Lingering Gout Pain in Knee

Lingering pain & weakness 6 weeks after gout flare

Stopping Gout Together Forums Help My Gout! The Gout Forum Lingering pain & weakness 6 weeks after gout flare

This topic contains 20 replies, has 3 voices, and was last updated by  cjeezy (old forum) 10 months, 3 weeks ago.

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  • #2226

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    TL;DR: Had a major gout flair in my right knee. Still having lingering pain/stiffness/weakness about 6 weeks later.

    The longer version:

    I was first diagnosed with gout in my right big toe about 10 years ago. After a treatment with indomethacin, the pain went away and I’ve been symptom-free since then, even though I’ve consistently had high Uric Acid readings (ranging from 8.5-10.7, depending on when the test took place).

    That all ended in mid-September. I had some stiffness in my right knee one day. No pain, just some arthritic stiffness that went away when I would move around. The next day I had some pain, weakness, and limited range of motion. The third day I could barely move my knee without major pain, so I finally went to the Dr. There was no pain to the touch, no redness or warmth, just major pain when I moved my knee beyond a very limited range. So I didn’t think “gout” and was just treating it with 800mg ibuprofen 3x/day. The urgent care Dr didn’t think gout either and sent me for x-rays to see if there was any damage. No damage, but there was some fluid so she sent me to see an orthopedist a few days later. I had no improvement in the meantime. The orthopedist aspirated the fluid and gave me a cortisone injection. That helped some. A day or two later he called and said there were crystals in the fluid and I had gout. By that point, I was about 90% better so they didn’t recommend any additional treatment beyond the ibuprofen.

    That’s about where I’ve plateaued. I still have stiffness/weakness/pain, especially if I’ve been sitting for a while. And my range of motion in my knee isn’t 100%, more like 90% on a good day and 75% on a bad day. I saw my PCP last week and he said that there can sometimes be some lingering arthritic symptoms after a gout flare. He wants me to wait a while longer to see if I get better on my own before looking to see if there is any undiagnosed structural damage that could have started all of this.

    Have any of you had any experience with lingering pain/stiffness/weakness following a major gout flair? This didn’t happen when I had it in my big toe 10 years ago.


  • #2228

    Keith Taylor
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    Hi, Chris

    TL;DR Lingering pain, stiffness, and weakness, is common after a gout flare. This situation worsens as the uric acid burden grows.

    So, “What’s the uric acid burden?”, I hear you ask.

    Every day that uric acid is above the crystallization point, uric acid crystals form in our bodies. Our immune system engulfs uric acid crystal when it sees them. This prevents further inflammatory response. It hides the problem, but our bodies cannot cope indefinitely, with excess uric acid. Gout flares occur when the immune system gets overwhelmed.

    As you’ve experienced, Chris, the uric acid burden can grow over several years, without experiencing a gout flare. Eventually, the burden starts to produce low levels of discomfort, even when there is no acute gout flare. Also, the battle of uric acid crystals depresses the natural repair of joint tissues. So, joints become weaker as time passes.

    The crystallization point of uric acid is measured in the lab at usual human core body temperature as 6.8mg/dL. But, our joints are cooler than our core. So, uric acid crystals form at lower than 6.8. Anyway, your levels are much higher, Chris. Extensive, your burden is.

    Medics have a policy of not prescribing uric acid lowering until you get 2 gout flares in a year. That’s going to happen to you very soon, Chris.

    If you’ve been following my recent posts, you will see that I’m obsessed with Gout Groups. They make it easy for me to focus my help. And they also help me to ask the right questions at the right time. So, my question is, where do you want to go next? Questions for Gout Sufferers has the choices.

    You can ignore high uric acid, and join the Gout Victim Group. Or, you can start to consider the best uric acid lowering treatment for you, in the Gout Recce Group. You might even know which type of treatment you want and move straight to one of the treatment groups.

    What next, Chris?

  • #2229

    GoutPal Seeker
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    Thanks for the reply. I’m definitely not interested in ignoring my high uric acid any longer. The earlier attack in my toe was more acutely painful but this knee attack was far more debilitating. I’d like to do what I can to reduce the risk of having it come back, and also to get my knee as close to 100% again as possible.

