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What Does This Uric Acid Levels For Gout Indicate?
Question: Gout attack...pain since 30th may. Serum Uric acid 10.2 on 25th April and 8.2 on 29th may. Started on febucip 80mg and indomethacin 75 mg daily. Please suggest
Brief Answer:
Gout management
Detailed Answer:
Good evening
thank you for writing on health care magic
Well your uric acid levels are still high. But I am not too worried about it as it will take time to come down. What I would like to know here is,
1. Did you get a recurrent attack after starting Febucip??Since you have mentioned about the pain which started again on 30th may??
2. Which all joints do you get these pain attacks??currently which joint is involved??is it always one joint or more than that??
3. Any association with Diabetes, Hypertension or Raised Cholesterol?
4. Was you ultrasound done to check for Renal Stones??
5. Considering you are young, I would like to know if 24 hour urine uric acid was done?
Getting recurrent attack of gout is the most common side effect of the medication(febucip). So we always prefer starting prophylaxis with a medication like Colchicine for 2 weeks before overlapping with this drug. This way it helps to prevent the rebound release of uric acid.
Do let me know these queries. Would guide you further from here
Regards
Dr Naval
Gout management
Detailed Answer:
Good evening
thank you for writing on health care magic
Well your uric acid levels are still high. But I am not too worried about it as it will take time to come down. What I would like to know here is,
1. Did you get a recurrent attack after starting Febucip??Since you have mentioned about the pain which started again on 30th may??
2. Which all joints do you get these pain attacks??currently which joint is involved??is it always one joint or more than that??
3. Any association with Diabetes, Hypertension or Raised Cholesterol?
4. Was you ultrasound done to check for Renal Stones??
5. Considering you are young, I would like to know if 24 hour urine uric acid was done?
Getting recurrent attack of gout is the most common side effect of the medication(febucip). So we always prefer starting prophylaxis with a medication like Colchicine for 2 weeks before overlapping with this drug. This way it helps to prevent the rebound release of uric acid.
Do let me know these queries. Would guide you further from here
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Shanthi.E
Hi Doctor Naval,
I have been diagnosed with gout since roughly 15 yrs back when I had pain for the first time and uric acid levels at that time was 9.5. I have been taking zyloric on and off with painkillers. Last time I had an major attack was around a year and half back. At that time my doctor suggested to take febucip 40 mg daily. i have been taking this medicine but not been very regular.
Once I saw my uric acid level at 10.2 on 5th may i started febucip 40mg. I have been eating chicken/non veg around once a week but I do take veg soya and whisky 2-3 time/week.
Second test on 29th may my uric acid levels was 8.2 but i could feel a bit of discomfort in my legs. the pain started on 30th may morning. I have pain in either leg in the soft tissue ares between toe and ankle or in the nerves below ankle. this time pain was in both legs going upto right knee. I took febucip 40mg and voveran 100. After 3 days when it did not get better I started on febucip 80mg and indocap 75mg once in morning. the pain rotates between left and right leg every second day. I have swelling in the right leg in the soft tissue area (which looks like an egg on the head) which has happened for the first time. Continuing with same medicine though once I had indocap morning and evening.
i do not have diabetes/hypertension or cholestrol (last checked couple of years back) however I do have some extra stress lately and reduced 3-4kg in one last two months. I had started skipping meals and eating at irregular intervals. Have improved on my eating from this week though.
never tested for renal stones.
random urine uric acid test result was 56 done on 5th may. (Attaching report)
Please advise.
thanks.
I have been diagnosed with gout since roughly 15 yrs back when I had pain for the first time and uric acid levels at that time was 9.5. I have been taking zyloric on and off with painkillers. Last time I had an major attack was around a year and half back. At that time my doctor suggested to take febucip 40 mg daily. i have been taking this medicine but not been very regular.
Once I saw my uric acid level at 10.2 on 5th may i started febucip 40mg. I have been eating chicken/non veg around once a week but I do take veg soya and whisky 2-3 time/week.
Second test on 29th may my uric acid levels was 8.2 but i could feel a bit of discomfort in my legs. the pain started on 30th may morning. I have pain in either leg in the soft tissue ares between toe and ankle or in the nerves below ankle. this time pain was in both legs going upto right knee. I took febucip 40mg and voveran 100. After 3 days when it did not get better I started on febucip 80mg and indocap 75mg once in morning. the pain rotates between left and right leg every second day. I have swelling in the right leg in the soft tissue area (which looks like an egg on the head) which has happened for the first time. Continuing with same medicine though once I had indocap morning and evening.
i do not have diabetes/hypertension or cholestrol (last checked couple of years back) however I do have some extra stress lately and reduced 3-4kg in one last two months. I had started skipping meals and eating at irregular intervals. Have improved on my eating from this week though.
never tested for renal stones.
random urine uric acid test result was 56 done on 5th may. (Attaching report)
Please advise.
thanks.
