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What is the cause for gout pain in foot while taking allopurinol?

DOCTOR OF THE MONTH - Jul 2013
Jul 2013
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Answered by

Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
Question
I have recently been diagnosed with type 2 diabetes which I am able to control with diet. I am also on allopurinol the last 5 months as my gout attacks were getting so frequent taking colchicine 3 or 4 times a year was not practical any longer. I was having out attacks weekly last summer, mostly in my feet, ankles and on occasion my knees. Also late last summer both of my big toe were swelling some and felt like I was walking on a pea centered on them, not painful but very uncomfortable. These would come and go in both at a time or only one, I assumed they were gut relate as they appeared to coincide with the gout pain in my foot joints. I have been on allopurinol since September, my euric acid is down to the 350 level, and I have not had a gout attack for 2 minths or more. But the pea like hardened lumps on the inside of my big toes have become permanent, or very near so. Although there is no swelling any more. Your thoughts please. XXXXXXX
Posted Wed, 12 Feb 2014 in Arthritis
 
 
Answered by Dr. K. Naga Ravi Prasad 3 hours later
Brief Answer: They may be GOUTY TOPHI. Detailed Answer: Hi, thanks for writing to XXXXXXX Based upon your description, most propably they are Gouty tophi. These tophi are nothing but nodular masses of monosodium urate crystals deposited in the soft tissues of the body. They are a late complication of hyperuricemia. If these gouty tophi become very much painful and limiting the involved joint mobility along with skin ulceration, then they may need to be removed surgically. Hope I have addressed your query. I welcome any more clarification. Regards
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Follow-up: What is the cause for gout pain in foot while taking allopurinol? 4 hours later
Thank you for the quick response. There are no misshapen areas on the underside of my toes, the entire lumps are on the inside directly below the toe joint. Can the tophi move as some days they are much smaller and nearly gone and other times under the ball of my foot the width of the big toe as well as the second toe. Thank you. XXXXXXX
 
 
Answered by Dr. K. Naga Ravi Prasad 16 minutes later
Brief Answer: Please find your answer below. Detailed Answer: Hi, Nice to hear from you. Generally, the tophaceous deposits will not form on the plantar aspect (underside) of involved toe. They develop mostly on the top and inner/outerside of the toes. At times, the tophi deposits may break to become "loose bodies" in the toe joints and may migrate onto the undersurface of the toes presenting as painful nodules. There is a possibility that the tophaceous deposits may become less marked and less noticeable, once the active inflammation of the disease subsides with medications. However, they may become more visible during acute flareups of the gouty arthritis. Hope I have justified your query. Happy to help further Good day
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