    Everything I’ve read about treatment to lower Uric acid says that you shouldn’t start while in a flare. Is the lingering pain and weakness considered still an active flare or would it be safe to start treatment now? What have you seen to be effective in dealing with the pain and stiffness while working on lowering Uric acid levels? I’d of course talk about these with my doctor prior to starting treatment but I like to be an informed consumer of health care and would like to have some options already in mind when I meet with him.

    I’m in the US if that makes a difference in the available treatment options.

  • #2231

    Keith Taylor
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    I understand why people suggest waiting until gout flare has gone before starting treatment. I know why I would not wait ( http://www.goutpal.com/4853/start-allopurinol-quickly-but-carefully/ ). What really matters is the view of your mentor.

    I believe all gout sufferers need a mentor, who will support them during the planning and therapy stages of uric acid lowering. I can improve my explanation of the importance of mentoring. But, for now, my best effort is my first Gout Mentor article. I believe your gout mentor should be your doctor. But, I’m happy to share that role.

    Leaving aside the question of starting allopurinol now, or waiting a week or 3, let’s focus on what is more important.

    To successfully manage uric acid lowering, I believe you have to be confident with your gout pain therapy. This is because most gout sufferers will experience gout flares, until allopurinol has worked it’s magic. That is why early start of allopurinol works in the study I mentioned. Because, gout patients who take preventative pain relief can start allopurinol without problem. It is logically and practically correct. But, it won’t work if your mentor doesn’t understand it.

    In theory, this is simple logic based on established medical facts. In practice, gaps in knowledge cause problems. That’s why I offer diaries for personal gout facts. And structured help for personal gout therapies. My services should support doctor’s medical history, and doctor’s scheduled consultations. Ideally, you don’t need my help. Especially if, your doctor provides the right treatment, with the right pre-treatment guidance and support.

    Pain control should address:
    1. Limiting inflammation spread
    2. Reducing inflammation
    3. Blocking residual pain.
    Country mainly affects the first of those 3. Limiting inflammation is usually a job for colchicine. I’m not getting any feedback on the latest situation on the Colcrys price problem. Officially, cheaper generic colchicine should now be available. Anyway, I’m visiting the States in January 2017. So, I can check it out for myself.

    Sorry, Chris, this has got a bit long-winded. Detailed timing and dosing must be personal. Also, there are individual choices about specific meds. A general guide for effective gout pain control during urate debulking is:
    1) 1 preventative colchicine at bedtime for 2 to 6 months. Additional 1 colchicine in morning, as required if gout symptoms justify.
    2) As required, gout strength ibuprofen, naproxen or other NSAID.
    3) As required, gout strength acetaminophen/paracetamol between NSAID doses.

    I hope it goes without saying that this must be doctor/pharmacist approved. It’s a starting point for discussion. Some doctors advocate steroids for gout pain control. To me, that’s a last resort.

    As with all things gouty, there are alternative points of view. So long as the final choice suits the patient best, we cannot ask for more.

  • #4865

    geoffz (old forum)

    Why does gout swelling in my ankle linger like this?

    I had my worst gout attack ever, 2 weeks ago now. It focused around my ankle bones on my left foot. It was so bad I did not sleep for a couple days and I had to see the doc to get a pain shot.

    Anyway, a week plus later I can walk pretty normal but the subtle swelling around both ankle bones just lingers. I’m wondering if that is swelling from lingering gout or inflammation from damaged tissue around the ankle? I can’t seem to get past this “last phase”.

    Any advice?

    • #4866

      gout bruise (old forum)

      I have had a gout attack on the same spot.

      Just got my 2 days of treatment down, a lot better but spot below ankle is still tender, sort of like a bruised feeling.

    • #4867

      zip2play (old forum)

      An acute attack of gout is an overwhelming insult the joint and some residual swelling might not be unexpected as your body tries to deal with the last remnants of uric acid. For persistent sufferers, the condition never fully resolves and that is often referred to a “chronic gout.”

      As long as there’s no pain, there’s not much point to analgesics. To relieve the swelling faster, try to sleep with your leg raised…same for Telly watching or reading.

    • #4868

      Jane (old forum)

      My husband’s latest gout attack seems to be lasting for over two months. He is still in great pain.

