Reply To: Getting mobile fast during an acute flare.

Stopping Gout Together Forums Help My Gout! The Gout Forum Getting mobile fast during an acute flare. Reply To: Getting mobile fast during an acute flare.

Keith Taylor

Yeah, good weekend thanks. But not so good as last weeks family garden party for my sisters birthday. These events get better as the generations grow. : grin:

Anyway, let me explain my thoughts and investigations so far about mobility during an acute gout flare.

Firstly, for the thousands of gout sufferers who will read this in future, let me summarize the background. Because this starts with my approach to acute gout pain management. Where I stated:

First and foremost I had an epiphany when I realized gout pain stems from an immune reaction. Prior to that, I had the more typical view that sharp uric acid crystals were forming. So, I understood the importance of getting mobile as soon as possible. Fortunately, prescription strength ibuprofen (Aleve) kept me going almost every time. But if it didn’t I supplemented with paracetamol (Tylenol).

So, I’m explaining my approach in an acute gout flare setting. But I also want to explain the science. Then gout patients can explain to their doctors why they need the right pain treatment to stay mobile during acute attacks. Because in my experience, you get a better response when you ask your doctors opinion about a specific medical study. Compared to “some bloke on the Internet says…”

Eventually, I want to incorporate this into the facts and templates on my main gout website. So, here’s some work-in-progress. But, please note this is not about the general benefits of exercise for gout sufferers. Because I should already have explained that at Gout & Exercise. Though, I can see that needs some updating after 6 years.

Acute gout pain is an inflammatory immune system response to uric acid crystals
I’m emphasizing this as my starting point. Because I still see references to uric acid crystals as “sharp needle-like”. But this is nonsense as it describes objects at a microscopic level which cannot be sharp. Also, to describe them as needle-like is like describing grains of soft sand as “craggy boulder-like”.

Unfortunately, this led me in the wrong direction as a newbie gout sufferer. Because I thought I should avoid more physical damage from these “sharp” crystals and rest as much as possible. But I couldn’t understand why attacks lasted more than a week in bed. Yet, if I had to force myself to work I was OK in 2-3 days.

Medical approach to inflammation
Before I get to the science of inflammation, I must point out I cannot find any specific investigations into the effect of mobility on gout flare duration. So, I have looked at inflammation in general. But, I’m aware that some aspects of specific diseases might mean we cannot apply certain findings to gout. Therefore, if you are looking for exact gout science about mobility during acute gout, please leave now. Perhaps you can raise funds for specific research. Or experiment on yourself. In any case, I can only give some strong pointers that remaining mobile is best.

Half a century ago, the attitude to inflammation was rest and immobilization. So Partridge’s 1963 arthritis study[1] advocates

a period of complete immobilization can safely be used in the treatment of rheumatoid arthritis to control pain, muscle spasm, and disease activity.

But, this contrasts completely with Pinto’s 2017 investigation[2]:

make the patients “sit less and move more”, particularly light-intensity activities and/or breaking-up sedentary time, is a simple and prudent therapeutic approach to minimize physical inactivity and sedentary behavior, which are overlooked yet modifiable risk factors in the field of autoimmune rheumatic diseases

So now, I’m trying to understand what are the specific inflammatory factors that mean mobility is beneficial during acute gout. Because I think there are specific gout-related factors behind Pinto’s recommendation.

Most recently, I’m looking at Wood’s 2009 investigation[3]. In turn, that has me frying my brain with Bruunsgaard’s 2005 explanation of physical activity and inflammation[4]. To explain “frying my brain”, I understand half the keywords: “myokines; TNF-alpha; IL-6; proinflammatory; antiinflammatory; exercise”. But, I think there’s real scope for a clear explanation. Because many of the terms in this study look like terms in complicated gout pain studies (which also fry my brain)

Practical Advice
Let’s assume I can convince the world that for acute gout flares, mobility is best. Then I hear the next question: “But I have a desk job, so I can’t stay active”. Well, I tripped over the answer in Bort-Roig’s 2014 study[5]. “17 tips for mobilizing gout recovery” Coming Soon!

And now you know why I never find time to answer forum questions promptly! 😮

Gout, Inflammation and Physical Activity

High Fat Meals cause Gouty Inflammation – Physical Activity reduces it

Mobility During Gout Flare References

  1. Partridge, R. E. H., and J. J. R. Duthie. “Controlled trial of the effect of complete immobilization of the joints in rheumatoid arthritis.” Annals of the Rheumatic Diseases 22.2 (1963): 91.
  2. Pinto, Ana Jéssica, et al. “Physical inactivity and sedentary behavior: Overlooked risk factors in autoimmune rheumatic diseases?.” Autoimmunity Reviews (2017). Ask if you need a PDF. Because I need to dive into my pocket for it.
  3. Woods, Jeffrey A., Victoria J. Vieira, and K. Todd Keylock. “Exercise, inflammation, and innate immunity.” Immunology and allergy clinics of North America 29.2 (2009): 381-393.
  4. Bruunsgaard, Helle. “Physical activity and modulation of systemic low-level inflammation.” Journal of leukocyte biology 78.4 (2005): 819-835.
  5. Bort-Roig, Judit, et al. “Uptake and factors that influence the use of ‘sit less, move more’occupational intervention strategies in Spanish office employees.” International Journal of Behavioral Nutrition and Physical Activity 11.1 (2014): 152