medication for years and before that it took me years to get it right, hence i had a number of Tophi which were operated on and removed

      The smaller ones which were left have been broken down by a combination of Allupurinol, Benzbromarone and Cochicine

      You should tell him you want a referral to a Rheumatologist

      Yes Gout is a symptom of something wrong, as most people get rid or the excess uric acid normally. Whereas you are most likely to get Gout if you are producing too much and your kidney's cannot cope

      Thanks

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    • Posted

      I think i developed a small tophi that has restricted range of movement by half compared to my other toe.

      I still feel intermittent stiffness in my foot especially in the morning, pain is subtle but i know its not right when i compare it to my other foot.

      Should i start taking allupurinol to try to get rid of tophi? Does it work better in combination with colchicine or on its own?

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    • Posted

      Allopurinol. Don't take it if you are of Chinese Korean or Thai decent. If not start 100 mg. if all okay after few weeks go to 300 mg. most toohi are gone in 6 months if you get blood urate down to 4. If not almost all go in 30 months.

      Allopurinol will trigger gout attacks in first year (mostly first few months) as it cleans out the monosodium urate crystals. For this reason you need allopurinol- at beginning 1 per 12 hours. As it gets better just as you get a twinge.

      Drink loads of water. Stop fructose. Reduce alcohol. Get your BMI down to 23.

      •••• all the above assumes you are not taking any other drugs and in good health•••

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    • Posted

      Thanks for advice

      I nevert for a test to check my uric accid levels, GP just assumed (educated guess) it is a gout so he just prescriped me all these meds including 300mg of allopurinol to take once a day.

      So right now I have no idea what my uric levels are and i already started taking allopurinol..

      I suppose he is certain it is a gout and a small  lump on my big toe joint is tophi caused by excessive uric accid from last attack.

      Sometimes I feel a bit uneasy when doc dont do any test (blood, xray..) and he still has confidence to diagnose you on the spot and prescribe you with 3 diff medications...is that normal for GPs do do it that way or proper way would be to refer you to a specialist(rheumathologist in this case) and do all the necessary tests before taking furder steps.

      For all we know my uric accid could be within normal range and  yet we are trying to lower i further, I read that people with normal level still get attacks

       

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    • Posted

      Your doctor is not following the protocols set down by NICE and potentially leaving him/herself open to being sued.

      However with a bit of experience I'm sure they can identify gout 95% of the time, especially if the attack came on suddenly and during the night.

      There are (rare)?people who have gout attacks with low levels of blood urate. However, I have see it suggested this is because the doctors did the test within 1 month of a gout attack, thus invalidating the test.

      Are you taking allopurinol?

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    • Posted

      Yes, i just started taking allopurinol 2 days ago.

      Im in Australia so im not sure what protocols GPs are supposed to follow.

      I see gout as a symptom of some other problem, not a problem per se, so proper test would show what is going on inside my body so maybe i can tackle underlying issue. BTW I dont drink alcohol, avoiding sugar and i excercise, im 190cm, 95kg...

      Gp was writing prescription as i was explaining my problem, bit odd they do it in such a casual way and i was expecting referrals to specialist.

      Now i remember he said something like ''take it for a month and see how it works'...

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    • Posted

      Frankly I think the GPs relaxed attitude is probably realistic. However allopurinol is associated with a rare but fatal complication - all the skin falls off (that is not hyperbole). You should have been warned that if you get skin flaking or extreme itching - stop and go to doc/A+E. if that is going to happen it will occur in the first week or so, which is the reason to start on 100mg them move to the 300.

      The only reason that gout per se is a problem is that long term it destroys joints and bones near the joints.

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