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Hi
I am currently located in China on business so please keep that in mind in reading my story.
Several days ago, played some squash and had quite the workout. Next day or so i felt an ache in my right knee. Since i didn’t recall injuring myself at the time, i decided to see the doctor at a local Chinese hospital. The doctor put it off as being a strain of a ligament or something. That night had some food that I guess could be considered “high in purine” but nothing too crazy. No alcohol. I have always been a person who watches my purine intake due to my father having had gout and also from my own blood tests showing my Urate levels incredibly high (634 ?mol/L). Looking back i think my first gout attack was back in November, 2013 after i stubbed my toe, had some swelling and pain for a couple days but it went away so i didn’t suspect gout. Since then i had one or two incidences of ankle soreness (after playing sports) but those disappeared quickly.
Now, to the right knee. Boy, this is the most severe agonizing pain i have ever had to deal with. Even the slight movement of my leg a cm or two in the wrong direction results in severe pain. So, after that night of eating the pain moved from the area where i had the “strained ligament” to the other side of the same knee but this one was even more severe. It progressively got worse and now I am here typing 4 full days later and nothing seems to have been improved. I was able to get myself to a hospital today (had to have a friend literally carry me) and the doctor gave me 1) Mobic 7.5 for twice a day 2) Rabeprazole Sodium Enteric-coated Tablets (i guess to protect the stomach from the Mobic) 3) and this chinese type medicine thats supposed to help with swelling but not sure whats the name of it as it seems to be of chinese origin.
Anyways, i’ve only had a chance to take 1 of the Mobic + stomach protection medicine so far and no change as of yet. I have read that Mobic acts pretty quick but its been several hours with no relief yet.
I guess i was wondering of what you have heard about these drugs and is it the right course of treatment or, more importantly, suitable course of treatment. Please keep in mind the limited availability of drugs here so I cannot necessarily get everything i ask for.
I just want this agonizing pain to go away. I do not know what else to do. I have been drinking a lot of water, eating fruits, vegetables….no meat…and nothing is getting better. The knee feels locked into its current position which is 90% fully extended…any deviation from this angle results in pain. I am afraid i am doing some other damage to ligaments, etc. I am also afraid i will never be able to play sports again, which i love to do. It takes me few minutes to put on socks, 5 minutes to walk to the washroom….just to put it in perspective.
This incidence has taught me a lesson and i definitely will be going on Uric Acid lowering therapy drugs as soon as I resolve this knee gout flare up which seems to be extremely bad.
Any feedback on my situation would be appreciated.
Hi, welcome to the world of pain 🙂 I hope i can do something to pull you out of it.
Indomethacin (Indocin) is very good when acute gout attacks but it is more important to take Colchicine as soon as you feel the pain is coming in. But what is even more important – get yourself on Allopurinol or Ulloric when the pain goes away (and trust me, it will soon) and drop your UA level below 5 mg/dL and make sure (regular blood tests) it stays there. Good luck!The advice to wait until the pain goes away before starting allopurinol or Uloric is now out-of-date.
Allopurinol dosing guidelines:Allopurinol [or Uloric] should be started as soon as possible. Every day of delay means more destruction of joints and damage to organs. Skin, kidneys, and heart are most commonly damaged, but you will see in the gouty tophi guidelines that all organs are at risk. Specifically, ignore common bad advice to wait until your gout flare has subsided before starting allopurinol. Initiation of allopurinol at first medical contact for acute attacks of gout makes it quite clear that starting allopurinol [or Uloric] dosing should not be delayed.
Hello
To update my story..the pain in my knee has subsided a lot but i still have pain when walking so I still have a limp. I cannot fully bend my leg yet. It has been over 2 weeks now and I am worried about any permanent damage caused. Any feedback regarding my knee? It just feels like its not stable and ready to give out any minute and it also feels strained with one area very tender when i press it. At least i am mobile now but i cannot play sports or walk normally and its been a long time already. I think because i delayed my anti inflammatory medicine in the beginning, it is causing this extended leg pain problem.
