Wits end, Gout or Pseudo....3 weeks in and not working 😪

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History;

Had 2 suspected gout episodes in past 12-18 months. First was hideous but cleared in 3-4days with Naproxen. 2nd I caught early and never came to much. All base joint of big toe right foot.

3 weeks ago today, Easter Monday, I woke to a minor toe pain which gradually increased over 2 days to unbearable. Since then its varied between being able to get a sandal on the foot to not being able to speak due to pain. I'm 45 and male.

Treatment;

I started this current bout with Naproxen and Paracetamol, this didn't help after 4 days so I went to my GP. GP prescribed Colchine which I took for 3 days and I felt made it worse, also took bloods for Urate levels. After that I took Prednisolone for 4 days which I thought started to help, but course ran out and back to hell! I've been back to the GP last Thursday and she is wondering whether it may be Psuedo. Bloods for Urate came back normal, and fact Colchine didn't help. So I've had x-rays, awaiting results, and booked in for more extensive blood tests next week. She gave me more Steroids and lots of Codeine which I'm still on today Monday but should start tapering off the steroids. The pain subsides enough after loading the codeine for a few hours to just about get a low shoe on with no foot bend required, but as soon as tablets ease off I'm back to unbearable pain.

I'm off work, I only started my job 2 months ago and I'm loving it but can't drive or walk in PPE shoes which I need in my role. Work are great but I'm feeling very down about the whole situation and being holed up in the house is making me snappy.

Diet;

I can't narrow it down at all. I like a bottle of real ale and a glass of wine but nothing silly. All other dietary considerations I've looked at. I've not touched a drop in two weeks now but it's not helping.

Anyone got any suggestions? How should I be helping my GP get me to a solution?

Many thanks. Feeling hopeless.

0 likes, 13 replies

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13 Replies

  • Posted

    Stop the ale , it must be the real problem
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  • Posted

    Gout is known to trigger Bursitis which is  very painfull though not as bad as Gout itself. Just a suggestion, I've had this problem. Clears up on its on . . . eventually.

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  • Posted

    Big toe is not bursitis , bursitis is just under the knee , had that too myself. I am also on cholchicine as i was feeling the pain slightlu coming , so i start taking 1 tablet every hour , i had 5 yesterday and now it seems to be in control altough not walking right now have pain on outer legaments . i woukd stop the ale as that is a strong trigger , wine not as much
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  • Posted

    Hi Beefy

    The problem with Colchine is that you need to drink a lot of water with it, to help flush out the uric acid, if you don't the gout can be triggered. I had the problem of driving at least an hour each way to work and from drinking so much water I was crossing my legs by the time my journey was almost at an end and praying there were no delays.

    My GP moved me to febuxostat, seems to work for me, no attacks for years maybe you should give it a try. PLus you do not have to drink as much water

     

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    • Posted

      You have mixed colchicine with allopurinol.

      Using Febuxostat or allopurinol the patient is liable to get attacks of gout during the first year (you seem to have been lucky). Regardless of which blood urate lowering therapy one uses, or even none, drinking plenty of water is a good idea. Not only does it help to flush through the uric acid, but it also protects the kidneys: kidney damage is a problem with hypericemea, gout and gout lowering therapies.

      The reason that allopurinol is the first level therapy is that it is well understood having been known about for 4,000 years and well tolerated by the overwhelming majority of Caucasian patients. Patients take it life long for the most part without trouble. It is also dirt cheap for the NHS (£10 year). Februxostat is a much newer drug (under 10 years to patients discovered 20 years), and is expensive (£25 month); the consequence of life long exposure is as yet unknown.

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  • Posted

    Almost certainly gout, simply based on your age and the fact that gout is common among males of your age and pseudogout much more a problem of the super geriatric; and much rarer anyway.

    So why did the Uric acid test come back normal? The reason is because your GP alseep while doing her medical degree and doesn't bother to read the recommendations of the computer from NICE on her computer. It is gout 101 that during an attack of gout blood urate will fall to normal levels (the monosodium urate precipitaties into the joints causing the attack). So the negative blood urate test means nothing except you should change your GP.

    What you need to do short term is get some colchicine. That will calm the attack. After the attack is calmed (15 days) take a blood urate test. When you have the result come back and ask us because I seriously doubt your doctor will understand it.

    As for changing your diet - alcohol is a problem so is suagars esp high fructose corn syrup, but most of your purines comes from your own body not from your diet.

    If you have gout (and it's odds on you do) you'll need urate lowering therapy. Getting your body weight down to BMI of say 24 would be a good idea; so would exercise (as you can hardly walk either swim or wait till attack ends).

    Be aware that urate lowering therapy will create attacks in short term so you ll need colchicine as prophylaxis.

    Try putting the

    And of course drink loads of water.

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    • Posted

      Hadn't finished ... try putting the foot in hot water or cold water or both - some find one works other the other.

      The colchicine would not have made it worse but in 3 days it's not enough time to make a difference.

      The take away message is don't let this get you down. You've almost certainly got gout - and you can easily get it sorted .... but probably not with your doctor.

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  • Posted

    So.........thanks to those who replied and sorry for taking ages to come back. The summary, to date, is still no conclusion. I'm back on 15mg prednisone (? Think that's the one, steroid) daily, as when I tapered off it just came straight back. I'm doing this for a month whilst my Ferritin, which was HIGH, is waiting to be repeated. Could be Iron Overload issues.

    Whilst I keep taking the steroids I can get a shoe on and walk fine, not for long distances but enough to do the day job with no pain, ride my motorbike (yippee) and generally not be a miserable git! I've also not had alcohol for a month (being around the rugby scene a few times a week makes this tricky!) and I've lost a stone in weight. So lots of positives!

    Will update further when blood tests are all completed around mid June.

    Thanks.

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    • Posted

      Be aware: losing weight quickly will (in the short term) make gout worse. In the medium term it will definitely improve it.

      Congratulations on the weight loss btw. If you have any advice on how it's done, I'm all ears (or eyes).

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    • Posted

      Cheers. Portion control and no beer.....definitely not exercise as I've been pretty immobile. I'm hoping that's the cause of the weight loss anyway. 👍

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  • Posted

    I would seriously stop taking medication other than Advil. Trust me I know how painful it is, but opiates and steroids are only going to mask your pain. Also I've found doctors don't really know much about gout and are quick to make bogus suggestions. Drink more water than you think is healthy and stop walking on the damn thing, and you should be seeing signs of improvement after a few days. Taking a lot of hard medicine is just going to confuse your brain about any progress that is almost certainly occurring.

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  • Posted

    Beefy:

    How are things a month on?

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