This sound like gout? Or am I in denial?

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Let me start by saying I'm 44 now and quit playing vball at a young age due to very bad tendonitis. A couple years ago my right knee got extremely sore. The tendons below and above the knee cap we sore to the touch. To the point the pain would radiate into my thigh. It didnt swell much, but was warm to the touch. My doc checked my uric acid levels. They were slightly elevated. She put me on alopurinol and prednisone. The pain came back to my right knee twice since then. Now, this past Sunday,, my left knee got extremely sore. To the point that I cant bend it. 5 days later and I'm at about 50% better. No part of my knee hurts, except the tendons and where they attach to my knee cap. Does this sound like gout or some kind of tendonitis flare up? The pain is almost unbearable if I try to bend my knee. Is this a tendon problem, or am I a gout sufferer in denial?

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  • Posted

    Hi Brandon

    Firstly welcome to your first taste of middle age! 

    The doctor took the decision that you have gout (clue: allopurinol). Most gout starts in the big toe - but knees are also common. If you have a higher than normal level blood urate during an attack - it’s well out of spec when the knee recovers (attacks reduce urate). The warmth to the touch is also a clue I think. My memory of tendon problems is not hot to touch - and there’s usually an obvious cause.

    If you have gout then the allopurinol will trigger gout for a time till it flushed you out. I’d stick with the allopurinol (how many mg you taking?) and after 6 months max you should start to see a marked improvement. 

    You are lucky that your doc is on the ball. Long term untreated high blood urate is a severe threat to your health.

    In the meantime drink plenty of water, get slimmer if needed, avoid excess alcohol, bread, cut out as much sugar as you can, cut out all HFCS and just be grateful that you have a condition which is eminently treatable with minimum fuss and it will bearly impact your life. 

    As I said .... drink more water! 

    To answer your question - probably the doctor is correct. 

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    • Posted

      Thanks for the quick reply and advice, Rusty. The doc put me on 300mg. Of course, everything you mentioned is a vice for me. Beef, pork, captain and diet coke. Oh, and I could lose a solid 50 lbs😢. I also have HBP which I'm sure doesn't help. Sounds like I have some serious decisions to make about my health.

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  • Posted

    Brandon, I would not think that is gout.  Your pain description does not come up to the gout level.  Did they even take an x-ray, as would be SOP for sports injuries?  It's infamous in sports injuries, when the doc just gives the athlete prednisone and sends them back to keep playing and wrecking their bodies.

    ?I also presume you stopped the prednisone when the pain stopped?  You can easily get hooked on the stuff and it's very hard to stop, and it's not good to stay on.

     

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    • Posted

      Thanks for the reply JX. I don't want to candy coat it. The pain can be pretty intense, unless my leg is straightened out. The real pain hits when I attempt to bend it. Getting in the car is a real treat. Bending the knee puts strain on the tendons. My uneducated guess makes me think my whole knee would be sore if it were gout. Instead, its the tendons and where they meet the knee cap. This pain brings me back 20 years ago to my vball days. The soreness is what caused me to quit playing. But it was never this bad. My neighbor did talk me out of retirement 6-7 weeks ago and both knees have been tender since. I've heard an area affected by gout is painful to the touch. I can touch...just can't bend. And, I dont want to continue taking medications that I dont need. This is my 3rd "flare up" in about a year. The prednisone seems to bring some relief. I know I'm a perfect fit for gout. Just not sure that I'm sold on it.

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    • Posted

      With real gout there's no doubt.  Hey, it rhymes!  It can be a 9 at best, and then a fly lands on your toe and it's a 10.  Fortunately the pain is greater than the actual damage done, but it's very character building.  I don't know just how effective prednisone is for real gout.  Anybody?

      ?I'd been something of a gym rat, until I'm guessing a tore a rotator cuff, though I never got a real diagnosis.  It's not always gout.  Had other conditions that chased me from the gym about that time.  Age, dude, it happens to everyone eventually, if you're lucky!

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    • Posted

      Um, I meant "at best", but I also meant "at rest".  You just sit there, in the best possible position, and it *still* hurts like you can hardly imagine.

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    • Posted

      😂😂😂...Thanks for the input. Need some lifestyle changes to accomodate this older body. Going to try swimming for low impact....after rotator cuff surgery next month😡

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  • Posted

    Best way I can describe a full blown gout attack in the knee or elbow: at the peek of the attack, using a pain threshold of 1 - 10, 10 being "holy hell cut my leg off" - When your leg is straight the pain is a throbbing 8, when you bend it the pain is a 10+.  When the leg is bent it's a throbbing 8, when you straighten your leg it's a 10+.  The knew will also swell up and sometimes you'll develop bruising below the knee gap and the interior of the knee. 

    I've had several attacks in both knees.  I'll describe what the attach always feels like, hopefully it will help: 

    When it first comes on, the tendons behind my knee hurt (fibular collateral ligament.  Almost like I've pulled something. At first, it's just a soar type of pain.  Then the pain is more noticeable on the interior, 2'' down and to the right of the left knee cap for example.  Again, the pain is more annoying at this point than it is painful. Then over night (or sometimes later that same day) bending it hurts, walking becomes painful. Untreated (or full blown attack) without medication you'll need crutches, with over the counter pain killers you'll do a slow shuffle around the house. Full blown attacks for me in the knee, symptoms are major, visible swelling, redness, hot to the touch, sometimes bruising. 

    Getting it in other joints are pretty similar, i.e. the pain always starts out feeling like you sprained something. 

    Also note: Alopurinol only attempt to control your uric acid level and it's limited by its dosage.  Meaning, if you are suffering from too much uric acid (which leads to gout) - if your uric acid levels are 'high' and your dosage may only be bringing it down a few points. Which means, it is typical/possible to still get an attack while taking allopurinol.  In fact, once the uric acid begin to form tophi crystals (this is what causes the pain) allopurinol becomes useless, because it doesn't contain any medicinal purpose to treat the crystals. This is when you'll need to take something like Colchicine to treat the attack, then once the attack subsides you re-start the allopurinol.  

    For me (a gout sufferer of 10+ years), I cut out all caffeine and found that this one thing is my personal gout trigger. And I promise you, I went through every remedy/diet modification imaginable.  Cutting out the caffeine, for me, stopped my attacks completely.  Hopefully this was helpful information, if not I hope you find yours! 

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    • Posted

      Attacks that start away from the big toe should be seriously considered as pseudo-gout.  Whether your doctor will do the work to show this, is another question.
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