Secondly, my doctor here in China has given me a drug called Benzbromarone. It is widely used and effective in lowering uric acid levels but it is not approved for use in the USA. I did take that into consideration but after talking to the doctor and finding out my uncle takes this drug with good results, I am going to try it first. Allopurinol and Uloric is not readily available here. So, Keith Admin, you are saying I should start to take the drugs right now despite the pain in my knee (which indicates gout attack has not fully finished)?
Thanks a lot. Great website here.
Well…another update. Just when i thought things would get better…last night it struck back. My same right knee is again swollen and very painful. No foods I ate were high in purines lately and the only thing i did was massage the area that was hurting. I have now gone back to the Mobic anti-inflammatory medicine. Now, the doctors are thinking maybe Rheumatoid Arthritis but i don’t believe it is that, although at this point i am totally lost what’s going on.
How common is it for a gout attack to start subsiding (not fully subsided) and then come back as a full attack in the same general area within days?
I took anti-inflammatory for 7 days and it helped, but 4 days after i stopped, its back now.
I am hesitant to start taking the Benzbromarone now that an acute attack has happened in the same spot.
Benzbromarone will not make existing attack worse, but it will lower uric acid so that future attacks will be less frequent and less intense.
Without detailed uric acid blood test results it is impossible to guess if existing attack is gout or something else. Even then, if there is doubt, it needs a rheumatologist to analyze joint fluid.
Personally, I took preventative pain relief for about two months when starting uric acid lowering treatment. I recommend that, but if not, for gout pain you need maximum strength taken at fist sign of a twinge.
It is very common for a “gout attack to start subsiding (not fully subsided) and then come back as a full attack in the same general area within days.” If uric acid is not brought down to 300, it is an almost definite certainty that this will happen – which is why the latest research I linked to earlier advises uric acid lowering as soon as possible.
Well, now my knee pain has subsided a lot. Probably 1.5 on a scale of 1-10 (where i was at level 10 just a couple weeks ago and level 8 when my attack came back. The Mobic anti-inflammatory medicine has helped a lot. However, i still cannot fully flex my right leg all the way. Any ideas when that will return to normal?
My last Urate level test i did was a couple days INTO my attack a couple weeks ago. The reading was 448 ?mol/l. (Down from my 634 ?mol/l back in sept 2013, although i do realize levels drop during an attack)
I have reduced the Mobic to one 7.5 mg tablet per day until I see the Doctor again on Monday. I must confess i have not started my Benzbromarone just yet. I guess holding out a few more days so i can run some liver function tests and collect data doesn’t hurt…..so i can monitor if the drug will have any side effects. In the past i have had slightly elevated Liver function test related results. (Such as occasionally high ALT, Bilirubin…although they seem to fluctuate over the years between normal to elevated over my last 4 years of blood tests)
My main concern is whether i have Rheumatoid Athritis which my doctor suggested i may have. I am also going to take a “Rheumatoid Factor” blood test to collect information on that. I still think it’s more a sign of Gout and not RA….but i guess you never know.
This really is quite simple, now that I know your uric acid level.
At normal body temperature, uric acid forms into crystals at around 400 ?mol/l. In colder joints that crystallization point is lower. The absolute maximum is 360, but for safety it should never be above 300 ?mol/l (5mg/dL). People who are exposed to prolonged cold should aim lower. People who have had a gout for a few years should aim lower.
You can treat gout pain with many different pain relieving medicines and other techniques. But, if you do not get uric acid down to 300, it will keep returning. The longer you leave uric acid, the worse gout attacks become. They get more intense, more frequent, and more widespread.
Every day that uric acid crystals exist, is another day of damage to cartilage, bone, and tendons. It is another day where you risk crystal deposits beyond the joints. Kidney disease becomes a problem. Tophi burst through skin, or damage the heart. These processes take many years, but there is only one way to stop them. Get uric acid safe. That is why I push the recent research that proves it is OK to start uric acid lowering treatment as soon as possible, even if you have a gout flare.
Gout flares can always be overcome by taking the right combination of painkillers. If you do not do anything about uric acid lowering, there is nothing to stop one flare being replaced by another.
It is quite possible that you do have other health problems besides gout. A rheumatologist can test for RA and other joint problems. But as you are not doing anything to stop the gout, why bother looking for anything else at this stage?