Brief Answer:
Management of Gout
Detailed Answer:
Good evening
Well the egg sort of swelling, is a bit hard to figure out without examining it , but i want to be sure you are not having Tophi( that is the uric acid collects like a ball). These tophi are present over the foot, toe, elbows and lot of other places as well.
The soft tissue pains you are describing could be due to uric acid deposition over the tendons as well as your levels have never come to normal. Last uric acid was significantly raised. ( 10.5)
Since you are already on Febucip 80, I would suggest you continue with it. You will need to increase it to 120 mg but not when you have an attack going on. At this stage, you can consult your doctor for starting colchicine. If indocap is not working, I would suggest a short course of steroids as it will control the inflammation immediately. It is a better alternative than taking daily pain killers of heavy dose.
I guess you know about the diet. Non veg once in a while is ok( except mutton and sea food) but no alcohol. Once it comes down, you can may be try wine later on( beer is strictly contraindicated). Avoid soft drinks as well.
Gout we cant take it lightly as high uric acid is itself a risk factor for heart diseases.
And please get your kidney ultrasound done as well to look for renal stones as uric acid can deposit there as well.
Little bit lifestyle modification and you will be good:) .
Do let me know for more queries. Would be happy to help out
Regards
Dr Naval
Management of Gout
Detailed Answer:
Good evening
Well the egg sort of swelling, is a bit hard to figure out without examining it , but i want to be sure you are not having Tophi( that is the uric acid collects like a ball). These tophi are present over the foot, toe, elbows and lot of other places as well.
The soft tissue pains you are describing could be due to uric acid deposition over the tendons as well as your levels have never come to normal. Last uric acid was significantly raised. ( 10.5)
Since you are already on Febucip 80, I would suggest you continue with it. You will need to increase it to 120 mg but not when you have an attack going on. At this stage, you can consult your doctor for starting colchicine. If indocap is not working, I would suggest a short course of steroids as it will control the inflammation immediately. It is a better alternative than taking daily pain killers of heavy dose.
I guess you know about the diet. Non veg once in a while is ok( except mutton and sea food) but no alcohol. Once it comes down, you can may be try wine later on( beer is strictly contraindicated). Avoid soft drinks as well.
Gout we cant take it lightly as high uric acid is itself a risk factor for heart diseases.
And please get your kidney ultrasound done as well to look for renal stones as uric acid can deposit there as well.
Little bit lifestyle modification and you will be good:) .
Do let me know for more queries. Would be happy to help out
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hello Doctor,
My pain is much better today and the swelling is down.
Should i continue with indocap or stop. Should I have febucip 80mg or 120mg or should I get another serum uric acid test first. Also as suggested by you should I immediately get an kidney ultrasound done.
Can I take fish sometimes, i thought thats better than chicken. I take sea food and mutton very very rarely like once or twice a year.
For tophi or uric acid absorbtion on the tendons should I urgently go for a physical check-up.
Please also let me know what long term/lifestyle changes should be done for uric acid management.
thanks, XXXXXXX
My pain is much better today and the swelling is down.
Should i continue with indocap or stop. Should I have febucip 80mg or 120mg or should I get another serum uric acid test first. Also as suggested by you should I immediately get an kidney ultrasound done.
Can I take fish sometimes, i thought thats better than chicken. I take sea food and mutton very very rarely like once or twice a year.
For tophi or uric acid absorbtion on the tendons should I urgently go for a physical check-up.
Please also let me know what long term/lifestyle changes should be done for uric acid management.
thanks, XXXXXXX
Brief Answer:
Gout managament
Detailed Answer:
Good evening
Well, that is good that the swelling has come down. You can discontinue Indocap.
But dont increase FEbucip for now. Let the attack subside. I would have liked to start you on Colchicine and then increase it after a period of 2 weeks , so you dont get acute flare again.
But yes, Ultrasound for kidneys is a must especially when you have such high uric acid to look for the stones. If it is normal, we are good to go.
For life style changes:
1 Well fish does have very high purine which can trigger the gout attack. At least for now avoid it till you get the levels in range.
