October 22, 2014 at 9:36 pm #17939Chris DoironParticipant
Had a pretty serious gout attack last month, so the doctor put me on Allupironol(100mg) per day. She said that my uric acid level was in the 400’s and it should be around 300. The initial pain is gone, but my ankle is very stiff, like recovering from a sprain. How long does this last?
Also, I teach Judo, and I haven’t been able to participate in a few months, when can I start again?
October 22, 2014 at 10:45 pm #17951Keith TaylorKeymaster
Hi Chris, welcome to the gout forum. Everyone’s first post gets held for checking, but now that your first post is approved, others should appear immediately. Thank you very much for adding some information to your personal gout profile. That makes it much easier to respond, when I can quickly see some facts about you. When you get blood test results, please add them to your profile, and also add any prescription changes. Test results and medications history are invaluable information that helps everyone give better advice.
I’m really pleased that your doctor understands gout. The “around 300” target sounds about right, though better phrased as “no higher than 300mmol/L.” Of course, I’m guessing the scale used to measure your test results, but mmol/L seems the most likely. For most readers, the equivalent result is 5mg/dL which I always refer to as the upper safe limit. There’s more info about this in the right-hand sidebar below. Look for the multicolored table.
300mmol/L is a good target for maintenance treatment, but for the early stages of uric acid lowering, I would always aim lower, unless there are health complications that prevent this. That is why personal targets for uric acid are so important. They vary from person to person, and from time to time. As well as recording test results in your personal gout profile, it is good to add a note about your current target, and a history of target changes. I find that when you and your doctor agree a target, and review it until you reach stability, then you stand the best chance of getting gout completely under control.
That lays the foundation for a future of gout-free living, but you also have to plan for the early months of uric acid lowering treatment, until your gout is stable, and all gout inflammation has stopped.
A low uric acid target will reduce the period of time you are at risk from gout flares.
Maintaining fluid intake to avoid dehydration remains important.
Healthy eating can improve inflammation, especially if saturated fats are controlled. Unfortunately, there are no clear guidelines on controlling fat intake for gout. The overview is that you need to aim for good balance of unsaturated fats against saturated fats. I’m working on refining this for better specific food advice, but it’s a slow process. The point is that uric acid crystals alone do not cause gout attacks. The inflammation process needs Free Fatty Acids (FFAs) to provide the pain signal pathway. Most of the advice available about improving omega-3/omega-6 balance is relevant to gout sufferers, but might need some specific gout refinement.
All this is general advice, and doesn’t really answer your question about how soon you can get back to judo. As a non-medical website provider, I cannot give professional medical advice. That has to be your doctor’s job, as medical history and physical examination are vital.
In theory, there is no reason to avoid any physical activity with gout. Acute gout pain is an inflammatory response to uric acid crystals. You might not feel like exercise, and swelling might restrict mobility. However, unlike a sprain, resting the affected joint will not improve it, though it might feel better, especially if raised above heart level.
Unfortunately, untreated high uric acid is likely to have a joint weakening affect that is separate from the pain we experience as a gout flare. In your profile, Chris, you refer to “a few years” of gout. Every day of those few years may have contributed to weakened tendons, cartilage, and bone. I must stress that the degree of damage varies enormously from one gout sufferer to the next. You might be perfectly OK now, or you might need to wait for joints to recover with a few months of no uric acid crystals. Only a physical examination can tell, so please let your doctor take a look.October 26, 2014 at 3:34 am #18032Chris DoironParticipant
Thank you for your response Keith, much appreciated.
Is there anything I should know starting off with allupirinol? The main attack is gone but some days the side of my toe is feeling gouty but not full on pain, around a 5 out of ten. Should I be taking the colchine at this time? Is it a good idea to take colchine and allupirinol together?
ChrisOctober 28, 2014 at 9:37 am #18062Keith TaylorKeymaster
The things to know about starting allopurinol are:
1. Start as soon as possible even if you are having a gout flare.
2. Agree a target uric acid level with your doctor for first year of treatment. This is your personal target which should be no higher than 5mg/dL unless you have other health complications.
3. After 2 to 4 weeks, get uric acid test and increase dose until target achieved. Typical pattern is 100mg, 200mg, 300mg, 600mg, but every case is different, and usually depends on how you are responding.
4. Discuss pain relief with your doctor. Preventative daily colchicine is best, but some people prefer ‘as required.’ You will need pain relief for a few months. The time period you are at risk from gout flares is reduced if you aim for lower target in step 2. Personally, I went for maximum dose of allopurinol, and got down to around 2 or 3 mg/dL, with no flares after about 4 months.
Once stable, you should arrange annual uric acid check. Always get kidney function, and liver function tests at the same time as uric acid if you are on any uric acid lowering meds.
So yes, colchicine and allopurinol should keep you fairly pain free until the allopurinol does it’s job. On bad days you might also need anti-inflammatories or general analgesics.
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