submit my clinical history

[Glen Rasmussen]

Hi I would like to register and submit my clinic history, and why my Gout was not dx, for almost a year, and suffered. I have a interesting Clinical Presentation.

My right knee pain started with a typical catching, transient locking of my knee, which continued to escalate, over a 3-5 month period.

I saw a local orthopedist, had blood test that were negative, and got scheduled for Arthroscopic Surgery. As my surgical date approached, the knee pain increased far beyond normal mechanical arthritic pain levels, (should have been my first indicator).

I consider my self pretty tough individual. I rode a bike 3 days after Total Hip replacement, and had major back surgery a year ago, outpatient, and had no bed rest other than sleeping and trx with ice and Interferential Current therapy.

I am a sports injury Chiropractor, with 34 years of experience. Self treatment is normal, but even after a knee meniscus, clean up, which demonstrated very minor damage, to articular cartilage, and synovial inflammation. I should have had the synovial fluid sampled at that time. I suffered for another 3-4 months until finally I had a ++ Uric Acid blood profile. X-rays were normal and my so called good knee looked worse than my painful right knee.

In hindsight this gouty knee pain, the most sever pain I have ever endured, other than a rupture Appendix, should have been notification, that i was dealing with much more than mechanical knee pain. My knee was hot and mildly swollen, day and night, responded to my Trx, but never got better.

I am scheduled for a Mri in a few weeks and just started Meds. 2nd day of trx and am 30-40% improved from pain already. The fact that I had monoarticular knee pain with orthopedic findings of a torn meniscus, I had similar pain and surgery 15 years previous in my other knee, but the pain got much worse in this case. I figured I was just older.

The severity of the pain and the development of almost complete immobility and inability to walk for more than a few hundred yards, should have been a indicator. Hindsight is always 20/20.

Hope this helps others.

Cheers.

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[Gout Support Admin: posted via feedback form at Help For Gout]

[Keith Taylor]

Hi Glen,

I can see that Stevio sent you a note about self-registration. In the past couple of days, I’ve added some notes about different levels of gout help access. I strongly recommend you register as a GoutPal Member, and start posting here regularly.

It’s always a shame when gout doesn’t get diagnosed as early as it should. Whatever the reasons for that, I hope that you can get it under control now that you know you have it.

If you need any help getting your newly diagnosed gout under control, please just ask.

[doctorrazz]

I am a week into treatment, with 500mg Allopurinol once a day and 50mg Indomethacin, and .6mg colchicine twice a day.
Pain started to subside after the first few day, and finally have been able to walk on my knee, and ride my bike. Acuity of pain down from a 8-9 to a 3-4. Rom of motion is slightly more than 90 decrees, but pain past that. Have cut back on alcohol, beer consumption. Scheduled for visit with orthopedist in another month, assuming blood test to follow.

How long for the Uric Acid levels to normal? and when should I ease off of Indomethacin and colchicine?

Thanks in advance.

doctorrazz.

[Keith Taylor]

“How long for the Uric Acid levels to normal?”
I hate the term ‘Normal’ for uric acid. When applied to test results, it’s a statistical term that has no medical value. The lab averages include people with gout. It’s a bit like saying the normal range for breasts or testicles is 0.95 to 1.05.

What we want to see is safe uric acid levels. Better still, every gout patient should have a target range that changes during treatment. Long term, safe uric acid is 5mg/dL or lower. Other health conditions such as kidney disease might force a compromise around 6mg/dL, but the important thing is to treat to target, where targets are set based on personal medical history.

In the early stages of treatment, the aim should be to encourage old crystal deposits to dissolve as fast as possible. We can do this by getting uric acid as low as possible. The target during early uric acid lowering treatment is something that you and your medical team are happy with. No higher than 5, as low as you can get it with maximum allopurinol dose, or somewhere in between. It makes for interesting discussions.

Once you have gone 6 months without a gout attack, whilst maintaining safe uric acid levels, you can adjust allopurinol dose to maintain that safe level. But nobody knows how long that will take. It depends how long you have had excess uric acid, how high it was, and how low you get it now.

I was clear in less than six months with uric acid lowered to between 2 and 3, after almost 20 years. Other gout sufferers who don’t get uric acid low enough have struggled for years.

If you have some definite numbers, I can try to guess. The main thing is to be confident that your uric acid is low enough, then you can look forward to an end to gout attacks. Which brings me to…

“when should I ease off of Indomethacin and colchicine?”
First, Colchicine.
I was advised to take for 2 weeks at start of allopurinol, and whenever dose increased. In reality, I reduced this to a week or less after my second increase. I’ve since learned that it is best to take one at night, then take the second next morning if there is any sign of a gout attack. That would be a more scientific approach to easing off colchicine. Go from two a day to one at night, then none. Always be prepared to start again at the first sign of an attack. Colchicine is only useful before the inflammation has set in.

Next, Indomethacin.
I took ibuprofen rather than indomethacin, but the principles apply to all NSAIDs. Ease off as swelling reduces, but be prepared to go back to full strength as required.

doctorrazz, I could write at length on uric acid levels, allopurinol, colchicine, and NSAIDs, but to avoid boring everyone, I will finish for now. If I haven’t been clear on any points, or if you have any other questions, please don’t hesitate to ask.

It’s been far too quiet in these gout forums lately. I need more people who don’t mind spending a few minutes every week to ask questions and comment on other people’s posts. Thanks for your interesting posts.

[doctorrazz]

Thanks for you advice and info, as mentioned previously, I had two blood test that were negative, and then just recently, my uric acid levels were measured at
MY INITIAL DX 8.96mg/dL, .53mmol/l , WAS 533?mol
So I had underlying uric acid levels in my knee that was masked by the torn meniscus. Called the orthopedist today, who advised me to get a family doc so I could get my levels checked regularly. My assumptions are that the Colchicine, and Indomethacin have done there job in the first week of treatment, and that journey to be symptom free with no knee pain at all will be dependent upon when the remanence of uric acid is out of my knee? Never one to take Meds at all, I would like to cut back on Indomethacin and colchicine, so with the dramatic decrease of pain I will ease up on the two, and continue the allopurinol, until I have no knee pain. Then I will see how low I can get my uric acid levels and get it checked regularly. Thanks again for the advice cheers, and thanks for this blog.

[Keith Taylor]

Great plan doctorrazz.

Ease off the pain meds unless you need them. Keep them on hand for swift use. Colchicine limits inflammation spreading, but doesn’t reduce swelling or pain. If indomethacin has done it’s job of reducing swelling, I think you are right to save them for another day.

With good control of uric acid, you’ll soon never have to rely on gout pain relief. I hope you’ll share your uric acid test results here when you next get tested.

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