      Has anyone else had one that has lasted for so long? Or is this a sign that something else is at the bottom of the pain and swelling?

    • #4869

      zip2play (old forum)

      Jane,

      What is your husband doing for the attack? Colchicine, Indocin? Has he had gout for a long time, long enough for it to have gotten “chronic?”

      My longest attack was 9 days before I started the colchicine…cure took 22 hours.

    • #4870

      gout bruise (old forum)

      I too was surprised how long the attacks can go on and then the pain linger with only a few good days between attacks. For me, it has been 5 months now. I hate myself my tolerance level has become so low and my family is suffering for it.

      I have a few good days once in awhile. But, for the most part, I am miserable and in so much pain. As the days go on my Right Big toe swells more and more as does the severity of the pain.

      Colchicine does not seem to help and neither do the NSAIDs.

      I am on Allopurinol 200 mg. and drink plenty of water.

      5 months ago, before the Allopurinol, my serum uric acid was 8.5

      One month ago it was 6.5 yet attacks continue.

      I search every information I can find as the Dr. wait is always at least 2 months.

      6 weeks ago he referred me to a Rheumatologist and that appointment is not until mid-September.

    • #4871

      Keith Taylor
      Keymaster
      Ŧallars: Ŧ 1004.66
      GoutPal Scholar Badge Rank: Scholar

      At 6.5, you are just on the cusp of uric acid control. Because I believe what is happening is that you are moving constantly around the point where urate crystals form (around 6.8). So as soon as the crystals start to dissolve, the uric acid rises again, and new ones might form. For more information, use the search box near the top of each page to Google “Gout Hell”.

      Ask your doctor to approve 300mg, to get your level down more. Please don’t give up on the allopurinol, as it is your best chance of controlling the gout.

      You will still get some attacks for a few months, but they will reduce in intensity and frequency. Colchicine should help. How much do you take?

  • #4881

    cjeezy (old forum)

    Lingering gout symptom question

    Like many, mine started with the pulsating burning, throbbing feeling in the bunion area.

    Over the past weeks, the pain has subsided and that area is basically healed. The odd thing is that now the lingering pain is different spots that are NOT joints.

    First I now have pain in between the 2 tendons that stretch across the top of my foot (big toe and 2nd toe tendons). 2nd, I have slight pain on the pad of my foot (under neath the ball joint of the big toe).

    Is all this normal with gout? I thought it was a joint disorder.

    • #4882

      cjeezy (old forum)

      Looks like I spoke too soon! Woke up this morning and my bunion area is VERY sore again. What the hell?!?! This is starting to get really annoying.

      Do most people have lingering symptoms all the time. Or do you completely heal eventually?

      It’s now been almost 5 weeks. I go back to the Dr next week to have UA levels tested, but how can one ever even consider starting Allopurinol if you can’t ever get over the damn attacks, to begin with? What else can I do to get through this? I’ve watched my diet, I drink at least 3 liters of water/juice a day, cut out beer entirely, I take celery seed and cherry pills.

      I stopped taking Indocin (switched to Ibuprofen)because it was hurting my stomach and making me depressed. But I started it back up again today (gonna call Dr and see if there is an alternative).

      Any words of encouragement? Will I ever completely heal?

    • #4886

      cjeezy (old forum)

      Thanks Zip. I’ll post an update later today. Do most people eventually get back to normal or is there typically some sort of lingering pain at all times for gout sufferers. I guess what I’m getting at is is this pain something I’ll have to accept and live with daily?

    • #4883

      zip2play (old forum)

      Colchicine!

    • #4884

      cjeezy (old forum)

      I called my Dr this morning and explained that I had an appointment next week but wanted to see if they could call me in some Colchicine and renew my pain meds. She said that they would probably not do that unless I came in for a visit. I explained to her that the Indo was hurting my stomach and making me depressed…and didn’t work that well anyway. I also told her that I could not wait until next week to come in and I needed something now before I have a full blown attack again. She took my number down and said they would call me back.

    • #4885

      zip2play (old forum)

      Good luck,

      cjeezy

      (Indomethacin makes me dizzy)

    • #4887

      Tavery (old forum)

      It’s funny to read your posts because they are nearly carbon copies of my own posts over the last few months. I was at this stage a couple months ago and asking the same question.

