Battling Gout

[MartyVA]

I have CKD stage 4. My eGFR is stable at 22, my BUN is 51, and my creatinine is 3.07. I am careful about what I eat, and I pay attention to the purine content in foods and other things. Despite my best efforts, I am beginning to see a slight increase in the number of gout flare-ups and the intensity of the related pain. I was using black cherry juice twice daily but switched to once daily, then once every other day. I have restarted the daily routine again. But my question is, is anyone else experiencing gout flare-ups related to your CKD? I had been stage 3a and 3b for years and never had an issue with gout. My gout problems started about two years ago, and since then, I have had probably six flare-ups. My flair-ups were only on my left ankle. Two weeks ago, I had a gout flare-up involving my left ankle and left knee. That was the worse pain I have ever had. And because of my kidneys, I cannot take the standard gout medications. My nephrologist and care team agreed that Methylprednisolone would be good to help deal with my problem. Within a couple of days, the swelling and pain were gone. Is anyone else having issues with gout, and how are you dealing with it?

[NilsB]

Yes, but it took a while before O had it diagnosed. I now avoid NSAIDs even though especially Arcoxia was very effective for shortening the bouts and controlling the pain. Now, the method to deal with it is Prednisolone and Colchicine. A study on dosage of Colchicine came to the conclusion that 2 pills right away and one one hour later with no subsequent medication is the best approach and several sources said that Colchicine should be taken as early as possible during the gout attack. Now, I always have those medications as well as pain meds for kidney stones at home. My gout is, when it hits, so painful that it is completely incapacitating, almost as bad as when kidney stones start moving. I have also tried Epsom Salts and acupuncture and the former may have done some good. Very doubtful about the acupuncture but some studies have shown that to be of potential use as well.

[htpi1543 in reply to NilsB]

Hello NilsB, sorry to hear about your gout attacks. I had a gout attack about 4 years ago. My Nephro gave me prednisone. One dose cured it like magic. Since then I haven’t had severe gout attack.Prednisone has its own short comings so be careful. Since it is a prescribed med, you should ask your Nephro to prescribe. At that time I was CKD 3. Now I am at stage 5, but my Uric acid is around 7.Good luck with your gout control 🙏🙏🙏

[Okiksaints1955]

For 30 years, I have seen my gout issue escalate. From once a year to almost monthly. Even when I basically avoided all gout inducing food and I also increase my water intake. I use colchicine for unbearable flare ups (can"t walk).

Then I had a kidney transplant and the gout issue went away after 3 months. I was off any gout medication after that. But I still cant get out of my old diet - force of habit and some conscience guilt.

The kidney can't process properly, thus retains urate crystals that accumulates in the joints.

All actions were of course under the care of my Nephrologist. Hope this helps

[drmind]

I had one gout attack 6 years ago and was put on allopurinol, 100 mg a day and then 200 mg a day which I currently take. This medication put my uric acid level at 6 or below within the year. As a result, I've never had another attack although several tried to start but never flated up. My CKD stayed at GFR 3 for several years while on this medication.

Hope this information helps.

[Bassetmommer NKF Ambassador]

I was put on Alopurinol to lower my uric acid. I passed so many uric acid stones in was not funny. That stopped it . I had one gout attack in my foot. Bu I have psoriatic arthritis and it is very similar to gout. Even with allopurinol, my acid levels were still high so now I have sodium citrate daily to lower it. Sometimes, simple baking soda can help but ask your doctor to make sure it is safe. Makes all the difference to get the right meds.

[MartyVA in reply to Bassetmommer]

I have an appointment with my nephrologist coming up in two weeks. We had discussed the possibilities of gout becoming an issue as my uric acid numbers have been slowly increasing. My PCP has been pushing me to start gout meds, but my nephrologist has cautioned against that. I had been doing a pretty good job of managing things through my diet, but obviously, things are changing. We'll see what happens in two weeks. Thanks to all for your input.

[Blackknight1989]

May be of some interest:

2021 Patient Education Forum- Gout, Arthritis and CKD

Link to register: kidney.secure.force.com/rc_...

[MartyVA in reply to Blackknight1989]

Thanks I've registered.

[Blackknight1989]

Cool glad I could help. I have been stage 4 since 1996. I have terrible regular osteoarthritis and had my first joint replacement in 2004. Gout started in 2004. I did what you do and went to urgent care got diagnosed by different doctor and got a methylphenidate or prednisone pack, colchicine and allopurinol. So the steroids would cure that glare in about 48 hours. But the when I started the allopurinol I’d have another flare. (Anytime uric acid fluctuates it can cause a flare. So I’d get better and then a week later another flare.) I had it in the big toe, ankle, knee, elbows, shoulders and fingers. I had such bad gout that I developed the tophi in all the joints I had the flares in most prominent in the elbows and toes. Here is a description of chronic tophaceous gout from John Hopkins:

Some patients only experience acute gout attacks which may be limited to 1-2 times per year (or even 1-2 times in lifetime). However, for some patients, gout can be a chronic, relapsing problem with multiple severe attacks that occur at short intervals and without complete resolution of inflammation between attacks. This form of gout, called chronic gout, can cause significant joint destruction and deformity and may be confused with other forms of chronic inflammatory arthritis such as rheumatoid arthritis. Frequently, uric acid tophi (hard, uric acid deposits under the skin) are present and contribute to bone and cartilage destruction. Tophi are diagnostic for chronic tophaceous gout. Tophi can be found around joints, in the olecranon bursa, or at the pinna of the ear. With treatment, tophi can be dissolved and will completely disappear over time.

Link: hopkinsarthritis.org/arthri...

One of the last times I went to urgent care for a flare in my knee, the doctor did not believe or know that chronic gout can occur in all joints so he diagnosed me with osteomyelitis and put me in the hospital. The Hospitalist tried to give me IV NASIDs. I did not let them do that and that led to a fight between me and the docs in the hospital. I then was referred to a great rheumatologist (this was in 2007) and she started the correct treatment plan. I did not have another gout flare due to her treatment plan from 2010-2020. Due to losing my business in 2020 and losing my insurance I did not have my allopurinol starting in February 2020. My first gout flare hit again in June 2021. I had COVID in July 2021 with a bad case of COVID pneumonia so I was in bed for a month or so. Finally able to get back to close to normal around Labor Day. Since then I have had 4 additional flares. My VA doc will not manage the treatment plan that my former rheumatologist did for me and she is not “in-network” for the VA community care. So I was able to get my nephrologist to mange that plan. Now I have started back on 150mg of allopurinol with .6 colchicine on Monday and Friday plus 7.5mg prednisone daily as prophylactics to prevent flares.

You need to see a doc and get that taken care of because gout with CKD is an indicator of metabolic disease. With the high uric acid that causes gout it increases lots of comorbid complications especially CVD.

Link:

ahajournals.org/doi/10.1161...

So get treatment and get the uric acid levels under 5. Good luck in you journey with CKD and gout. Gout flares suck!

[Blackknight1989]

Her is another site that has good information on gout from the perspective of the arthritis foundation. Link:

arthritis.org/search?query=...

[MartyVA]

I cannot tell you how much I appreciate the time and effort you put into these responses. Both sites are very informative. I am concerned that I may be developing Tophi in my right ankle. I am looking for a rheumatologist to confirm and get advice on dealing with gout and arthritis. Thanks again for your help.