February 28, 2019 at 6:16 am #8830
How do you gauge the difference between the two? What’s your threshold considering pain and swelling as factors?
I’ve what I considered four full blown attacks in my first four years of experience with this affliction, skipped two years, had a bad one last April, and one other not quite as bad a few months later. But I’ve been riddled with flares for the rest of the past nine months.
I’d say attacks entail significant swelling, with possible displacement of the joint, accompanied by excruciating amounts of pain. As they’ve always occurred in my foot, so mobility is severely affected and swelling will make putting a shoe on practically impossible. I thankfully have never had an attack severe enough where “the weight of a bed sheet” on my foot was painful.
Flares on the other hand, have been far less sever in both pain and swelling, varying from annoying or slightly uncomfortable, to moderate swelling with bearable pain, possibly strong enough to result in a limp, but not cause sever mobility issues.
So what’s your barometer for attack vs flare?
February 28, 2019 at 8:24 am #8831nobodyParticipant
I don’t know that these words are defined anywhere in a standard manner. Some people might use these two words to mean the same thing.
Because of the different locations which might be affected, you could for instance have severe mobility issues or be unable to put your shoes on (not necessarily both at the same time) without much pain at rest. You might also not see much (if any) swelling or redness if the inflammation is deep under the skin.
So what we’ve got is mainly a standard description of the textbook MTP1 (big toe joint) attack: severe pain (at rest as well as to the touch), swelling (with unusually warm skin) and redness. But not having all the signs doesn’t mean it’s not gout, especially if a different location is affected. If you want to call it flare rather than attack when your big toe gets some but not all the symptoms or when the pain isn’t that bad, that makes sense but don’t expect everyone to use the word “flare” that way.
February 28, 2019 at 7:50 pm #8832
I understand that “flares” aren’t a technical medical term, I literally meant “you” as in the members of the forum. I’m curious how other sufferers are gauging their own experiences. I saw the “Monitor Your Gout Pain” graph after I posted this, and I’d basically say levels 1-5 I’d call flares, and 6-10 I’d classify as an attack. The attack that started this ten month run was probably an 8 on that scale, and I’ve been bouncing between 0-4 regularly since, with a couple of forays into the 5-6 range.
My primary source of discomfort these days isn’t my big toe at all, it hasn’t bothered me in months. In fact, the big toe joint has flattened back to totally normal looking. For whatever reason, my crystal deposits have migrated one joint over to the base of my second toe. It sometimes looks like I have a little marble in what you’d call the Proximal Phalanx. It’s looked slightly puffy for months, and it swells a bit more roundly when I “flare”.
February 28, 2019 at 9:07 pm #8835nobodyParticipant
As you can see the forum isn’t very active and so the members of the forum pretty much all use words in their own way.
I’d say the duration, location and specificity of the symptoms matter as much as the pain. The main thing I take away from your description for instance is that you’d probably benefit from increasing your allopurinol dose sooner rather than later (assuming the blood test doesn’t come back with a red flag). And that’s got nothing to do with pain levels. Instead, I focused on things like “slightly puffy for months” because one of the points of increasing one’s dose slowly is to avoid triggering inflammation. But it looks like you might have constant inflammation to begin with! Inflammation in a single location which hasn’t resolved after a week also suggests you might have too much uric acid in your blood.
Either you take the time to describe your symptoms or you don’t. If you want to sum them up with a word or two, I don’t think the choice of word matters a great deal: absent a fairly detailed description, people will have trouble guessing what’s happening to you.
Gout symptoms vary quite a bit, which is part of why doctors have so much trouble diagnosing gout when you’re not in the middle of a textook acute MTP1 episode. Indeed I wouldn’t swear the ongoing symtpoms you’re experiencing on your second toe joint are due to gout. Don’t get me wrong: it’s probably gout. But if you didn’t have big toe attacks for several years previously, I would be more skeptical.
In all likelyhood, you had deposits there for years by the way (they haven’t migrated).
It’s your body’s irritation with the deposits which migrates, for instance because some dormant deposit becomes unstable or because fresh crystals develop next to it.
March 1, 2019 at 5:35 am #8838
Excellent advice as always, thank you. That second toe joint has been flaring regularly for a while now as I said, every week or two for a few months. I assumed it stays puffy because it hasn’t gotten a break, pointing to as you said, consistently elevated UA levels, not having a chance to shrink down enough before the next flare puffs it again. It was just about normal looking when I had a flare the second week after I started the Allopurinol, and it twinged a little two days ago.
I had the blood test done today, so I should have results by the middle of next week. Then my doctor and I will discuss what to do about dosage based on initial results. And of course I’ll report everything here, and ask what the opinion is.
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