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Well this is an unpleasant surprise. Had an achey foot at the end of last week. Last night after squeezing into a set of cycling shoes it’s gone into proper meltdown.
Spoke to the docs this morning and I’ve got some naproxen to take the edge off and the swelling down.
Bottle of cherry juice to hand.
What else do I need to know?
What does it look like? I keep thinking I might have a touch of it in a couple of toes, but I am not sure.
Naproxen? for gout? Usual treatment , AFAIK ,is Alopurinol (highly effective!) or Colchisin (dubious benefits)
Is your toe joint red and angry?
if not, you have far worse to come!
As above - get tested then get on the Allopurinal.
Colchisin is OK for a flare up, when taken with some heavy duty painkillers.
My toe is indeed red and angry. Blood test scheduled for 6weeks time when it’s settled to see if I need regular meds
I'm pretty sure you should try to get bloods done when you're mid flare up to confirm gout.
My GP was reluctant to put me on alupurinol until I had multiple attacks, which happened last year and am now thankfully taking it.
Diagnosed about a year ago. Mostly attacked in the bunion on my right foot, but just occasionally it finds somewhere new to land and cause it’s agony.
Alupurinol works well, and emergency Colchizine treatment for flare-ups on standby. Colchizine is supposed to cause violent stomach upsets in some folk so I’m always a bit wary of taking it. However, it stops the pain within a day or so.
If it's a flair up I go for colchicine and lots & lots of water. That's on top of the daily dose of allopurinol ive been taking for about 15 years. Stay away from booze too.
It's officially more painful than childbirth. I've been told that by three different female gout sufferers who also gave given birth 😳😳😳
Cochicine has me shitting through the eye of a needle within a few hours!
I have gout according to my doctor
I don't according to me
Have you had a go at working out what might have triggered it? I found that certain beers, even in very small amounts would make it go wild. Warsteiner in particular is an instant switch for me. Really weird.
Fresh or dried cherries keeps it at bay and if it does flare up then ibuprofen and ice packs is an ok stand in for proper medicines.
I've had it since my mid 20's. I find that red meat and white wine are my main triggers. These days I don't eat much meat or drink much and have only had two flare-ups in the last 5 years.
I'd rather control via diet than take a pill every day for the rest of my life (Allopurinol) Which is what my dad has been doing for the last 20+ years.
I heard the best thing for gout is a daily bottle of port and a wheel of Stilton
I’d rather control via diet than take a pill every day for the rest of my life (Allopurinol) Which is what my dad has been doing for the last 20+ years.
It's not always a choice im afraid.
It’s not always a choice im afraid.
Yup, my GP doesnt beleive in gout, so diet it is!
Ouch.
Literally.
I’d rather control via diet than take a pill every day for the rest of my life (Allopurinol) Which is what my dad has been doing for the last 20+ years
I’d rather control it by very well tolerated pills rather than have a flare up every 2-3 years. I speak as someone taking Allopurinol for the last 35 years. But it’s your personal choice.
I've been on allopurinol for the last couple of years but have just packed it in to see if my diet changes do the trick. I'm pretty much vegetarian now. 3 months in and it's ok so far.
I did have naproxen at first, it didn't really do anything for the gout but it really helped for my Achilles tendonitis!!
Yeah - I started getting it 5 or 6 years ago - I couldn't believe it when I was told it was gout..... something that I put in the same category of Victorian diseases as rickets etc.
I have about one flare-up a year, which I manage with Indometacin (a strong non-steroidal anti-inflammatory). I can tell when an attack is coming, and usually one day of treatment is enough if i catch it early (I have a supply of meds to-hand, so I don't have to go to the GP). Generally I can knock-it-on the head before it becomes painful. It's usually in my big toe.
My GP checks my uric acid levels periodically, and says that unless the attacks become more frequent, not to treat with allopurinol prophylacticaly - just treat the attacks.
I've been pretty successful in managing it with diet - cured meats are a big trigger, as are stronger/hoppier beers. Having a beer or two, or eating a pepperoni pizza are not going to do anything: the attacks usually happen when I slip for a sustained period of time (about a week) - having a craft-type beer every night, or getting a sandwich from my local deli with salami in it for a few days in a row, for example. My worst attack was when I was trying to lose some weight and ate biltong as a high-protein snack for 3 days in a row. What was I thinking?!?
