Is this joint pain related to Gout?

Stopping Gout Together Forums Help My Gout! The Gout Forum Is this joint pain related to Gout?

This topic contains 21 replies, has 5 voices, and was last updated by  Keith Taylor 1 year, 3 months ago.

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  • #2698

    d q
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    Hi Patrick / Keith,

    I was just wondering as I’m now getting pain in various joints but more specifically my right elbow joint. The rest are all pretty much ok. I haven’t taken any anti-inflamatories as of yet as I seem to be dealing with the pain reasonably well despite it actually being quiet painful.

    My question is similar to Mauri’s. I started on 100mg and my UA dropped from 580 to 555 after a month (not much). My rheumatologist increased my dose about 6 weeks ago to 200mg. I’ll be taking a blood test this week and should have the results early next week. As you say Patrick I also don’t think 200mgs will be enough so I think the dose will probably be increased further to 300mgs.

    Could these joint pains be a result of crystals dissolving despite not yet finding a stable therapeutic dose? I mean will crystals still dissolve at lower then a patients usual UA (originally 580 in my case) but far greater then the 350 safe limit? Or are these pains completely unrelated?

    Thanks 🙂

  • #2702

    Keith Taylor
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    It’s hard to put exact figures on the crystallization point. Uric acid concentration is one factor. But, it can vary in different points of the body. So, you get an exact result of 555. But, that probably means “around the 540 to 570 range”. And, I’m being deliberately vague, because we never really know the upper and lower values. Then, we have several other factors that affect crystallization. Temperature, blood flow, and mysterious factors that some people have that give them very high crystallization points. So, we don’t know. But, the most likely explanation is, a normal gout flare because your uric acid is still too high.

    I realize that’s not at all helpful. But it’s true.

    Personally, I just rejoice in the fact that you know you need to get uric acid lower. Other than take pain meds, there’s little else you can do.

  • #2705

    Patrick
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    Could these joint pains be a result of crystals dissolving despite not yet finding a stable therapeutic dose? I mean will crystals still dissolve at lower then a patients usual UA (originally 580 in my case) but far greater then the 350 safe limit? Or are these pains completely unrelated?

    Thanks 🙂

    James,

    I’m not sure. I can tell you in my case specifically, I used to get severe Gout pain in my left ankle. Then it started to happen in my right ankle. Once I got my UA under 4.5 mgs, the pain in my ankles went away, and has been for over a year (knock on wood). BUT….in the last 2 months, I’ve developed pain in my left shoulder. Now, several things may be happening here. In my line of work (firefighter) I may have injured it on an incident. Or, as an active guy, I recently dumped my mountain bike on a trail, but I don’t recall falling on my shoulder. I fell hard on my back, so I’m not sure. ORRRRRRRRRR, it may be Gout related. I am scheduled for an updated blood test next week, so I’ll have current UA results.

    Either way, I found it weird that all of a sudden I had pain in an area I’ve never had pain before. I’m leaning toward an injury, but I’m hesitant to go to the doctor because I don’t want to be put on injury leave at work, if indeed it is an industrial injury. I’m one of the lucky people who actually loves their job and loves going to work.

  • #2712

    d q
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    Hi Patrick / Keith

    Thank you both for your encouraging posts.
    I did my blood test today and I’ll have the results on Tuesday. We’ll know were we stand then. It’s more then likely they will increase the dose but we’ll find out soon.

    I was just wondering and wanted to confirm, is it when crystals form and get stuck in joints or when crystals break away from joints does inflammation occur and the pain start? The reason I’m asking is because I was curious as to whenever it’s crystals breaking away from let’s say ankles and getting trapped in other joints (like my elbow) or if it’s just crystals breaking from the same plac and causing pain there?

    How long or how many attacks did you have to endure until you got to your therapeutic stable doses?

    Thanks!

  • #2713

    d q
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    Patrick, following your last post, I just wanted to say I admire people like you (firefighters). It’s people like you that make a huge differences in people’s life let alone saving lives.

    I’m constantly worried about doing any physical exercise in case I cause an attack whilst finding my optimum allopurinol dose. 🙁

    My left toe has never felt right since the first attack and I’m really hoping in time allopurinol will fix that and I’ll regain complete flexibility.

  • #2716

    Patrick
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    Patrick, following your last post, I just wanted to say I admire people like you (firefighters). It’s people like you that make a huge differences in people’s life let alone saving lives.

    I’m constantly worried about doing any physical exercise in case I cause an attack whilst finding my optimum allopurinol dose. 🙁

    James,

    First off thank you for the nice compliment. I’ve learned a lot from working in the city of Los Angeles for 27 years doing this job. It’s a great job and a rewarding profession. My son has followed in my footsteps and he is also a Firefighter in Los Angeles, and has been for almost 5 years. Occasionally, we work together on the floor. I love that, my wife hates it.

    As for the apprehension of physical exercise, I understand that, but physical exercise is actually beneficial for your condition. That is, if you are capable of doing it. I know that since I’ve been diagnosed with Gout, I have lost a lot of mobility in my left ankle. I try and power through it, but I can’t run long distances anymore because of it. Anything longer than 5 miles is painful.