2. Keep adequate hydration all the time. Make sure you are drinking 2 litres of water a day as Dehydration can further increase the attacks
3. Avoid soft drinks/beer. Once in a while whisky is fine. But try to refrain for a bit till the levels come in a range
4. REgularly monitor your blood pressure, lipids, blood sugar( at least once a year) to be sure no other metabolic problems are cropping up.
5. For the tophi, I would suggest you visit a Rheumatologist as they can guide the further management according to your condition. If tophi are present, you will need a more stricter control of uric acid.
You can let me know your location, and I will guide you to the nearest Rheumatologist for further management
Hope the information was useful
Do let me know for more queries
Regards
Dr Naval
Gout managament
Detailed Answer:
Good evening
Well, that is good that the swelling has come down. You can discontinue Indocap.
But dont increase FEbucip for now. Let the attack subside. I would have liked to start you on Colchicine and then increase it after a period of 2 weeks , so you dont get acute flare again.
But yes, Ultrasound for kidneys is a must especially when you have such high uric acid to look for the stones. If it is normal, we are good to go.
For life style changes:
1 Well fish does have very high purine which can trigger the gout attack. At least for now avoid it till you get the levels in range.
2. Keep adequate hydration all the time. Make sure you are drinking 2 litres of water a day as Dehydration can further increase the attacks
3. Avoid soft drinks/beer. Once in a while whisky is fine. But try to refrain for a bit till the levels come in a range
4. REgularly monitor your blood pressure, lipids, blood sugar( at least once a year) to be sure no other metabolic problems are cropping up.
5. For the tophi, I would suggest you visit a Rheumatologist as they can guide the further management according to your condition. If tophi are present, you will need a more stricter control of uric acid.
You can let me know your location, and I will guide you to the nearest Rheumatologist for further management
Hope the information was useful
Do let me know for more queries
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Prasad
hello doctor,
I played badminton that evening because i felt better but in the night I again had extreme pain both legs. So from saturday night till now i am unable to go to office. i am taking febucip 80 once a day and indocap 75 twice. Pain in both legs with swelling, you can see the veins bulging in the soft tissue area. pain is considerable and switching between left and right leg.
I am avoiding drinks, non veg, only having some dal once a day and having 2-3 ltr water.
What kind of exercises should I do now and in future. Till when should I refrain from physical stress on legs like playing games during and after a gout attack.
i stay in XXXXXXX so please let me know who to visit. What test should I have, please tell the exact name of the test. What changes in medications should i do?
You said a short course of steriods can be done. please let me know more details. I do want to know whether this is in medications or injections. If i take steriods then would normal pain killers still be effective or in future every time an attack happens then i would need to take steriods. Or would i go on a regular annual steriods course.
Thanks, XXXXXXX
I played badminton that evening because i felt better but in the night I again had extreme pain both legs. So from saturday night till now i am unable to go to office. i am taking febucip 80 once a day and indocap 75 twice. Pain in both legs with swelling, you can see the veins bulging in the soft tissue area. pain is considerable and switching between left and right leg.
I am avoiding drinks, non veg, only having some dal once a day and having 2-3 ltr water.
What kind of exercises should I do now and in future. Till when should I refrain from physical stress on legs like playing games during and after a gout attack.
i stay in XXXXXXX so please let me know who to visit. What test should I have, please tell the exact name of the test. What changes in medications should i do?
You said a short course of steriods can be done. please let me know more details. I do want to know whether this is in medications or injections. If i take steriods then would normal pain killers still be effective or in future every time an attack happens then i would need to take steriods. Or would i go on a regular annual steriods course.
Thanks, XXXXXXX
Brief Answer:
Leg Pains
Detailed Answer:
Good evening XXXXXXX
Well the leg pain you are describing, may not fit in with the gout exactly. Gout we expect the pain to be at the toes or feet. But yes, without examining it is a bit hard to say where exactly is the source of the pain. Also Gout does not last so long, so we expect it to resolve by then. I feel we need to look at the other causes also rather than pointing it to gout.
As for steroids, short course is always helpful in gout. Dont worry about it, normal pain killers will be as effective. Just that in some conditions you need steroids to stop the inflammation going on. But for you to continue or not, I would like to examine you and then decide how much is the need for it.
XXXXXXX is a bit too far for you to visit here. You can meet Dr Bimlesh at Fortis XXXXXXX He is a rheumatologist and will take care of the gout problem and if anything else is happening as well causing examination is the key here , so we know exact source where the pain is coming from. Till we figure it out, I would suggest you hold any strenuous exercises.