I recon I drank gallons of cherry juice when it first started happening. Does naff-all. Learn what causes it to try to avoid attacks, and treat anything that breaks through with proper drugs, is my advice.
Find it what's causing it then stop that
I tried cutting it a few things, red meat etc but it wasn't until i stopped drinking that it finally went away.
Didn't want to go on a daily meditation so made the choice to stop drinking and since then, 2yrs ago, no more gout.
It's bloody painful and made me feel like a right old duffer, limping around so worth giving up the booze to feel better
You can help with diet. Identify the things you eat that contain purines, like molluscs and shellfish, offal, fungi and yeasts, asparagus. Don't give anything up, just don't have them all at once. And stay hydrated to help prevent the crystals forming. Citrus triggers the body to do something I can't remember that also attacks uric acid, so that's good too.
Quit booze, cut carbs. Keto works great for Gout alleviation.
Well the naproxen has hit the spot. Foot no longer cramped into a claw and more of a 3 out of 10 compared to previous.
Still limping but I reckon proper walking will be in scope for the weekend.
Im a bit of a beer monster so looks like some changes are on the horizon. Seems low alcohol beer isn’t great either.
What’s the go to long drink for a former beer drinker? Like a treat. I’m familiar with pop and water 🙂
You need to find the trigger for the gout.
Mines pork products which I've mostly cut out now.
I'm ok drinking lager but found any IPA can set it off again
Suffered with gout from my late 20s but never actually realised what it was until mid 40s when it started getting really bad. Refused to accept the need for medication and spent a few years trying and failing to manage it via diet.
Eventually, after a thread on here, went to the doctor and got it properly diagnosed then onto the Allopurinal. Absolute game changer. I think I've had one flare up in 3 years now, and that was completely self inflicted. Naproxen is great to calm down flare ups if/when they do occur. I've got quite the stash now and use it occasionally for other self inflicted ****tery, like falling off bikes.
Someone mentioned getting bloods done during a flare up - the doc will need to wait til things have settled so they can check your day to day levels of uric acid, it's the build up and subsequent crystallisation that causes the gout. Your levels will determine the Allopurinal prescription. You'll probably need a few tests to get the dosage right.
Lots of good advice so far.
GP perspective: A diagnosis of gout should really trigger 2 things:
1. The management of gout to reduce the risks to joints. Colchicine or anti-inflammatories like naproxen/indometacin (NSAIDs) to treat acute attacks. In terms of preventing attacks there is some debate around whether you should aim for a target urate but over my career there has definitely been a move to using allopurinol earlier (eg offering after a single attack). We do the bloods a few weeks after an acute attack as they can be falsely low during the flare.
2. An assessment of cardiovascular/metabolic risk - having gout is a risk factor for cardiovascular disease (CVD) and metabolic illness like Type 2 Diabetes (T2DM), Fatty Liver etc. This involves blood pressure check and blood tests including diabetes, liver function and cholesterol.
The best management of 1 and 2 is to move to a healthy lifestyle (wholefood "Mediterranean Diet" being a reasonable choice, minimal or zero alcohol, refreshing sleep, plenty of daily activity and 150 minutes of moderate exercise weekly). By and large that takes care of many of the common triggers (high fructose/salt/alcohol) and if that doesn't work then specifically reducing purines (red meat/seafood etc) can be helpful. Lifestyle is also the most effective way (+stopping smoking) of reducing your CVD risk.
If you prefer you can just try and find a specific trigger (eg red meat or alcohol) but then you are completely ignoring your CVD and metabolic risks.
If it was me I would definitely try and move to the healthiest lifestyle I could sustain (manages both the gout and the CVD/T2DM risk) and then get my urate checked again 3 months or so later, and would only consider allopurinol if still high and symptomatic then. Other doctors would do things differently - plenty wouldn't start allopurinol unless several attacks yearly.
Interestingly using allopurinol does also seem to reduce blood pressure and diabetes risk in people with gout but to my knowledge we are not at the stage where we would recommend it just for that.
I can see how keto would work (mainly by reducing fructose/salt I guess) but I'd be concerned about the lipid changes which may follow (in the context of higher CVD risk already) so if I was doing that I'd want to ensure I was having polyunsaturated rather than saturated fats, and would get my lipids/cholesterol checked at 6 months.