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5/26/08 7:27 P

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WEEK 8: Gout hasn't "quieted down" enough to take ALLOPURINOL,which helps rid the body of uric acid. Since I can't take NSAIDS,my Dr.has prescribed a 4-wk course of Prednisone to get the swelling down. 2 wks.after initiantion of Prednisone I am supposed to initiate Allopurinol.
Why It Is Used
Corticosteroids may be used for:

Gout attacks that are limited to a single joint.1
Gout attacks that do not respond to nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine.
People who cannot take NSAIDs or colchicine, such as those with kidney disease or a history of serious ulcer disease and gastrointestinal bleeding. Corticosteroids may also be used by people who have congestive heart failure or take the blood-thinner warfarin, or are allergic to aspirin.
Corticosteroids are not recommended for people who have a joint infection.

How Well It Works
Corticosteroids usually provide rapid relief from gout symptoms.2 Because of their potential side effects if used for a long time, corticosteroids are usually prescribed only for a short time.3

Side Effects
Common short-term side effects include:

Mood swings.
Weight gain.
Fluid retention.
Very rounded (moon) face.
Poor wound healing.
Increased risk of infection.
High blood pressure.
Uncommon short-term side effects include:

Muscle weakness.
Stomach ulcers.
Long-term side effects include:

Cataracts (uncommon).
Damage to the hip, shoulder, or knee joints (uncommon).
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About
Corticosteroids are most often used in people who are unable to take nonsteroidal anti-inflammatory drugs (NSAIDs) or colchicine. If only one joint is affected, injection of corticosteroids into the joint may be most effective. If multiple joints are involved, corticosteroids may be injected into a vein or muscle or taken by mouth in pill form, in gradually decreasing doses.
Corticosteroids should not be used when bacterial arthritis is present.
People with high blood pressure should monitor their pressure while using corticosteroids.
People with diabetes may need more medication or insulin when using corticosteroids to treat their gout

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5/16/08 1:54 P

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I read that aspirin made your gout flair,so that's why I wanted to check this article out.There's also a drug that you take when you're not in a bout,which is supposed to decrease the uric acid. I'm still having some gout twinges,though,and you're supposed to wait unti the gout is COMPLETELY gone. My gout has lasted so long because I can't take the usual protocol...NSAIDS,corticosteroids.

I have this 1 drug,Cholchicine,that you use in the acute stage of gout,but it's side effects are almost worse than the gout!

I can't take most things either because of my liver and kidneys. All medicines are metabolized/excreted in on or the other. My new Doc did give me a sctipt for Salcalate,which is for pain. It's a cousin to aspirin,but will not build up uric acid like aspirin. Frankly, since I've taken it the last 2 days I really can't tell a difference pain-wise. Mind over matter!


Edited by: IT*SNEVER2LATE at: 5/16/2008 (13:57)
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5/16/08 12:27 P

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This sure is an eye-opener for me, Sandy. Besides your gout medication, what can you do about the pain when you have a flare-up? Does Tylenol help? Or does it make it worse? When I hurt my shoulder, I could not understand why taking Tylenol did not help, until I read that Tylenol typically does not relieve the kind of shoulder pain I had. Because I cannot take aspirin or other anti-inflammatory OTCs, I had to get prescription Celebrex. Although Celebrex is an anti-inflammatory, my doctor double-checked to make sure that it was not going to exacerbate my von Willebrand's disease (blood disorder that is life-threatening only under extreme cases).

Anyway, I hope the wonders of medical science will get you painfree soon!

Look into your heart, work towards your dreams, and they will come true.

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;..♥Janet F. in N. California♥.;..
SP joined Nov. '07, active with SP Jan. 5, '08

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5/16/08 11:30 A

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Gout & Aspirin
Medical Author: William C. Shiel MD, FACP, FACR

Did you know that aspirin can affect Gout?

Many patients will read that aspirin increases the level of uric acid in the blood and that the blood level of uric acid is important in Gout. What is the relationship between the two factors? Additionally, many patients are prescribed a low dose of aspirin (75-81 mg daily) to prevent heart attacks or strokes. What should patients be told about aspirin and Gout? Will it cause Gout in them?

These questions bring up a number of important issues about Gout.

First, Gout is medical condition that is characterized by abnormally elevated levels of uric acid in the blood, recurring attacks of joint inflammation (arthritis), deposits of hard lumps of uric acid in and around the joints, and decreased kidney function and kidney stones. While Gout is often associated with an abnormally elevated blood uric acid level, it need not be. This means that the medical condition of Gout can exist in an individual regardless of an elevated uric acid level in that person. This even holds true for an acute attack of gouty arthritis! Moreover, many patients with elevated blood levels of uric acid (hyperuricemia) never develop gout.

It is, therefore, important to understand that it may not necessarily be the level of uric acid that triggers an acute attack of gout. Frequently, acute attacks are precipitated by a rapid change of uric acid, either up or down. Additionally, the tendency toward developing gout seems to be significantly influenced by the metabolism a person inherits.

Secondly, it is true that small doses of aspirin can increase the level of uric acid in the blood because it can impair the excretion of uric acid from the kidneys. However, this change is typically only noted when aspirin is taken in the usual over-the-counter doses (two 325 mg tablets every four hours). An extremely low dose of aspirin (75-81 mg per day), which is given, for example, for heart attack or stroke prevention, should not significantly alter the level of uric acid in the blood. Furthermore, even the higher doses mentioned should only cause an attack of Gout in a person who already has the condition or is at risk for an attack, not in an individual with a normal metabolism.

Finally, it is interesting to note that aspirin has a very different effect on the blood level of uric acid when it is taken at very high doses, such as is prescribed by doctors for treating serious forms of inflammatory arthritis (like rheumatoid arthritis). In these very high doses, aspirin actually blocks the normal reabsorption of uric acid by a different part of the kidneys, thereby causing uric acid to be dumped out of the body in the urine and resulting in a LOWERING of the blood level of uric acid.

However, because of the effects of moderate and high-dose aspirin, which can alter the blood level of uric acid, aspirin and aspirin-containing products (see below) are generally avoided by persons with a known Gout condition

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