    Instead, I mountain bike and swim. Both are easier on the joints, and really beneficial for your overall health. Especially swimming. My advice is do what you can to stay active. Walk at a brisk pace, swim, bike, etc…as long as you do something. I take some ibuprofin and Glucosomine and it seems to help. Try that.

  • #2722

    Keith Taylor
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    I’m constantly worried about doing any physical exercise in case I cause an attack whilst finding my optimum allopurinol dose.

    My left toe has never felt right since the first attack and I’m really hoping in time allopurinol will fix that and I’ll regain complete flexibility

    James, I don’t want to push you towards exercise that might make your toe pain worse. But, my experience is similar to Patrick’s. I found walking always helped me control pain better. Initially, boosted with ibuprofen. Then later, as allopurinol started to work it’s magic, it was a joy to realize I could walk bigger distances with increasing freedom from discomfort.

    I know we’re all different. But I sense a similar tendency with you, James. Because, I believe we both sometimes overthink potential problems. So, if I’m right, it’s time to get those walking boots on. By the way, stout boots are always better for gouty feet. Because, they support your joints better, if they are fitted correctly.

  • #2741

    d q
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    Thank you for your encouraging words Keith / Patrick.
    I’ll definitely try and get those joints moving more.

    Just an update, I got my UA results back yesterday!
    We’ve gone down from 555 to 388..! I am shocked and extremely excited to say the least. My elbow pain has also reduced slightly but my left toe still feels a little painful when bending it far back (which wasn’t painful before gout). I’m hoping all these joint pains are crystals dissolving away rather then side effects of the Allopurinol. The only one thing that my haematologist wasn’t to happy with was my haemoglobin dropped by approximately 1 point so from around 7hgb to 6hgb. He asked me to come next week and do another blood test to verify if that is indeed case. I asked him several times if it’s the allopurinol that may be causing this hub drop and he feels reasonably confident that’s it’s not. In fact he felt increasing the allopurinol dose to 300mg to drop UA further is the a good idea.

    My worry now is if allopurinol may be causing my haemoglobin drop?
    I’ve done a little research on blood counts and allopurinol and that it may interfere with haematological counts (including the leaflet in the box). All other results seem normal enough though.

    Any advice or test one can do apart from stopping allopurinol to see if my haemoglobin returns to my normal levels?

    Thanks guys

  • #2745

    Keith Taylor
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    I think the toe pain is most likely to be uric acid crystals dissolving. So, increasing allopurinol dose to hasten that process is a very good idea. If you want me to explain why you get pains where you never got them before, please ask.

    I’m sorry, I can’t comment on the iron blood test. I don’t understand the blood chemistry of iron enough. And, I can’t find anything to make me think it would be allopurinol related. But, I’m always happy to learn, if anyone has relevant information.

  • #2811

    d q
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    Hello Keith,

    I’ll be seeing my haematologist tomorrow to discuss the haemoglobin issues etc. I’ve personally decided not to start 300mg until we see what the latest results are. I’m currently taking 200mgs daily and sit at around 388 ummol. Let’s hope things are ok for me to increase further. He has no issues but I’m the one who is a little worried as my haemoglobin levels have come down a little since starting but thats necessarily allopurinol.

    Keith I would really appreciate if you could explain why I’m getting pains that I never got before. It would really help me understand further.

    Thanks mate.

    James

  • #2817

    Keith Taylor
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    OK, James, this is for you: Ouch! Why does Gout Recovery hurt?

    Thank you for the inspiration. It’s been one that I particularly enjoyed writing. 😀

    In fact, I got so distracted writing it, I’m late for an appointment. So, my other lovely gout correspondents must wait for my responses tomorrow. 😳

    Gout Recovery photo

    How will you avoid joint pain during gout recovery?

  • #2825

    d q
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    Hi Keith, thank you so much for that fantastic article!
    I’ll get started reading it and get back to you if I have any questions. Thank again mate 🙂

  • #2859

    Mark
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    I have seen several comments stating that there is pain during debulking. My question is – does your UA% go up during debulking? I have previously posted an excel chart showing my almost daily readings. I was pretty happy that I was able to get down in the 5.5-6.0 range, just by going vegetarian and cutting out alcohol, with some supplements, etc. I had a recent ultrasound, where my UA stone went from about 9mm to 6.5mm. I was thinking everything was going in the right direction. My diet has been VERY consistent and out of the blue my readings started going 6-8 and I have some pain in my toes. It’s not bad pain, but it is definitely there. I have been OK by taking an Alleve before bed. It would make sense that if these crystals broke up and had to be eliminated, you could see a spike in UA%. Just wondering if this would be over about a week’s time?

    Thanks in advance for any comments and I am very grateful for this forum.

    • #2861

      Keith Taylor
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      Great question, Mark:

      My question is – does your UA% go up during debulking?

      To me, logic dictates that it must go up slightly, unless uric acid excretion rises to compensate. That’s the opposite of the phenomenon we often see in diagnostic uric acid tests during gout flares. By which I mean blood uric acid drops during gout flares. Because uric acid has gone from the blood into crystals.

