Sausage fingers and gout medicine reactions

[Kev Avery]

Hi Keith.

I had a first gout attack in December 2016 in my ankle which led to an arthroscopy and crutch use. Since then have been on a course of probenecid as I had a quick allergic reaction to allopurinol. My uric acid levels never went below 6 on this medicine.

My doctor in Indonesia (I am an English teacher from UK) said febuxostat was available and advised swapping over. I tried 80mg a day and after 4 days had an allergic reaction again. I had to take antihistamine and then go back onto probenecid.

I have had swollen fingers when I wake up for a few months. (These disappear after a while), have had arthritis tests but show up negative. The doctor thinks the sausage fingers are caused by uric acid in fingers but I am dubious about that.

My doctor recommends going back onto febuxostat when things stabilise. But 40 mg a day.

My questions to you are. Is it a good idea to try febuxostat again on a lower dose? Also, how can I get the uric acid levels below 5? Do you think the stuff morning fingers are caused by uric acid? Is it possible to take a small dose of febuxostat and a small dose of probenecid together?

I really appreciate any advice. I am an under excreted according to the tests. Am on a pretty healthy vegetarian diet.

Am worried that the doctors are not doing things well given the numbers over 6 and the stiff fingers.

Best wishes

Kevin

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Do your gouty fingers look like sausages?
(click for references)

[GoutPal HelpDesk]

Thanks for posting about your gout Kev. But you included your email address in your post. So I removed it. Because it encourages spammers to contact you.

Anyway, Keith will be along soon to respond. But he’s also asked me to pull out some photos of “sausage-fingers” associated with gout. So it looks like that is a recognized condition.

Speaking of photos, do you have any photos of your fingers? If so please Send Your Gout Pictures to GoutPal. Also useful for posting photographs of your uric acid test results. Then people commenting have a better idea of how your uric acid has responded to different treatments.

Or use this form:
[gravityform id=”3″ title=”true” description=”true”]

[Keith Taylor]

Hi Kevin,

Gout and Sausage Fingers

I found several reports suggesting that gout is associated with sausage-like swelling in the fingers (dactylitis). But I don’t know how common it is. So it’s impossible to say if your case is gout-related or something else. Because a third report I looked at suggests that the usual tests for getting the right diagnosis are:
1. Trauma
2. Cellulitis
3. Osteomyelitis
4. Rheumatoid “variant” disorders (psoriatic arthritis and Reiter’s syndrome)
5. Gout
From:
Forrester, D. M. “The “cocktail sausage” digit.” Arthritis & Rheumatism: Official Journal of the American College of Rheumatology 26, no. 5 (1983): 664-667.

So it’s possible you have something as well as gout. But it’s up to you and your doctor to decide if its worth doing further tests now. Or better to wait for a few months to see if dissolving old uric acid crystals resolves the problem.

Febuxostat Dose

80 mg seems very high to me for a starting dose. So given you have had a reaction, I suggest starting with 20 mg febuxostat. But you should discuss this with your doctor. Also, note that pill-splitters are easy to find online and in pharmacies if the smallest pill size is 40 mg.

After 2 weeks you should get retested for uric acid with kidney function and liver function tests. Then discuss increasing your febuxostat dose slowly achieve your uric acid target.

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