Should You Continue Anti-Inflammatory Meds for Joint Pain? When to Get Blood Tests

Q: Should You Continue Anti-Inflammatory Meds for Joint Pain? When to Get Blood Tests

Dear Miss Xiao Hong：<br>1. <br>The pain in the joint of your big toe near the foot can commonly be diagnosed as gout, bunions, toenail ingrowth, toe fracture, calluses, cellulitis, or paronychia, among others.<br>2. <br>Since you mentioned a history of hallux valgus, it is partic

Should I continue taking anti-inflammatory medication? How much should the joint pain improve before I go to the hospital for blood tests?

This past Monday, I visited an orthopedic doctor due to pain in the joint of my big toe near the foot.
The doctor suspected it might be gout and prescribed anti-inflammatory medication for three days.
He advised that after the inflammation subsides, I should fast and go to the hospital for a blood test.
The reason I sought medical attention was that the joint near my toe felt more painful last Saturday, and the pain intensified while walking, resembling a sprain.
I couldn't identify the cause, but there was some swelling and a sensation of warmth.
I have a slight bunion on my right foot, so I didn't pay much attention to the initial pain, but it worsened to the point where I couldn't run or jump, and I had to walk slowly.
I also couldn't put my weight on it when squatting, so I went to see the doctor as soon as the clinic opened on Monday.
In the days leading up to my visit, I had been staying up late, had low physical activity, and my diet didn't include much meat.
I tend to be overweight with a BMI of 26 and consume a lot of carbohydrates, as I don't particularly enjoy eating meat, so I try to make an effort to include more protein in my diet.
I'm a bit confused about whether I should continue taking the anti-inflammatory medication.
After taking the first pack, I felt almost completely better—about 95%! Although I often forget to take my medication, I've only taken two more packs since then, and the pain has become very mild.
For instance, I still feel a bit of pain when I concentrate my weight on that area, and it still feels slightly warm.
The effectiveness of the medication seems to have diminished compared to the first pack, and I'm unsure if it's possible to feel completely better.
I have a habit of exercising, but it's not very regular.
I tend to engage in more intense workouts, but I haven't exercised much in the past six months.
Now that gout is suspected, I'm hesitant to exercise.
Additionally, my toenails have a bit of a grayish color.
I previously consulted a dermatologist who said it wasn't athlete's foot, but when I researched gout, I found that gray toenails could indicate arterial blockage, which worries me.
However, my blood pressure is not high, around 112/70.
I was instructed to go for a blood test after the inflammation has subsided, but I feel that the inflammation hasn't completely resolved yet.
I'm unsure if I should go for the blood test now.
I've heard that fasting for 12 hours is necessary for the test; can I drink water during those 12 hours? For example, can I have 1000cc? Should I see an internist, an orthopedic specialist, or a rehabilitation specialist? Can I also get tested at a clinic, and will I receive the results immediately after the blood draw?

Xiao Hong, 20~29 year old female. Ask Date: 2018/03/22

Dr. Xiao Yongxun reply Internal Medicine

Dear Miss Xiao Hong:
1.
The pain in the joint of your big toe near the foot can commonly be diagnosed as gout, bunions, toenail ingrowth, toe fracture, calluses, cellulitis, or paronychia, among others.
2.
Since you mentioned a history of hallux valgus, it is particularly important to consider the possibility of bunions.
3.
The discoloration of your toenails could have various causes, with common ones being fungal infection, poor blood circulation, trauma, subungual hematoma, or paronychia.
4.
Serum uric acid levels can only serve as a reference for diagnosing gout.
Generally, fasting for about 8 to 12 hours is recommended.
It is best to avoid drinking water; however, drinking a small amount to quench thirst should not significantly affect the results.
As for whether immediate results will be available, that is not guaranteed.
Since serum uric acid levels are not absolutely necessary for diagnosis, clinical evaluation and joint fluid analysis are the definitive bases for diagnosis.
Therefore, many hospitals do not include uric acid testing in emergency evaluations, meaning results may not be available immediately.
If renal dysfunction or other conditions contributing to gout flare-ups are also considered, additional time for testing will be required.
5.
Due to hormonal factors and epidemiological studies, gout has historically been rare in young women.
However, in recent years, dietary or environmental changes may have led to an increase in cases, and there is even some medical debate on this issue.
6.
I recommend seeking assistance from an orthopedic clinic.
Of course, it would be even better to discuss this with your primary care physician before making a decision.

Reply Date: 2018/03/22

More Info

When it comes to managing joint pain, particularly in the context of a suspected gout diagnosis, understanding when to continue anti-inflammatory medications and when to get blood tests is crucial for effective treatment and recovery. Based on your description, it seems you are experiencing significant discomfort in your big toe joint, which has been exacerbated by recent activity and possibly dietary choices.

Continuing Anti-Inflammatory Medications
Given that you have been prescribed anti-inflammatory medication and have noticed a substantial improvement in your symptoms after taking the first course, it is generally advisable to continue the medication as directed by your healthcare provider. If you are feeling almost completely better (95% improvement), it may be tempting to stop the medication, but it is important to follow through with the full course unless advised otherwise by your doctor. This is particularly true if you still experience mild pain or warmth in the affected area, as these could be signs that inflammation is still present.

It’s also worth noting that anti-inflammatory medications can help prevent flare-ups, especially if you have a history of gout or other inflammatory conditions. If you notice that the effectiveness of the medication seems to diminish over time, this could be due to several factors, including the development of tolerance or the underlying condition itself. If you have concerns about the effectiveness of the medication, it would be wise to discuss this with your doctor during your next visit.

When to Get Blood Tests
Regarding blood tests, your doctor has advised that you should wait until the inflammation has completely resolved before undergoing testing. This is important because elevated levels of uric acid, which are often tested in cases of suspected gout, can fluctuate during active inflammation. If you still feel that the inflammation is not fully resolved, it may be prudent to wait a little longer before getting tested.
As for the fasting requirement for blood tests, typically, you should fast for 8 to 12 hours before the test. Drinking water is usually allowed and encouraged, as staying hydrated can help with blood draw and does not significantly affect the results. A small amount of water (like 1000cc) should be fine, but it’s always best to confirm this with your healthcare provider.

Which Specialist to See
In terms of which specialist to consult, since you are dealing with joint pain and a potential gout diagnosis, it would be most appropriate to continue seeing an orthopedic specialist or a rheumatologist. These specialists are well-equipped to handle musculoskeletal issues and can provide targeted treatment for conditions like gout. If you have concerns about your toenails or any skin issues, a dermatologist may also be helpful, but for your current joint pain, stick with the orthopedic or rheumatology departments.

Conclusion
In summary, continue taking your anti-inflammatory medication as prescribed until your symptoms are fully resolved, and consult your doctor about the timing of your blood tests. Ensure you stay hydrated before your blood draw, and continue to monitor your symptoms closely. If you experience any new or worsening symptoms, do not hesitate to reach out to your healthcare provider for further evaluation. Your health and comfort are paramount, and maintaining open communication with your medical team will help ensure you receive the best care possible.

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