Hello,

I am 53 years old and have the following health problems:

15 days ago I had a pain in first joint of the middle finger of his left leg.

I contacted the family doctor (by phone) and did blood analysis. Uric acid is 7.3%. Doctor's diagnosis was Gout.

I followed Colchinium treatment and Flamexin (piroxicam) and I kept diet indicated by the doctor. After 5 days decreased joint pain and swelling disappeared.

However, a dull ache still there. In this interval must contain Milurit treatment (allopurinol) but I have not respected treatment because I still doubt about the diagnosis Gout.

5 days ago started a new crisis. We resumed treatment but I'm already on day 5 of treatment and symptoms persist, especially at night and morning.

I have two questions:

A. The diagnosis given by my doctor be wrong? (That may be something other than gout?)

B. Treatment indicated can be replaced with a more efficient medication?

PS I do not want to be misunderstood. I generally respect the family doctor directions but now it is gone on vacation.
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replied June 25th, 2013
Especially eHealthy
adigalo,

Sorry you are having problems.


According to rheumatologists, for a diagnosis of gout to be made, uric acid crystals have to be seen in the synovium (joint lining) or synovial fluid (joint fluid) of the affected joint. To have elevated uric acid in the blood does NOT make the diagnosis of gout. That is just hyperuricemia and not all patients with elevated uric acid will develop gout.

Now, if a patient has hyperuricemia, and has a red warm painful joint, then it is more likely for that to be gout. But, again, the uric acid crystals have to be seen in the lining or fluid of the joint, for the diagnosis of gout to be made.

Of note, uric acid crystals are yellow and “negatively birefringent” under the polarized microscope. This is in contrast to the blue, aligned crystals of hydroxyappetite seen in calcium pyrophosphate dihydrate disease (CPPD), also called “pseudogout”. This is just for information, as most patients do not really need to know this.


Again, with the elevated uric acid in the serum, it is probably likely that your joint problem is gout. But, that is not definite.


The treatment you were given is the usual one. Usually, nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of treatment and should be started as soon as possible after the joint symptoms first show up.

Colchicine will also help to reduce the inflammation.

The allopurinol is to decrease the uric acid level in the blood. It is usually prescribed if the patient has gouty tophi, kidney stones, several severe attacks in one year, or significant damage to the joints.

Special diet needs to be followed. Alcohol intake should be limited. Exercise is also important.


About the only other treatment that might be tried is the use of opioids, if the pain is extreme. And, the use of steroids. Occasionally, cortisone injections may be tried, if the NSAIDs are not getting the inflammation under control. But, because of the side effects of steroids, their use should be limited.



So, it is most likely that you did have a gout attack. But, until the uric acid crystals are seen in the joint, the diagnosis cannot be made.


Good luck.
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replied June 25th, 2013
Gout!?
Thanks for the reply. Tomorrow I go to a clinic to complete investigations.

However I have a question. There are plenty of NSAIDs. On many prospectus appears recommendation for gout. How do I choose the medicine that would be the most efficient for my organism, for my disease?

For example: What do you recommend NSAIDs for gout?
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