Gout

[Mum1369]

My DH has quite bad periods of Gout. It has got much worse recently and nothing seems to help. He has been prescribed various things to manage long term and short term flare ups - Indometacin / Allopurinol, nothing seems to work. Now it seems to be affecting hands and shoulders mostly and include episodes of psoriasis on face and elbows (related ?)
Just wondered if anyone has had any experience of this and any advice / tips ?
Thanks

Snap!!, My DH suffers from gout and is having a really bad flare at the moment, mostly confined his one big toe/ankle/foot though. He is taking diclofenic for it, but it really isn't having a lot of effect this time,(usually just taking one of the tablets gets rid of it, but not this time) but you know what men are like, he won't go to the doctors From what I have been reading on the internet, it advises drinking loads of water, apparently cherry juice is supposed to be very good? and the usual avoiding of rich foods/alcohol. He also suffers from psoriasis, wonders whether it is related???

My mum suffers from it, as she swears drinking a lot of water helps ease it.

Interesting ! My DH has just been put onto diclofenic too - it seems to have no effect either.He used to onlyget itin his big toe too, but seems to have spread (IYKWIM)...water is a good tip, will try the cherry juice to - anything is worth a try.

Flare ups of gout can be caused by having a lot of purines in your diet (meat, fish, beer, wine). It is alsomore common in men.

Anti-inflammatories (ibuprofen, diclofenac, naproxen, indomethacin) and drinking lots of water can help. Some people benefit from allopurinol on a regular basis as a preventative measure, although it can cause acute flare-ups when first started and diarrhoea if the dose is too high.

That's really useful thanks - he does overdo it somewhat on the wine front, and the red meat come to that.
Dosage was an issue that came up recently - a Dr friend of ours thought his dose was too low to have any effect. Can anyone tell me what dosage they have been prescribed ? And any tips / herbal or otherwise would be gratefully received... his moaning discomfort has reached fever pitch and I may strangle, have to give him a bit more attention

Have a bit of sympathy, gout is bloody painful!!

The dose of allopurinol I start at is 100mg once daily and then increase it slowly by 100mg on a weekly basis, depending on if it is tolerated. Most people will be on 200-600mg daily as a maintenance dose. He should also have his blood uric acid levels checked when this episode has passed.

I always see loads of gout in barbeque season when the blokes have overindulged in the beers and burgers.

How bad is his psoriasis? It may be related.
It is definitely gout could also be something called pseudogout or even, less likely, arthritis related to psorasis.

Does he use anti-inflammatories or colchicine for his attacks?

I think arthritis related is likely. He is currentlt using diclofenac but it doesn't seem to have much effect. I'm now thinking diet / herbal / anything really to try - as the meds don't seem to be working as effectively as they once did.
Psoriasis is quite bad on his elbow and he gets it mildly around his nose and cheeks.

Could try colchicine would ask GP to consider other diagnosis as a lot of joints involved. Ask for referral to rheumatologist.
Are his nails affected by psoriasis? Any history of kidney disease or kidney stones?
Any family history of gout/arthritis?

Contrary to the History book idea of gout most gout is not related to bad diet.

Nails not affected.No history of kidney probs, but is some history of gout. Also, he played a lot of rugby (in his younger days) and a lot of injuries. It seems to me he appears to get problems at the sites of old injuries quite frequently.

From what you've said doesn't sound like psoriasis-related arthritis soemtimes psoariasis is so bad that it actually causes gout but large parts of your body need to be affected for this to happen.
Some other conditions can also cause gout so good to get a general MOT.

Just to be sure avoid oily fish ; marmite; red wine; offal. Avoid aspirin and dehydration

Ask Gp to consider Colchicine and allopurinol

The allopurinol is preventative in the long term but can bring on acute gout so need to take anti-inflammatory/colchicine with it to start.

Ask for referral to rheumatologist

Hi.
Thanks for all the replies. We had another difficult night, lots of throbbing pain & awake (luckily the baby sleeps right through now
Called GP this am for a chat and he has changed the medication to colchicine (good tip) - so we are continuing with allopuriool (current thinking on this seems to be split ?) , taking the colchicine, no alchohol,lots of water, cod liver oil & parecetamol/codeine for the pain -we'll see how we go tonight.
Any thoughts, advice gratefully recieved again !!!

MY DH used to get gout and was on Allupurinol but he lost a couple of stone 2 yrs ago and this seems to have done the trick-he is off the tablets now, not easy to do though - wish i had his will power