Gout or Arthritis?
 

The knuckle of the finger on my left hand next to my little finger is swollen and extremely painful. This happens on the same finger every few months but is extra painful this time.


This is either gout or arthritis which have similar symptons but are different. Arthritis can effect any joint. Gout usually starts in a big toe. Gout is caused by an overload of citric acid (?) and leaves crystals on the joint bones. I happened to be in an A&E dept last week and grabbed a doctor for his opinion. He said they could inject the swelling and might find out more. The thought of having a needle stuck in what is such a painful area fills me with dread.


I managed to get some gout tablets today so will see if they help. I also take as many Co-codamol as is allowed.


Any experience and please avoid "stay off the Port" comments? :p


David

Gout is notoriuoly a rich mans problem ;)

Arthritis is my guess, dont know whats for the best though

And your mrs said she had been tested :Whatever_


dl

The subaru impreza doctors aren't generally the best...lol

Any joint pain can be really painful. Every finger I've broken, doc has said get ready for early arthritis...

(Note: I avoided saying first 'port' of call should be the doc:D )

Blood test will tell you if it's gout. I've had gout for nearly 30 years now, and yes big toe first usually, normally right foot, and usually happens while asleep. All my attacks are feet, ankles or knees, and usually debilitating. Much as I don't want to take medicine long term, 300mg of allopurinol has the gout under control now.

OK thanks guys - some sensible answers at last. I'll try and sort out a blood test.


David

I had a gout attack 6 years ago. I did my research spoke to the odd person who were on long term preventative medication for it. I informed the doctor I wanted to be prescribed Allopurinol 300mg. I have not had an attack since and all my aching feet and knee pains have never returned.

It can attack any joint in the body. It is normally associated with leg joints but not exclusive

I have several friends who also have gout and met the odd acquaintance who also suffers from it. One of my friends refused to take the allopurinol and has had 6 major flare ups of gout which result in him taking super strong anti inflammatory drugs, wearing slippers for a month at a time.
after many years he accepted he needed to take allopurinol and since has not had an issue. The others dont suffer as often but still get the odd flare.

I met an American who constantly suffered and had never heard or was advised by his doctor to take allopurinol. I gave him the data sheet out of my tablet packet, so he could get better informed.

If you leave gout untreated it will damage the joint and arthritis will set in.

It could be gout, and it could be arthritis. Blood test for uric acid serum levels needs to be done during an inflammatory stage ideally

Gout effects distal joints only. so toes, fingers, feet, hands and less often (in more severe cases) knees and elbows. If the joint has been previously traumatised, it will be more likely to be targeted

It is hereditary and first symptoms can appear age 20. Gout is a miserable affliction and if you get more than 3 flare-ups in a year, the allapurinol is the way to go

It can be managed by prompt early anti-inflammatory meds (catching a flare-up very early is key), or every day medication (allapurinol)

Thanks gentlemen. Useful stuff. I'll try and get a blood test and chat to Dr. I am currently taking Colchicine but I suspect this may change to Allopurinol.


Slightly concerned to read there is a hereditary element as my son is a professional guitar player and not ready to go down the Django route just yet :nono:


David

As you're ringing all the gout bells, we'll talk it

Son - get early diagnosis. Onset can start as early as 20 y.old. Last thing he wants is recurrent gout flare-ups. While flares do too slowly respond to anti inflamms, the uric acid aftermath stay in the joint, causing (semi) permanent deformation

This

Thanks for advice. I'm inclined to see if I actually have gout before chatting to my lad. You say early diagnosis - do you mean for him or me? If him what would he need, a blood test alone?


I am guessing you work in a fracture clinic or similar?


Help appreciated. David

Colchicine is for generally for attacks, it quickly helps the attack pass, stick to the prescribed dose, it's an arsenic like medicine. Best get a few blood tests, in my experience once you're having an attack, the peak level of Uric acid has passed. I found diclophenic to work well for my attacks, but the NHS have pulled this medicine now and none of the others are quite as good for me - good thing I have a box stashed :) once on allopurinol, if you miss a day or two you know pretty quickly, any change in the dosage levels will lead to an attack. My 300mg level was built up over months of blood tests and attacks each time we upped the dosage - but been without an attack for a couple of years now.

I wouldn't fret anything

Wait till you get another painful joint and book yourself into the GP. In fact you don't need to wait. You can have a blood test now for raised urates

As for son. monitor, Any localised joint soreness get him in for blood serum inflammatory markers levels. Gout tends to effect a single joint alone and is very painful

Early catching is treating a flare-up in the early stages

All this is conjecture though without a blood diagnosis

There is a British Society of Rheumatology guideline from 2017 on gout you may wish to read. Mostly you should stop messing about and see your GP tomorrow because treating this acutely is beneficial. It is entirely justifiable if asked whether this is urgent to say that it is. As below the blood test is not 100% sensitive or specific for a diagnosis of gout, as most things in medicine.

