Q: I am 29 years old and have gout, for which I take allopurinol (Lopurin, Zylpoprim), indomethacin (Indocin) and colchicine. I don’t drink alcohol, and I have tried to limit the purine-rich foods in my diet, because I’ve heard these can make gout worse. But the bad attacks are becoming worse. What should I do?
A: The treatment of gout is plagued by multiple misconceptions. Most people with gout do not over-indulge in either alcoholic beverages or purine-rich foods, and even for those who do, eliminating these items is seldom enough in itself to improve gout symptoms.
I can think of two possible reasons your treatment has not helped. The first is that you may not really have gout, which occurs when a waste product called uric acid builds up in the blood and then is deposited as crystals in the joints and other tissues. Did your doctor draw fluid from an affected joint and find urate crystals in it? If not, you may actually have some other type of arthritis, one that would require a different type of treatment. Conditions that are often confused with gout include:
• Pseudogout, a condition in which calcium – not uric acid – forms crystals that deposit in the joints, causing pain and swelling
• Reactive arthritis, which occurs as a reaction to an infection elsewhere in the body, generally in the gastrointestinal or genitourinary tract
• Psoriatic arthritis, which occurs in 4 to 6 percent of people who have the skin condition psoriasis
• Infectious arthritis, caused by an infection within the joint itself
In the later and more chronic stages, disorders such as rheumatoid arthritis and osteoarthritis can be also confused with gout.
The second reason you may still be having trouble is that you do have gout, but your dose of allopurinol (a uric acid-lowering drug) is not sufficient to control the problem. A recent study showed that 50 percent of patients treated with “standard” doses of allopurinol do not reach the therapeutic target of lowering serum urate levels to less than than 6.0 mg/dl.
If the diagnosis of gout has been confirmed with lab tests, talk to your doctor about increasing your dose of allopurinol. Because it often takes six to 12 months even after the uric acid level is suppressed below 6.0 mg/dl for the symptoms of gout to stop, it is important that you take indomethacin or colchicine once or twice daily to help minimize or eliminate your flares.
N. Lawrence Edwards, MD
Rheumatologist, University of Florida, Gainesville
Why is it that no one knows why our how this condition presents itself? especially in young patients? Is there any research being done to understand pseudogout? Am I to live with swelling and pain so frequent that I am unable to work and live on my own?
The medication I have been prescribed does not seem to be working to reduce the episodes, I have actually experienced more frequent flares with treatment. Does diet have any effect on CPPD crystal formation? Is there any one else under 60 with pseudogout? Please help.
I agree that it is incredibly difficult to "prevent" attacks. Every case is different, but in my situation, my doctor has me on a reactive plan. Once I feel that little "twinge" we all fear, I take a colchicine (.6mg). If this twinge gets worse, I will take a prednisone (20mg). From there I will take Indomethacin if it gets worse (25mg).
Nine times out of ten I am pain free within a few hours after taking Indomethacin. The only downside is Indomethacin nearly knocks me out, so I have to be very careful when/where I take it.
Thanks in Advance,
Radhesh
blood test and discovered I had gout. He put me on Allopurinol (300mg). I was getting a little relieve over 3 or 4 months. Then the “change” set in. Hot flashes, moody, etc. My doctor put
me on Fluoxetine (20mg), not knowing the combination of these two drugs was going to “cure my knee pain”. After a few weeks I had went back to the doctor for a check-up. As I was sitting in the his waiting room I read a research article on gout. It said that with the combination of Allopurinol and Fluoxeline resulted in less or no pain for gout patients. I could not believe it. I
showed my doctor the article but was not sure he believed it. I had another follow-up with my knee specialist and showed him I could walk, run, etc. He took another x-ray but it did not show any improvement. He could not explain my sudden ‘cure’ and did not understand how Fluoxetine helped. I faxed him a copy of the article, but I have since lost it. It basically said that
Fluoxetine works the part of your brain that tells you if you feel have pain. Apparently, in my case it is telling my brain I feel no pain. I know it’s weird, but hey it works and I’m going to continue to take them.
docters are not ALWAYS RIGHT
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