      Yes, it will get better. I had lingering soreness for quite a while also and it will eventually fade.

      For general soreness, I would stick with Ibuprofen and only go back to Indo if the pain became problematic. In general, if you continue on a path similar to mine, it will go something like this.

      • Soreness around bunion, by the end of the day you are ready to put your feet up. Wife gets mad the grass isn’t getting mowed and the dog crap needs to be picked up.
      • Soreness fades after three days or so, but the area is still sensitive to the touch (i.e. it hurts if you push on the bunion area) This lasts a couple weeks and you spend a lot of time in loose fitting shoes or soft slippers. You mow the lawn, but by the early evening, you are looking for excuses to park your butt on the couch in the evening. Folding laundry became a personal favorite.
      • Twinge! You wake up one morning and feel something not quite right but it’s not debilitating either. You pop some drugs and up your water intake. It goes away by the next day.
      • You slide back into your old routine a bit and after a few weeks you wake up with that familiar pain of a flare-up, except this time it’s maybe half as bad as your original. You hobble and whine a lot and the wife reaches deep into her well of patience to keep from killing you.
      • You hobble to the computer and spend the $150 to order a home test kit from Britain.
      • Drugs, water and a week later you are back to something resembling normal. Just in time to get your new home test kit. Number fascination ensues. You spend a lot of time thinking about how to best poke your finger so you get a great blood sample.
      • You spend a month or two being attack free and you think that with the diet changes, a bit more exercise and self-monitoring you got this gout stuff licked.
      • One morning you wake up to yet another twinge and you analyze everything you have eaten/drank for the past week and can’t find a solid reason for a gout flare-up. Now you are in pain AND pissed.
      • Tired of laying awake and thinking about your own mortality and tired of trying to fight it, you then go back to the doctor and request 100mg of Allopurinol and set a date three months hence for another review.
      • You are on a pill every day for the rest of your life, but you sleep better. You make a few changes to your lifestyle anyway because you know it’s the right thing to do.

      😎

    • #4888

      cjeezy (old forum)

      LOL! Your post is funny! and somewhat true..except I’m not married yet and I already spent the damn $150 bucks for the home kit (should receive it next week).

      This stuff is really starting to tick me off but I appreciate your confidence that it will eventually go away (temporarily of course). 5 weeks of this crap and it’s still not gone? wtf? I know I’ll eventually need to take a Rx every day, but I think what I’ll probably do first is try and get through this attack completely (If that ever even happens!) and do the moderation thing for a while…just to see how long it takes for another attack to happen…UNLESS My UA levels are very high. Then I’ll start the pill sooner.

      I’m not going to obsess about triggers either. If I get another attack in the next year then I’m going to ask my Dr to start me on 100mg of Allopurinol to see if a minimal dosage can help lower UA levels below 6.5.

      Question about the home kit, if I’m on a Rx, is the home kit and accurate way to check my UA levels and the success of the drug? Or do I need to go back to the Dr every couple weeks?

    • #4889

      zip2play (old forum)

      Once you have had an attack, a serum uric acid of 6.5 is NOT low enough to avoid others. It may be fine for some one with NO uric acid crystals, but once you have had your first attack you will NEVER reach the point of no uric acid crystals and thus you cannot have supersaturation.

      Control below 6.0 is minimum treatment and control below 5.0 is optimal. Do not settle for 6.5.

      I described my 9 days of MURDER TOE and my 22 colchicine ad nauseum. I immediately began 300 mg. allopurinol and took my UA down to 4.7 by the next week. When the pain ended abruptly on colchicine, there was no lingering soreness at all in my toe…not for a single day.

      Yes, I get twinges years after if I am walking all day in the Summer sun, but never an attack or what I would call gout-related pain. I don’t doubt that the gout attack DID some damage to my bunion joint permanently and it will never be perfect but that is different from a gout attack.

      So there are two different scenarios for gout attack aftermath: with allopurinol and without.

    • #4890

      cjeezy (old forum)

      Rightfully said. Ok, less than 5 will be my goal. I’m curious what my Dr will tell me.

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