September 17, 2009 at 3:50 am #2983
I was finally able to get an appointment with a Rhumatoligist for this Thursday. She is a DO as opposed to a Dr. I have had gout in my toes and ankles before but now I have had gout in both knees since June. I am on a daily dose of Uloric 80mg. Allapuronal did nothing for me and I don't think the Uloric is doing any good either. A buddy of mine went to aurologist who did a 24 hr urine test tosee how he is getting rid of the uric acid. His problem seems to be being able to sufficiently getting rid of the uric acid so he was put on Probinicid which helps to keep the uric acid in the urine and apposed to depositing it back into the blood stream. He may also have the problem of producing too much also, I don't know but all he takes now is the probinicid and has not had a gout attack in a year. I am going to mention this to My doctor this Thursday. I hope I get a plan. I don't like being crippled. Any comments are welcomed. Thanks.September 17, 2009 at 4:02 am #5641
I am on a daily dose of Uloric 80mg. Allapuronal did nothing for me and I don't think the Uloric is doing any good either.
Do you understand that both these drugs take weeks, if not months, to have any effect?
They will do nothing for your pain immediately, in fact both Uloric (febuxostat) and allopurinol can cause gout flares before they get rid of all the old uric acid crystals. They will only work if the dose is high enough to reduce uric acid in the blood below 6mg/dL. Anyone prescribing these drugs must know that they must also prescribe pain relief to cover the occasional gout flare.
Probenecid is good for under-excreters, but allopurinol and febuxostat work for both over-producers and under-excreters. If they don't work either they are not being taken properly, or it aint gout.September 18, 2009 at 7:12 am #5655
I do not know much about medications for gout, but I do know from personal experience that black bean broth is very effective in relieving gout pains and inflammation.
I do understand the pain and agony you are going through. So, you could give it a try. Perhaps it could work for you too – at least in relieving you of your terrible pain.
For more details go to – Black Bean Cure for Gout, under the topic Gout CuresSeptember 18, 2009 at 8:35 am #5658
It is extremely important that you have your serum uric acid measured regularly. THere is no way too control it unless you know what it IS. Do you have any numbers from past doctor's visits? UA numbers before and after treatment with allopurinol and uloric will be extremely helpful in moving forward.
Yes the 24 hour urine test is a good follow-up once you have determined that you are hyperuricemic. And if you need it, probenecid is a very good drug but a little harder to take than allopurinol.September 21, 2009 at 8:23 am #5688
I went to the Rheumatologist the other day. She is a DO as opposed to an MD. She seems very smart on Gout . I have had numerous bouts with gout in my feet and ankles, but this last bout in my knees is a killer…since June. I think that there is something else going on in my knees besides gout. I showed the Rhum doc the test I had last month on the fluid my orthopedic doc drained from my knee, and he wrote “GOUT”across the top of the lab page. He took 100cc of yellow fluid from each knee and gave me a shot of steroid in each. Ten days later I went back wit both knees swollen again and he drew 50 cc off my right knee but didn't do anything on the left knee. Then I went to walMart and walked around, and my right knee was right back where it was an hour before, as in swollen again. The crystals from the Orthepedic lab were “calcium oxalates in a background of rare white cells”. My Rhum doc said those crystals are not gout crystals and are more indicative of someone with kidney issues. The Rhum lab took blood for a liver screen due to taking Urolic and a uric acid test. She told me to keep taking the Urolic for now. She set me up with and appt with a kidney specialist on Oct 1 and a visit with her later the same day. She also gave me an RX for an MRI of both of my knees which I will do tomorrow. My knees are still killing me, and I can not walk far with out pain. This has all started since June 09. Will keep you posted. Comments are welcome. ThanksSeptember 22, 2009 at 7:08 am #5718
I'd be thinking more lawyer than doctor at this stage.
Calcium crystals indicate pseudo-gout. It needs investigation for an underlying condition that is causing it. It is perfectly possible to have this, and gout at the same time. However, you would need supporting evidence of urate crystals (and blood uric acid above 6.8 at some point, though not necessarily all the time).
Gout diagnosis can be tricky, and though analysis of the joint fluid is the best commonly available test at the moment, it still needs someone with more than half a brain to interpret the results.
Complex cases can involve not only gout and pseudogout, but also other conditions and forms of arthritis. One of the standards is to look for any indication of septic arthritis or other bugs. If they are present the absolute last thing in the world that you want is a steroid shot – giving it to the bugs is like giving spinach to Popeye.
Sorry this is not very positive, but I am struggling to suggest what to do next. The first thing is to find out exactly why allopurinol and Uloric have been prescribed. If they were done on the back of a properly diagnosed uric acid problem, then you have at a minimum got gout and what sounds like pseudogout together. Continue with the Uloric and keep a detailed record of your uric acid numbers. If they were done on the back of a guess and confusion with calcium crystals then there is no point continuing the Uloric.
It is a little hard to track all the details, but I get the impression that the Rheumy is on the case with the calcium crystals (sorry, but this is way outside my knowledge – I just know that it isn't gout). If this is so, then push for proper explanations and details of treatment options. The orthopedic doctor should be shot or sued (disclaimer – unless there is something suggesting gout that I'm not aware of).
One point that worries me a little is that I've just learned that a DO is a Doctor of Osteopathy. Nothing wrong with that, but does she also have Rheumatology qualifications? Osteology will not help with gout or pseudo-gout.September 22, 2009 at 7:45 am #5722
Let me share a personal experience: My brother in law had a painful knee swell up and stay swollen for weeks…it was crippling for him. The first probable diagnosis was gout but they didn't leave it lie there. Instead he was given a battery of antibody tests and lo and behold he had LYME ARTHRITIS; they judge he was infected something like 2 years before…he had a cabin in the mountains and was fond of fishing. Always be leary of a gout diagnosis unless it is podagra. This is ESPECIALLY true of knee pain which can be casued by SO many injuries.
After 30 days of some potent antibiotic combo he was right as rain.
So make sure they rule out LYME DISEASE.September 22, 2009 at 8:06 am #5724
Thanks Gout Pal…. I think that I can only wait till I have all the facts put together via the MRI,Kidney specialist, and follow up with the Rhumatologist Oct 1. I will let you know what washes out.September 22, 2009 at 8:08 am #5725
The “DO” doc's specialty is RheumatologySeptember 22, 2009 at 8:18 am #5728
zip2play, you really are a mine of the most fascinating information.
I had never heard of Lyme disease. Now I know that Lyme disease is actually classed as one of the forms of septic arthritis.
Furthermore, there are some forms of septic arthritis that do respond to corticosteroids, but this is dangerous ground for the inexperienced as there are several indications that steroid injections risks outweigh the benefits when infection is present. And I thought gout was complicated!September 22, 2009 at 8:22 am #5729
Look forward to hearing from you next month (though I remain unconvinced of your goutiness )