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Hi
I’m a 41-year-old male who had my first gout attack out of the blue at the beginning of the year. Hobbled around for a couple of weeks but gradually recovered to a more moderate discomfort.
However, I was continuing to have daily minor flares and to cut a long story short am now on 300 Allopurinol per day. This has reduced my uric acid level from 439 in Jan to a level 220ish over the last couple of months.
Despite this (and apart from a brief 2 weeks spell with no symptoms), my toe has shown various states of redness along with various levels of discomfort/ pain.
What is odd is that the original pain area (classic side of toe) is now fine and the redness/pain has moved around slightly the top of the toe area.
I’ve read widely and hope that it may just be the crystals dissolving but is there any way to be sure?
I am seeing a specialist who is now at a bit of a loss – I’ve tried oral and steroid injections along with naproxen and colchicine (not at the same time!) and none have particularly helped although fortunately, I’ve not suffered any side effects either.
Any advice would be much appreciated!
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The way to tell if you’re still dissolving crystals would be to take a DECT scan… way overkill.
If these aren’t crystals, I guess it could be some kind of tendinitis caused by a gout attack. Either way, it should heal. Naproxen-type drugs should help either way.I’ve taken a drug similar to naproxen at the same time as colchicine. I gather some people have done this a lot more than I did. If the pain/redness seems superficial, you could also use topical anti-inflammatories on top of colchicine. Run whatever drug combination you want to try by a doctor as side effects do not necessarily show up right away.
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Many thanks for the response!
As you say I don’t think that a DECT scan will be possible so I’ll just continue with the symptom management alongside the allopurinol in the hope that it settles sooner rather than later!
One thing I’ve noticed from the forum is that everyone’s gout experience is different so mine just might be a bit resistant. 🙁 Is 5 months (the length of time on allopurinol) a long time to dissolve all crystals?
One other point – I’m amazed at how different it can look throughout the day. One minute it can almost look as though nothing is there and then suddenly it looks purple. Have you any experience of that?
Thanks in advance!
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5 months ain’t much in the grand scheme of things but some researchers have found a correlation between the time during which you had untreated gout and the time it takes to cure it. By that measure, your gout should have been solved already. But that was a mere correlation. And as you say, everyone is different.
I’ve experienced color changes, sure. But color changes just like yours? Maybe not. I only used to get fast color change after changing position (like standing versus lying down) or doing something else that that would affect my blood flow.
Something else I had forgotten: if you’re getting symptoms you’re not used to, it’s worth checking your temperature, checking your skin for small wounds and pausing to ask yourself how you’re feeling. Because there’s a remote chance it could be an infection. Don’t get worked up over nothing: it would be very surprising if it was an infection. It’s just something to be aware of because you wouldn’t want to let that get worse and worse.
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Thanks for giving me some things to think about. To be honest apart from my toe I feel as good as I have in a while (small diet changes may have helped) and I have no temperature.
So, I’m thinking the most likely scenario is slow dissolving crystals. What is the quickest way of flushing these out once dissolved? Loads of water? Foot elevation? Any other ‘natural’ remedies?
Thanks again – I go on hols soon so some relief before then would go down a treat for me (and I suspect the family!) 🙂
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I looked over your posts and I see I messed up. While you’ve been taking allo for 5 months, it’s not clear how long you’ve been taking a strong enough allopurinol dose. If it’s only been “the last couple of months”, then it’s not surprising at all you still have symptoms.
You also don’t state the naproxen and colchicine doses you’ve tried. They may be inadequate. Fixing that could perhaps give you some relief but you should get that plan greenlighted by a doc (likewise, ask about taking both drugs at the same time).
Other than that, sure: drink water.
And make sure you keep the blood flowing (a traditional way to help with that at home has been bathing your foot in warm water but you might as well take a hot shower if you can stand). Like, avoid sitting in a cramped place without moving or tight socks/shoes. Some recommend exercise (I’d make that very mild exercise if the affected joint is at all involved).
Elevation helps with the swelling and pain but I don’t think it helps with the underlyling problem (that might even hinder its resolution if you keep it up for too long though switching between elevation, non-elevation and back might actually help a bit). Simply relaxing (an actual painkiller might help if the pain becomes unbearable) should also help a it. -
Hi and thanks
My uric acid level has been under 300 for around 3 months now I’d say but I guess I don’t know actually how long crystals have been forming before the attacks started in January. Some things I’ve read suggest this could have been years and therefore will extend the time to dissolve them?
In terms of management I’ve tried a full course of Colchicine (500 mg x2 per day) for 6 days. Naproxen wise it is currently 250mg x2 daily but upping it to 500mg x2 daily when very painful. I’ll discuss with doc next time.
I’m going to try the warm bath – I’m willing to try anything!
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It would make sense if having had high uric acid without symptoms for years would lead to substantial deposits requiring a long cleanup time but I’m not aware of any evidence to back that up. The evidence such as it is (it’s only tentative) is only in regard to the amount of time people had untreated gout.
In your case, it doesn’t look like you ever had really high uric acid anyway. Once you start developing gout, crystals are going to form with lower level of uric acid in the blood compared to people who aren’t affected by the disease. This may be a reason why the amount of time during which you had untreated gout is the relevant yardstick in many cases.Lots of people (myself included) have taken more than 1mg of colchicine per day (I assume you meant 0.5mg and not 500mg which would if I’m not mistaken be a fatal dose) for a limited amount of time.
It’s in some cases OK to push the Naproxen dose a bit higher for a limited amount of time as well. Your body would have to tolerate the drug well to warrant such an experiment.
I think it would probably be safer (but also less effective) to incerase your colchicine dose. And combining both drugs without increasing the doses might be the best option. But everyone’s body is different… -
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