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Gout flareup while on diuretic for arythmia?
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Gout flareup while on diuretic for arythmia?
by FoolsGold, Aug 31, 2005 12:00AM
I am on Furosemide, potassium and Digoxin for atrial fibrillation, but my left leg which is noticeably swollen despite the use of a diuretic recently started giving me pain particularly in the great toe which felt like a flareup of my gout.
I discontinued the diuretic for a few days and resorted to consuming copious amounts of fluit to flush the uric acid out of my system and thus end the gout flareup. However the pain in the great toe continues as does the pain throughout the leg due to the impaired circulation secondary to atrial fibrillation.
Should I resume the Furosemide etc. use?
Note: 60 year old male, no insurance, extremely limited mobility.
I discontinued the diuretic for a few days and resorted to consuming copious amounts of fluit to flush the uric acid out of my system and thus end the gout flareup. However the pain in the great toe continues as does the pain throughout the leg due to the impaired circulation secondary to atrial fibrillation.
Should I resume the Furosemide etc. use?
Note: 60 year old male, no insurance, extremely limited mobility.
Doctor's Answer
by CCF-M.D.-MJM, Aug 31, 2005 12:00AM
Hello,
Ouch. Unfortunately gout is often exacerbated by changes in uric acid levels as well as increased uric acid levels. Once you have it, the only ways to help it go away are steroids and colchicine. Nsaids can help with the pain. Once the flair is over, you can try a medication call allopurinol -- allopurinol can make gout worse in the acute setting.
I don't feel comfortable over the internet telling you when to restart medications.
Regarding your atrial fibrillation, is your rate controlled on digoxin alone? It usually requires another agent to help maintain good rate control (a beta blocker like atenolol if you have normal kidneys or metoprolol if you don't have normal kidneys and your liver is ok). Atenolol is generic and relatively inexpensive.
I hope this helps.
Ouch. Unfortunately gout is often exacerbated by changes in uric acid levels as well as increased uric acid levels. Once you have it, the only ways to help it go away are steroids and colchicine. Nsaids can help with the pain. Once the flair is over, you can try a medication call allopurinol -- allopurinol can make gout worse in the acute setting.
I don't feel comfortable over the internet telling you when to restart medications.
Regarding your atrial fibrillation, is your rate controlled on digoxin alone? It usually requires another agent to help maintain good rate control (a beta blocker like atenolol if you have normal kidneys or metoprolol if you don't have normal kidneys and your liver is ok). Atenolol is generic and relatively inexpensive.
I hope this helps.
>Nsaids can help with the pain.
Even though it was only one study and had a small number of subjects, the omission of Nsaids seems to help gout patients greatly. I'm trying to get the full article rather than just the abstract.
>gout is often exacerbated by changes in uric acid levels
I've been trying to get a uric acid test for six months but the doctor has refused to issue an Rx for one.
>allopurinol can make gout worse in the acute setting.
Yes. Though anecdotal evidence from sufferers who were mistakenly Rx'd allopurinol immediately seems to indicate it can really help to end the initial gout episode.
>I don't feel comfortable over the internet telling
>you when to restart medications.
I understand. Thank you for your efforts on my behalf.
It seems to be a question of the diuretic probably having exacerbated the gout but having properly been Rx'd for the
atrial fibrillation related edema. Perhaps this has happened to other forum members and they will post their views.
>Regarding your atrial fibrillation, is your
>rate controlled on digoxin alone?
I don't know. I had an initial EKG after months and months of being in the 145-158 bpm range (occasionally 104) but the physician I have refuses to show me the tape or discuss it. On a follow up appointment, he did not do any subsequent EKG but my rate then must have been lower since my own measurements had revealed it generally being in the low 90s and occasionally lower. He Rx'd a daily aspirin tablet at that time, so I imagine he is concerned about anti-coagulation therapy rather than rate-control. Obviously he remains silent on the issue.
>It usually requires another agent to help maintain good
>rate control (a beta blocker like atenolol if you have normal
>kidneys or metoprolol if you don't have normal kidneys
I don't recall any kidney tests but assume I have normal kidneys despite an episode a year ago of an unknown infectious agent and unilateral kidney pain which was treated with an antibiotic.
>I hope this helps.
I'm sure it will. Thanks again.
Should I use the diuretic pills to improve the circulation in my limbs and thus endure the pain of what I think is a gout flareup OR is it more important to continue the diuretic since the pain in the great toe akin to prior gout episodes may be simply due to the increased overall pressure caused by the edema?
I litterally have tossed a coin on this and decided to go back on a diuretic briefly and see what happens. It may indeed be gout again, but even if it is, the pain from the edema is so very bad also.
Good commentary on modern medicine: 'decided by a coin toss'.