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Re: Pain in big toe

Posted: 26 Jun 2020, 3:47pm
by mikeymo
Proofer wrote:Seen the GP and she said it was gout (no sign of infection) and gave me some pills, looking back on it I think it was down to dehydration on that first run.


Friend of mine (keen cyclist) had high blood pressure. Doctor prescribed diuretics. Diuretics caused dehydration, thus gout.

Re: Pain in big toe

Posted: 26 Jun 2020, 4:02pm
by Jdsk
One very commonly used family of diuretics, thiazides, have a direct effect on urate metabolism that doesn't depend on dehydration.
https://en.wikipedia.org/wiki/Thiazide#Contraindications

Jonathan

Re: Pain in big toe

Posted: 27 Jun 2020, 2:24pm
by Proofer
I take blood thinner (Apixaban) so normal NSAIDs aren't suitable so I'm on Colchicine.
The odd thing is the first attack was June 15th and I was walking quite a lot after that (2 or 3 miles at a time) with no problems, I knew it wasn't right just put it down to an injury but when I went cycling it came back.

Re: Pain in big toe

Posted: 27 Jun 2020, 2:27pm
by Jdsk
Interesting drug. We used to think we knew how it worked, but it's got more complicated:
https://en.wikipedia.org/wiki/Colchicine#Mechanism_of_action

Jonathan

Re: Pain in big toe

Posted: 27 Jun 2020, 2:34pm
by Jdsk
And there's a lot that isn't known about gout, despite its description since ancient times. And its repeated portrayal in literature.
https://en.wikipedia.org/wiki/Gout#History
Proofer wrote:The odd thing is the first attack was June 15th and I was walking quite a lot after that (2 or 3 miles at a time) with no problems, I knew it wasn't right just put it down to an injury but when I went cycling it came back.

It's pretty clear that both physical stress and wear and tear interact with the metabolic disturbance. But it's hard to explain in any detail what happens in individual sufferers.
https://en.wikipedia.org/wiki/Gout#Pathophysiology

Jonathan

Re: Pain in big toe

Posted: 27 Jun 2020, 3:38pm
by Audax67
Proofer wrote:Seen the GP and she said it was gout (no sign of infection) and gave me some pills, looking back on it I think it was down to dehydration on that first run.


I'm pretty bad at drinking enough myself, and have had horrible cramp on occasion both during and after rides. Post-ride lately I've started making myself up a pint of Isostar with a half-teaspoon of bicarb to kill the acidity. It has pretty well got rid of the post-ride problems. Last one I had, I added a ball of vanilla ice-cream. Highly recommended.

Re: Pain in big toe

Posted: 27 Jun 2020, 4:13pm
by NUKe
Proofer wrote:Seen the GP and she said it was gout (no sign of infection) and gave me some pills, looking back on it I think it was down to dehydration on that first run.


Quinine is good for gout, if you feel it coming on It, I find you can usually head it off with a tonic water best leave the gin out though as alcohol can aggravate it. The pills the doctor gave me worked when it was severe. But I fInd managing it with Indian tonic water works well

Re: Pain in big toe

Posted: 27 Jun 2020, 4:24pm
by Jdsk
NUKe wrote:Quinine is good for gout...

What's the evidence for that, please?

Thanks

...

There's a known interaction between colchicine and quinidine.
https://academic.oup.com/rheumatology/article/57/suppl_1/i4/4762112

I've never seen anything similar for quinine, but I'd probably abstain.

Jonathan

Re: Pain in big toe

Posted: 29 Jun 2020, 8:58am
by TimeTraveller
Gout.... I get a flair up about twice a year, its a right pain in the wheels as I can't even get my shoe on.
I think I may be aggravating the issue now days as I'm running on a low carb Keto lifestyle which has a lot of fat and protein in it and as I've been told this can increase in uric acid.. hence flair ups.
I'm on Meloxicam plus pain relief but that I don't believe helps :(
What I tend to do now when I notice the joints beginning to cause pain is increase my fruit, lots of cherries and berries and also pure cherry and cranberry juices when I can find them (nothing else in it).
Still takes a while to ease down but I'd rather not add more chemicals to the mix.. Just getting over a bout that has had me unable to get the shoe on for the first week, now on week two and finding things easing off..

Re: Pain in big toe

Posted: 29 Jun 2020, 4:13pm
by NUKe
Jdsk wrote:
NUKe wrote:Quinine is good for gout...

What's the evidence for that, please?

Thanks

...

There's a known interaction between colchicine and quinidine.
https://academic.oup.com/rheumatology/article/57/suppl_1/i4/4762112

I've never seen anything similar for quinine, but I'd probably abstain.

Jonathan

The only evidence I have was a doctor that told me and the fact that the medicine I was prescribed Contained it. apart from that it works for me.