Allopurinol and gout attack
My first attack was more or less ‘classic’:Nightime, in April, in the great toe and about aweek later migrating to the contra-lateral greattoe. However the pain and redness seemed centeredone-joint away from the ‘classic’ position.
My doctor was seeing his very first case of goutand being a young resident just starting out onhis career, he called his attending to supervisehis aspiration of synovial fluid. Despite theadvice the attending gave him he was unable toaspirate synovial fluid and therefore made only atentative diagnosis of gout since he could notobtain the confirmatory bichromatic confirmationof uric acid crystals. This made him a bithesitant to Rx any allopurinol and was a causefor much suffering by me and probably damage tome.
A recent poster’s “ankle gout” that for 30 yearshas not struck the great toe or anyplace else andis limited to only one ankle, the one with aprior injury does not “sound like” gout. However,it certainly could be gout. Not everyone has aclassical case or a classical progression. Ithink ‘avoiding attacking a weakened joint with afine needle to aspirate some fluid’ is notproper, but some doctors are very conservativeand really do not want to “do something wrong”.Its legal to treat you for gout even though thereis no confirmatory test establishing that you dohave gout. I think an infectious agent hasprobably taken up residence in the injured ankleand is giving some problems that just might begout but could well be something else.
Allopurinol and Colchicine, the two most oft usedanti-gout medications, are each also fungicidaldrugs and one researcher maintains that theirmanner of functioning is to kill the P. multocidathat causes gout. Certainly the classical onsetpattern and classical skin manifestations doindicate an infectious agent. His theory is notproven but it is biologically plausible and doesfit known observations in man and animals. Indeedhis theory originally was developed fromveterinary journals.
Does allopurinol really work in this mode?Perhaps.
If I had thirty years of ankle pain I would haveinsisted on an attempt at aspiration of synovialfluid during an acute attack. Or I’d haveinsisted on a different doctor. But we all haveto make choices and deal with uncertainty.