Managing Gout: Persistent Swelling and Treatment Options Explained

Q: Managing Gout: Persistent Swelling and Treatment Options Explained

Hello： 1. <br>If gout is confirmed, the use of urate-lowering medications should not be changed during an acute attack. <br>This means that individuals who have not been on urate-lowering therapy should not start it during this period, and those who are already on it must continu

Gout issues?

In April, I had my first gout attack.
After seeing a doctor and taking medication, it improved.
However, shortly after, at the beginning of May, it swelled up again.
Although it isn't very painful, it has been swollen for almost two months now (it's still swollen as of July).
During this time, I have seen a doctor and taken pain relievers, but recently I was prescribed steroids (5 mg) since the pain medication didn't seem to be effective.
Unfortunately, it still hasn't fully resolved.
In the mornings, it looks less swollen, but by the evening, it returns to its swollen state.
When I asked the doctor if further tests were necessary, he said it wasn't needed.
He advised to let the joint reduce swelling before starting uric acid-lowering medication.
Is this the right approach? It has been a long time without improvement, and I am quite troubled by this.
Would physical therapy, such as infrared or ultrasound treatment, help speed up recovery? Duration: almost two months.

alex, 20~29 year old female. Ask Date: 2006/07/10

Dr. Lin Xiaoyi reply Orthopedics

Hello: 1.
If gout is confirmed, the use of urate-lowering medications should not be changed during an acute attack.
This means that individuals who have not been on urate-lowering therapy should not start it during this period, and those who are already on it must continue their medication.
2.
In the early stages of gout, symptoms usually improve within a few days, and the sooner treatment is initiated, the better the outcome.
If symptoms persist for two months despite the addition of corticosteroids and there is still joint swelling, other types of arthritis should be considered.
3.
If there is only soreness without significant swelling, physical therapy may be effective.
However, if there is obvious redness, swelling, heat, and pain, it is advisable to consult a rheumatologist for further diagnosis and treatment.
Wishing you good health, Lin Hsiao-Yi, Department of Rheumatology and Immunology, Taipei Veterans General Hospital.

Reply Date: 2006/07/10

More Info

Managing gout can be quite challenging, especially when symptoms persist despite treatment. Gout is a form of inflammatory arthritis caused by the accumulation of uric acid crystals in the joints, leading to pain, swelling, and inflammation. The management of gout typically involves both acute treatment for flare-ups and long-term strategies to lower uric acid levels.

In your case, it seems that you experienced an initial flare-up of gout in April, which responded to medication. However, the persistent swelling you are experiencing now, which has lasted for almost two months, is concerning. While it is not uncommon for gout to have recurrent episodes, prolonged swelling without significant pain can indicate that the inflammation is not fully resolving, or it may suggest other underlying issues.

Your doctor’s approach to managing your condition by prescribing corticosteroids (5mg) is a common strategy to reduce inflammation when non-steroidal anti-inflammatory drugs (NSAIDs) are ineffective. Corticosteroids can help alleviate swelling and discomfort, but they do not address the underlying cause of gout, which is high uric acid levels. Therefore, it is essential to follow up with uric acid-lowering medications once the acute inflammation subsides.

Regarding your question about further examinations, it may be beneficial to discuss with your doctor the possibility of conducting additional tests. This could include checking your serum uric acid levels, kidney function, and possibly imaging studies to rule out other conditions that might mimic gout, such as pseudogout or other types of arthritis. If your doctor believes that further tests are unnecessary, you might consider seeking a second opinion from a rheumatologist, a specialist in arthritis and gout management.

As for the idea of incorporating physical therapy modalities like infrared therapy or ultrasound, these can be helpful adjuncts in managing pain and inflammation. Physical therapy can improve joint function and mobility, and modalities such as ultrasound may help reduce swelling and promote healing. However, it is crucial to ensure that any physical therapy is done under the guidance of a healthcare professional who understands your specific condition and can tailor the treatment to your needs.

In summary, while your current treatment plan may help manage the inflammation, it is essential to address the underlying issue of uric acid levels to prevent future flare-ups. Discussing further evaluations with your healthcare provider and considering physical therapy as part of your comprehensive treatment plan could be beneficial. Remember that managing gout is often a long-term commitment, and finding the right balance of medications and lifestyle changes is key to reducing the frequency and severity of flare-ups.

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