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Suggest Treatment For Recurrent Gout Attacks
Question: My husband has been suffering from Gout since 1986. He got a severe attack after taking xyloric so he stopped taking it and was taking Nise pain killers when ever he got pains. Recently on the 7th of feb he had a heart attack and two stents were put in. One day later he got a severe attack because of the contrast drug that was used (according to the cardiologist). Since then he has been put on many medications including febuget and goutnil. Initially he was given febuget 40 but when his pains were persisting they made it febuget 80. However within 3 days he again got severe pains in his left knee which made him wheel chair bound for 5 days. We went back to febuget 40. After about one month of these wandering gout pains the doctor suggested that he take Medrol (steroid) tablets - 16mg twice a day for 5 days. He has been taking it for 3 days with an increased dose of Febuget 80 and goutnil .5mg twice a day. He was fine till yesterday but last night again he got severe pain in right wrist. What is causing this gout to go on and on? Could febuget 80 cause the problem?
Brief Answer:
Gouty Attacks
Detailed Answer:
Good evening
Thank you for writing on health care magic
I have gone through your history. It is quite unusual for him to be getting recurrent gout attacks, but it is quite common in patients after a surgery. I would like to ask a few questions before i can guide you further
1. Is the knee pain and swelling being going on since a month?? IT is unsual for a gout attack to last so long
2. Has he had any previous backache or neck pain which has troubled him?
3. For how many days, does the pain and swelling last?
It is very possible that febuget is causing the attacks. It is normally not started during the acute attacks as it causes the breakdown of uric acid and more of it can go deposit in the joints causing further attacks. It is not a medicine to be started in acute stage. After the patient gets better with steroids/painkillers and goutnil, it is then started after 2 weeks of it.
My concern is , is it really gout attacks or something else as few other arthritis get triggered after surgery. SO i just want to be sure we are treating the right thing. DO let me know these queries. It would give us a bit of direction. Till then i would recommend to stop febuget. TAke medrol and goutnil for a few days and then start it later.
Await your reply
REgards
DR Naval
Gouty Attacks
Detailed Answer:
Good evening
Thank you for writing on health care magic
I have gone through your history. It is quite unusual for him to be getting recurrent gout attacks, but it is quite common in patients after a surgery. I would like to ask a few questions before i can guide you further
1. Is the knee pain and swelling being going on since a month?? IT is unsual for a gout attack to last so long
2. Has he had any previous backache or neck pain which has troubled him?
3. For how many days, does the pain and swelling last?
It is very possible that febuget is causing the attacks. It is normally not started during the acute attacks as it causes the breakdown of uric acid and more of it can go deposit in the joints causing further attacks. It is not a medicine to be started in acute stage. After the patient gets better with steroids/painkillers and goutnil, it is then started after 2 weeks of it.
My concern is , is it really gout attacks or something else as few other arthritis get triggered after surgery. SO i just want to be sure we are treating the right thing. DO let me know these queries. It would give us a bit of direction. Till then i would recommend to stop febuget. TAke medrol and goutnil for a few days and then start it later.
Await your reply
REgards
DR Naval
Above answer was peer-reviewed by :
Dr. Yogesh D
The knee was red and hot and the pain was very severe with swelling for 10 days from the 24th of Feb. For the next week the pain was less but the stiffness and slight swelling made the knee difficult to flex. However the pain was worse at night. From the 11th night the pain and swelling started in the right knee. On the 12th the doctor recommended that we start steriods so from the 13th morning he has been taking 2 doses a day. The pain and swelling started reducing dramatically and he can move freely now with very slight stiffness and pain.
He had backache on three occasions in 2013 - XXXXXXX July and towards the end of year.
He had backache on three occasions in 2013 - XXXXXXX July and towards the end of year.
Brief Answer:
Gouty Arthritis
Detailed Answer:
Good evening
Well it probably does look like gout attacks which have been precipitated by surgery and also being increased by the use of febutaz during the gout attacks. However i would still recommend you to get Rheumatoid factor, Anti CCP antibody and HLA B 27 done to rule out other forms of arthritis.
HE has responded to medrol, which is quite good. It is a known fact for any inflammatory arthritis to respond to the steroid drug. The key is to see if the joint symptoms flair on the tapering dosage as we normally dont continue steroids for long duration. SO start tapering the dosage after 5 days and we can wait for febutaz to restart for at least 2 weeks. Meanwhile you can get these blood tests done to be sure it is not some other form of arthritis as well for which we need to add other medications.
Do let me know for more queries. Would be happy to help out
Regards
Dr Naval
Gouty Arthritis
Detailed Answer:
Good evening
Well it probably does look like gout attacks which have been precipitated by surgery and also being increased by the use of febutaz during the gout attacks. However i would still recommend you to get Rheumatoid factor, Anti CCP antibody and HLA B 27 done to rule out other forms of arthritis.
HE has responded to medrol, which is quite good. It is a known fact for any inflammatory arthritis to respond to the steroid drug. The key is to see if the joint symptoms flair on the tapering dosage as we normally dont continue steroids for long duration. SO start tapering the dosage after 5 days and we can wait for febutaz to restart for at least 2 weeks. Meanwhile you can get these blood tests done to be sure it is not some other form of arthritis as well for which we need to add other medications.
Do let me know for more queries. Would be happy to help out
Regards
Dr Naval
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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