From a course I was on two weeks ago, advice:

Elevation, ice
Stop ALL alcohol

From the medical side:

Urate level (the blood test) may be normal in acute gout
If not 50% better after 24 hours, a second treatment may be added
Urate target level on long term lowering treatment is lower than previously (0.3mmol/litre)

The guideline stresses the importance of good information to patients to ensure they are aware of the risk of untreated or under treated gout as poor patient understanding has been shown to be one of the barriers to effective treatment.

I suffer from Gout. If it flares up, difiene is the only medication that with take down the swelling and only take a few hour to get rid of the pain.
allopurinol is only to be taken when the swelling and pain is gone. This is the preventative tablet and depending on your blood test, it will determine if 100mg or 300mg tablet.
Dont let your doctor inject. Wrong treatment and way way too painful.

Update
 

I phoned my surgery first thing and asked to speak to my named Dr. Away today. Was told someone would call me back sometime :rolleyes:. I politely said it was urgent and btw why didn't they open on a Saturday as my daughter would have taken me in. I had phoned several times only to get the "sorry we are closed today" answer phone. However they were open, just forgot to change message. F,ucking terrific.


If I give a blood sample after the cut-off time when van takes them to the hospital can my sample be kept overnight in a fridge?


David

Thanks JB


d

I had suspected gout a few years ago (over xmas and new year so had to lay off the sauce! ..... bad timing). And have a history of arthritis in the family so did alot of looking into stuff....... anyway, turned out to be a blackthorn infection so not relevant.

Anyhoop, if it does turn out to be arthritis, i can highly recommend rosehip capsules. I have a an old broken knuckle on a third finger which flares up in the same way and taking rosehip for the suspected foot thing inadvertently made that loads better! Im still aware of it but its bearable now. Theres a few potential side effects but if you havent got weak guts youll probably not notice.

Polybush it :thumb:


Sorry, I cant believe no one came out with that one before I got here, especially after the other comment about Subaru Impreza doctors.

Ill see myself out :lol1:

I don't even know what Polybush is :rolleyes:


d

Its a lump of polyurethane with a hole in the middle that ruins your ride when it gets rough. Not a sex toy, nor is it a shrub.

And unless you have bionic inplants, it's absolutely useless. :thumb:

< slams the door in Martianwrx's arse > :lol1:

Well I phoned my surgery first thing Monday and said I wanted to see GP and have a blood test. A Dr phoned late in the day but said he wouldn't see me but had authorised a blood test. He more or less refused to answer my questions but arranged for 56 x 500 mcg Colchicine tablets to be sent (which I had told him I already had).
The earliest I could get a blood test was Wednesday and that was a 2 hr wait for a 3 min test :mad:
Dr had promised to phone me with results but guess what :rolleyes: Prick.
I phoned another Dr and Uric Acid was 704, way too high (should be below 420). This indicates Gout and Dr sent me some 100 mg Allopurinol pills and said to take with Colchicine until blood back to normal.
Finger is now less swollen and painful.
Does above tie in with you gout sufferers?


David

Thanks. I spoke to my pharmacist about this and the thinking seems to have changed slightly. Medics now suggest taking 2 lower doses of Colchicine along with one a day Allopurinol.


May be JB can comment?


Appreciate your input. David

This seems sound logic, although as buzzer says is OK too

100mg allopurinol is not much (300 is a more usual daily, long-term dose), although you are taking it to reduce a ucute flare, which is interesting, as the tried and tested is more than 3 flare-ups in a few months, then go onto allopurinol
either way, you're on the right road

A mate suffers now and again with Gout in his big toes.
He reckons he cant even have a bed sheet on his foot as the pain is excruciating when it lays on his toe.
Not a lot of fun if you've got it.

Every time you change the dosage of allopurinol, up or down, it triggers an attack of gout, it's just the way the medication works.

I dabbled with allopurinol for 2 or 3 years but didn't use it regularly and never made the link between stopping and starting the medication and the attacks. Stupidly I thought once the attacks passed I could stop taking the allopurinol - doh.

You need to persevere with the allopurinol and blood tests, and if you step up the dosage make sure you have colchicine available. I started on 100mg a day, after a few weeks and a couple more blood tests it was raised to 200mg, this continued for a few more weeks and more blood tests until raising to 300mg a day when the Uric acid level came down to a high, but acceptable steady level. It probably took 3 or 4 months and a dozen or so blood tests to end up with the 300mg level - I was on the verge of asking for a different type of medication when things settled down.


Toying with the idea of trying to reduce the dosage slightly - under the doctors guidance of course, just because it looks like I'll be on them for a long time and even if I can reduce the dosage a little it might be better for my health.

Attack in big toe is painful as you've said, my big toe joint is now slightly deformed after lots of attacks, not painful but clearly you can see it's not how it should look, the attacks in the ankles are excruciatingly painful, but so far the attacks in my knees are probably the worst I've experienced.

I tell the wife its worse than childbirth :lol1:

Allopurinol is a life long drug, gout isnt going away. Dont stop taking it if you are fine with it.