Do let me know for more queries
REgards
Dr Naval
Leg Pains
Detailed Answer:
Good evening XXXXXXX
Well the leg pain you are describing, may not fit in with the gout exactly. Gout we expect the pain to be at the toes or feet. But yes, without examining it is a bit hard to say where exactly is the source of the pain. Also Gout does not last so long, so we expect it to resolve by then. I feel we need to look at the other causes also rather than pointing it to gout.
As for steroids, short course is always helpful in gout. Dont worry about it, normal pain killers will be as effective. Just that in some conditions you need steroids to stop the inflammation going on. But for you to continue or not, I would like to examine you and then decide how much is the need for it.
XXXXXXX is a bit too far for you to visit here. You can meet Dr Bimlesh at Fortis XXXXXXX He is a rheumatologist and will take care of the gout problem and if anything else is happening as well causing examination is the key here , so we know exact source where the pain is coming from. Till we figure it out, I would suggest you hold any strenuous exercises.
Do let me know for more queries
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr Naval,
Since Tuesday night I stopped taking Indocap and started on Voveron 100 sr tablet. i was in a lot of pain since saturday and had a feeling that indocap was not working ( i was taking indocap sr 75mg twice a day) so when Indocap got finished I started on voveron. I felt better on Wednesday morning so i went to office however on Wednesday night on the way back I got feel my left leg swelling. I have had 4 tablets on voveron from Tuesday night till thursday morning.
My left leg is swollen from ankle to toe, however pain is bearable, maybe due to painkiller. I have some pain in right leg too but not so much. I had a serum uric acid test on Wed morn and the report is 4.9mg. However the swelling is there even now with pain.
Do you think that it could be something other than gout. Could the swelling be due to medications? What tests if any should I go for.
I will try to take appointment with Dr. Bimlesh on Saturday.
thanks, XXXXXXX
Since Tuesday night I stopped taking Indocap and started on Voveron 100 sr tablet. i was in a lot of pain since saturday and had a feeling that indocap was not working ( i was taking indocap sr 75mg twice a day) so when Indocap got finished I started on voveron. I felt better on Wednesday morning so i went to office however on Wednesday night on the way back I got feel my left leg swelling. I have had 4 tablets on voveron from Tuesday night till thursday morning.
My left leg is swollen from ankle to toe, however pain is bearable, maybe due to painkiller. I have some pain in right leg too but not so much. I had a serum uric acid test on Wed morn and the report is 4.9mg. However the swelling is there even now with pain.
Do you think that it could be something other than gout. Could the swelling be due to medications? What tests if any should I go for.
I will try to take appointment with Dr. Bimlesh on Saturday.
thanks, XXXXXXX
Brief Answer:
Foot swelling
Detailed Answer:
Good evening XXXXXXX
Well it is a bit hard to say without examining what sort of swelling you have, but I have my doubts on the gout as it normally does not last so long. It may be some form of other arthritis the way you are saying. But either way, you are not responding to painkillers as such. You still are on a high dose for a long period and if it was really gout, the pain and swelling would have subsided by now.
But just make sure it is not edema( that is there is a dip in it on pressing your finger.) If it edema, it can be due to use of painkillers
As for the uric acid, it can be in normal range during any form of inflammation as it gets removed from the body. So it can be normal in an acute attack as well and the significance at this stage can be questionable.
I would suggest get an X ray foot done and meet him cause the management will vary according to the swelling and pain you are having. The tests will be advised accordingly. For the basics you an get done: CBC, ESR, CRP, LFT and Renal function tests. It would give us a clue on the sort of inflammation going on. If any special investigations needed, he will advise from there.
DO keep me posted. Hoping we can sort it out for you. Take rest till then
Regards
Dr Naval
Foot swelling
Detailed Answer:
Good evening XXXXXXX
Well it is a bit hard to say without examining what sort of swelling you have, but I have my doubts on the gout as it normally does not last so long. It may be some form of other arthritis the way you are saying. But either way, you are not responding to painkillers as such. You still are on a high dose for a long period and if it was really gout, the pain and swelling would have subsided by now.
But just make sure it is not edema( that is there is a dip in it on pressing your finger.) If it edema, it can be due to use of painkillers
As for the uric acid, it can be in normal range during any form of inflammation as it gets removed from the body. So it can be normal in an acute attack as well and the significance at this stage can be questionable.
I would suggest get an X ray foot done and meet him cause the management will vary according to the swelling and pain you are having. The tests will be advised accordingly. For the basics you an get done: CBC, ESR, CRP, LFT and Renal function tests. It would give us a clue on the sort of inflammation going on. If any special investigations needed, he will advise from there.
DO keep me posted. Hoping we can sort it out for you. Take rest till then
Regards
Dr Naval
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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