Gout: Duration, Symptoms, and Treatment Insights

Please ask some questions about gout?

Hello, Doctor.
My mother suddenly has difficulty walking on her right leg, and her right knee is very swollen, hot, and painful, although there are no visible signs of redness.
After being hospitalized, it was found that there were bacteria in her knee joint, and later bacteria were also detected in her blood.
Since she has an artificial heart valve, the primary focus has been on her heart, and after a period of antibiotic treatment, both her blood and joint fluid showed no bacteria.
However, her ESR remains elevated, and her leg symptoms have only improved slightly; she can walk a bit better and experiences less pain, but the swelling persists.
Therefore, we have arranged for an inflammatory scan and prescribed medication to lower uric acid levels, as her uric acid was found to be 9.3, indicating several gout issues.

I would like to ask the doctor:
1.
Is it possible for gout symptoms to last this long? I read online that gout usually comes and goes quickly, but my mother's symptoms have lasted over a month.
2.
If it is chronic gout, could it lead to difficulty in mobility?
3.
If it is gout, how long does it typically take for medication to alleviate the symptoms?
Thank you, Doctor.

Mr. Wang, 20~29 year old female. Ask Date: 2022/01/06

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses to your inquiries:
1.
Can gout symptoms last this long? I found online that gout usually comes and goes quickly, but my mother's symptoms have persisted for over a month.
--> In terms of gout, this duration is indeed longer than usual.
If there is still persistent joint swelling and pain, and the joint examination shows effusion, we would recommend performing a joint aspiration.
This would help confirm that any infection has resolved and allow for joint fluid analysis to diagnose gout accurately, as joint fluid analysis is the most precise method for diagnosing gout.
2.
If it is chronic gout, can it lead to difficulty in movement? --> If gout is not properly treated, it can indeed cause joint damage, resulting in ongoing joint symptoms.
Since your mother’s joints have experienced a bacterial infection, there may be some damage, which could be a reason for the persistent symptoms.
However, if there is still joint effusion upon examination, further investigation is advised to determine the exact cause.
3.
If it is gout, how long does it typically take for medication to alleviate symptoms? --> Generally, gout symptoms can be controlled quickly, but chronic gout may require prolonged medication use to improve symptoms.
I recommend taking your mother back to a rheumatology clinic for a physician to examine her joints, as this would be beneficial.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2022/01/06

More Info

Gout is a complex form of arthritis characterized by sudden and severe pain, redness, and swelling in the joints, often affecting the big toe. Understanding the duration, symptoms, and treatment of gout is essential for effective management, especially in cases like your mother's, where there are additional complications due to her medical history.

1. Duration of Gout Symptoms: Gout attacks can vary significantly in duration. While acute gout flares typically last from a few days to a week, some patients may experience prolonged symptoms, especially if they have underlying conditions or if the gout is not adequately managed. In your mother's case, the presence of bacteria in the knee joint and her artificial heart valve may complicate her situation. The inflammation caused by gout can persist longer than usual if there are other inflammatory processes at play, such as infection or chronic inflammation. Therefore, it is not uncommon for gout symptoms to last longer than the typical duration, especially in chronic cases.

2. Chronic Gout and Mobility Issues: Chronic gout can indeed lead to significant mobility issues. Over time, repeated gout attacks can cause joint damage and lead to chronic arthritis. This can result in persistent pain, swelling, and reduced range of motion in the affected joints. If your mother is experiencing ongoing swelling and difficulty walking, it may be indicative of chronic gout or joint damage from previous attacks. Additionally, the presence of high uric acid levels (as indicated by her uric acid level of 9.3) suggests that her body is not effectively managing uric acid, which can lead to further gout flares and complications.

3. Medication Duration and Symptom Relief: The duration of medication needed to see symptom relief in gout can vary based on the severity of the condition and the treatment approach. Typically, during an acute flare, nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids are used to manage pain and inflammation. These medications can provide relief within hours to a few days. For long-term management, urate-lowering therapy (ULT) is crucial. Medications such as allopurinol or febuxostat are commonly prescribed to lower uric acid levels and prevent future attacks. It may take several weeks to months to achieve stable uric acid levels and see a significant reduction in the frequency of gout attacks. Regular monitoring of uric acid levels is essential to adjust medication dosages accordingly.

In summary, your mother's prolonged symptoms could be due to a combination of factors, including chronic gout, potential joint damage, and complications from her medical history. It is crucial to work closely with her healthcare team to monitor her condition, adjust her treatment plan as necessary, and ensure that both her gout and any underlying issues are being addressed effectively. Regular follow-ups and possibly imaging studies may be warranted to assess joint health and inflammation levels.

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