      Unfortunately, I can’t find any specific gout studies that show uric acid levels when crystals are dissolving. So far, the most useful report I’ve found is “Gout treatment: Should we aim for rapid crystal dissolution?”:

      Monosodium urate crystal deposition in gout precedes the first attack and, while hyperuricaemia persists, it grows and expands to other sites. Fortunately, it is reversible and slowly dissolves when serum uric acid (SUA) is lowered below its saturation point of about 6.8 mg/dl [400μmol/L] and with certainty below 6 mg/dl. Crystals finally disappear from joints, taking longer in those patients with longer disease duration, probably because of a larger accumulated load of crystals. The SUA level achieved affects the velocity of crystal dissolution and tophi reduction. Accordingly, by deciding the SUA level cut-off point to be achieved by treatment we are determining the time of crystal disappearance and cure of gout. 6 mg/dl is the usual target level, but lower levels appear appropriate to us, particularly in certain situations.

      So, that seems to be consistent with your gout recovery, Mark. In your situation, as a champion Gout Dieter, 5.5-6 should be effective. As nobody says (below), you may need patience. But, gout recovery is on your horizon.

      In James’ case, I think it’s more borderline. 388 is too close to the 400μmol/L upper limit. In particular, as an allopurinol patient, there’s no need to settle for long periods of gout recovery that Gout Dieters may have to endure.

      For readers confused by the scales, there’s a handy multi-colored chart in the sidebar. Or, use my Uric Acid Concentration Conversion calculator.

  • #2860

    nobody
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    Sure, your UA can go up and down for no obvious reason after you’ve lowered it modestly through diet. Whether the fluctuations might primarily be due to dissolving crystals or to metabolic variations I can’t say (I’ve never done frequent tests or owned a testing kit).
    In my opinion, you may need to be very patient if you can’t get your lowest readings under 5.5. Don’t let more frequent (if less severe) symptoms discourage you but make sure the medication you’re taking is something that you’re going to be able to tolerate on a long-term basis.

  • #2864

    d q
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    @nobody, whilst I totally agree that you shouldn’t let the severe or not so severe symptoms deter you from your goal of lowering UA levels some people might not actually have a choice but to tolerate the medication unless there is a medical interaction with another medication one may be taking, even then there are other UA lowering medications to try.

    From all the research I’ve done and the fantastic source of information this site provides everyone will quickly come to realise what harm high UA levels can do to our bodies.

  • #2866

    nobody
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    The medication in question is so far as I know not a UA lowering drug but an NSAID, a class which commonly does more damage than moderately high UA. Unlike UA lowering drugs, people should ideally not take an NSAID for very long.

  • #2867

    Keith Taylor
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    I’m getting a sense that @d-q and @nobody are discussing 2 different meds here. James is talking about his allopurinol, and nobody is talking about Mark’s Aleve. Both make sense. But only if you split this topic into 2 different threads.

    So, here’s a gentle hint. Instead of typing “the medication”, give it a name. Both the meds we are talking about have less characters. So, as well as achieving clarity, you save some finger energy.

    You can use some of that saved finger energy to stick 2 of them up at me! 🙂

    Please tell me you read the “at” in my previous sentence! 😀

  • #2877

    d q
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    @keith Great response!

    By the way Keith I read your fantastic explanation of why the “road to recovery hurts article” and I’d like to thank you for it. Especially the sentance devoting it to me 🙂

    I do have a few questions regarding it though, do you want me to raise them in this thread or start a new one?

    Thanks again!

    @nobody, I totally agree on the NSAID.. When I’ve had a flare up and start my course of them (Naproxen) the first tablet always causes me painful stomach cramps then things get a little better. I’ve managed to get my hands on the gastro resistant tablets which I will try next time (hopefully there won’t be a next time or a need for them though). 😀

    • #2878

      Keith Taylor
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      Thanks James. If in doubt, start a new topic, unless it relates specifically to something we’ve already discussed here.

  • #2921

    d q
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    Hi Keith, a few days ago I started taking 300mgs of Allopurinol every other day so that my body gets use to the higher dose rather then going straight to 300mgs from 200mgs (also hoping an attack won’t occur if going up slower). Unlucky for me I got caught up in a gout flare today.

    I’m assuming I should not go back to 200mgs from tomorrow and stick with 300mgs going forward now correct?

    Could it be that the increase to 300mgs caused the flare up and started dissolving more / older crystals?

    I would have thought 388 ummol was reasonably safe and another increase wouldn’t “really” be necessary.

    It’s the same left toe as before…

    🙁

    • #2950

      Keith Taylor
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      I’d say 388 is a kiss away from danger. It’s certainly very much in a range of Gout Hell. I’ve upgraded my article to try and make it clearer. See http://www.goutpal.com/9942/ouch-why-does-gout-recovery-hurt/why-does-gout-recovery-hurt-history/ and find the [*] explanation.

      So, I believe you cannot tell if your flares are from new crystals forming, or old ones dissolving. And the sooner you get the right dose of allopurinol the better. There’s far less chance of a flare below 300. And, the lower you get your uric acid, the quicker your gout is fully recovered.

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