These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.
Gout
Question: I have had been diagnosed with gout. I am a 35 year-old male being treated for high blood pressure with tenormin. I have had an attack about 4 -1/2 weeks ago that has affected both my ankle and my knee joint. I began taking indocin for swelling and vicodin for pain. After the 3rd week I was put on allopurinol. Several nights later, I began to get a severe headache which lasted about 12 hrs. I stopped the vicodin, but the pain in my joint has lessened but is still present. A. Why this terrible headache? B. Does gout go on this long normally? and C. When will it end?
Answer: Gout is caused by the formation of uric acid crystals in joints and body parts. Uric acid is accumulated by the breakdown of DNA in the diet and normal breakdown of body cells. The pain and inflammation of gout are caused by the body’s own white cells attacking these crystals as if they were foreign bodies. Conseqently, turning off this attack or inflammatory response is critical to treating gout once it starts. Gout is best treated at the early stages before the inflammatory response gets really turned on. Consequently, taking non-steroidal anti-inflammatories(NSAIDS) such as indocin at the first signs of gout is very important. Once white blood cells get turned on, turning them off is very difficult and pain for several weeks is common. Often, a diet called a “low purine diet” is helpful. This seeks to decrease the DNA in one’s diet to reduce the uric acid. Allopurinol is very useful in preventing gout. However, it is of no use during an acute attack. Indeed, allopurinol can produce gout when initially started. Allopurinol is an extremely useful drug – one word of caution – some individuals will become allergic to allopurinol. This reaction can be severe and result in loss of skin and long term (3 to 6 months) there have been deaths from this drug in the 1 to 2% with this severe reaction. The reaction is usually delayed and not on the initial taking of the drug. It is difficult to tell any particular cause for the headache. I would discuss this with your physician.