I’m sorry if this sounds like a rant. I was foolish enough to delay uric acid control for a long time, even though I knew it was the right thing to do. I now feel that I could have done more to protect my joints. With uric acid under control, I no longer suffer gout, but I occasionally feel the type of creaking joints that make me feel old. Could I have prevented that by acting earlier? I don’t know, but I do regret taking the needless risks.
By the way, I should have mentioned something about your change from 634 to 448 ?mol/l. Obviously this is an improvement, but it is not enough.
Only getting to 300 or lower will reduce gout attacks. Lowering to 448 might delay the rate at which tophi grow and spread, but it will have no effect on gout flares.
Hello everyone
The latest update now:
I have now taken Benzbromarone for one month. I just had a test done and my Urate levels are now 227 ?mol/l.
Wow, so 634 in Sept, 2013, down to 445 last month (during an attack), and now 227 today.
I have had some pain suddenly come up today in my left foot (middle area on the very left side) but I heard it’s pretty normal for Gout to come out during the cleansing process of lowering uric acid levels. Taking some anti-inflammatory medicine now to reduce the pain. Hoping its gone in a couple days. No swelling, seems like a mild attack.
I had been taking 50 mg per day….I have asked my doctor if i can reduce that to 50 mg every other day and she said that is fine.
Is it better to break the pill in half and take 25 mg per day or 50 every other day??
The reason i want to reduce the dosage is because this drug seems to be doing wonders for me in a short period of time…almost to the point where its unbelievable and maybe too powerful for me…. and I don’t like to take drugs in general. In addition, i read some scary reports online of side effects. There is a reason why this drug is banned in USA/Canada. I had the Liver Function Test (LFT) done and everything checked out normal for me (ALT, etc) but my Bilirubin levels went from 6.5 ?mol/l last month to 19.0 ?mol/l this month. The normal range states it should be 3.4 – 17.1. (although I’ve seen ranges set higher in other labs) Having said that, I checked my last 5 years of Bilirubin levels and I’ve always ranged from 14 ?mol/l – 21.5 ?mol/l over the years, so i wasn’t very concerned about it. However, jumping from 6.5 to 19 in one month was a bit alarming considering it’s happened at the same time I took Benzbromarone. Maybe just a pure coincidence. Maybe not. I am taking my blood test again next month to monitor it.
Any feedback on this members? Keith? So, 25 mg each day or 50 mg every other day now?
Very pleasing to learn that your uric acid is below 300! 😛
Personally, I wouldn’t reduce the dose until I’d gone 5 months without a gout flare. If you are going to reduce it, the half life of benzbromarone is only about 3 hours on average. 1 report (Rapid and slow benzbromarone elimination phenotypes in man: benzbromarone and metabolite profiles) describes how elimination varies from person to person. A range of 1.77 to 5.24 hours in normal responders, but in one subject with an elimination defect, the half life was just over 13 hours. Logically therefore, it is best to spread the dose and 25mg per day would be better than 50mg every other day.
If you are getting fluctuating blood test results, it is correct to test every month. You can extend the period when results stabilize. Because of the rapid effects of benzbromarone, I’m wondering if results are affected by the time of day, and the interval between taking the drug and taking the test. The answer to that is beyond me, but something you might like to discuss with your doctor. I believe this could be important if it means you are only below 300 for a few hours per day? I’m a bit out of my depth on benzbromarone. Other uricosurics, probenecid and sulfinpyrazone are normally taken up to 4 times a day.
Not the best answer I’ve ever given, but I hope it helps.
Well, my fluctuating blood test results was in reference to my Bilirubin levels, as mentioned above. One concern I have are side effects of the drugs.
My Urate levels have been in steady decline since i have been watching my diet and taking the Benzbromarone 50mg.
I think I will continue to take the 50mg every other day for this month and then see my Urate results in May. If they are still low, then i think i would be ok with every other day. If they’ve creeped higher, I will take 25mg every day. Then, have another blood test in June. Of course, my LFT results will also have a factor in the dosage of the drug. Hopefully, I do not experience any negative side effects.
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