Pseudogout, Anyone?
Discussion
Gout. I've suffered the affliction for around three decades, give or take a few years. My first flare-up was when I was playing for Wasps and during a session of bare foot squats, I accidentally toe punted a 20Kg weight. The pain lasted a while but the knuckle area swelled up overnight leading me to believe that I had somehow fractured a bone in or around my big toe. An x-ray the next day confirmed that I hadn't broken anything and it was probably nothing more than some bruising. I now know it was gout.
Since that event, I've suffered a few attacks which have always been in the same area. The symptoms have always been the same however the levels of pain have ranged from still being able to walk on it to wanting to strike down on the area with a meat cleaver and do away with the affected toe.
About 10 years ago my knee swelled up during a beer jolly in Brussels. As funny as it was telling people that my knee had swollen up to the size of a small watermelon as a result of an unfortunate accident involving a tube of penis enlargement cream, that pain too (eventually) was also unbearable. In hindsight, carrying on regardless with the beer drinking was in ignorance as I did not think it was gout (probably a late reaction to a twist whilst playing five-a-side a few days earlier).
I found that I was more likely to suffer a flare-up in the hotter months of the year (simply not drinking enough water). However, over the years, no matter what I tried (even a stint on Allopurinol) an attack would eventually show up somewhere: big toe, ankle or knee. What made starting the preventative drugs was that I needed to wait for a period of around four-weeks - after being clear of an attack - before starting the course. I was rarely out of the weeds in that respect. Fast forward to about two-months ago and whilst watching my son play football I started to feel discomfort in my left shoulder which, as the time went on turned to intense pain and rendered my arm out of action within several hours. It took about three-days for the pain to subside and whilst there still was some discomfort and limited movement in the shoulder, I could return to work. Six weeks later, it happened again.
The second episode was - has, to date - probably been the worst pain I have felt overall. Pain from gout in the foot or knee can be incredibly painful and it has destroyed my soul a couple of times by breaking down my resistance to pain. At the time there is no pain worse; but, to a point, you can still hop along (albeit on crutches) to the toilet and even though you struggle to sit down and get back up, you eventually do (years of rugby training no doubt a factor in that). The acute shoulder pain felt worse, not because the pain was more intense, but because it was also affecting my neck and rib cage. It started in my left shoulder and after 24 hours, was also in my right shoulder. It made me feel completely helpless as there is no comfortable position standing, nor seated. Lying down was made impossible as I couldn't use my arms. As I waited for the ibuprofen to kick in, the pain just worsened and the discomfort (of not finding any position whatsoever) made the pain feel even worse. 36 hours without sleep did not help. I decided that if after 24 hours I didn't feel any significant improvement I would have to seek medical assistance.
Day three and some noted changes. The pain from my left shoulder had almost gone however, there was still much discomfort in my right shoulder which was affecting the right hand side of my ribs. Trying to cough to eject something that went down the wrong hole was extremely painful and whilst I've never suffered a broken rib, a couple of mates who have described similar symptoms. Leaning forward was painful, trying to lay down was very painful and getting back up from with action was even worse as the weight of my head and arm on my shoulder and rib cage made it unbearable. I felt paralysed. On day four my right wrist started to demonstrate some very gout-like pain and swelling and later into the day, my right elbow joined that party too. Days five and six were all about pain management (and trying to find a comfortable position so that I could sleep) and it was day seven before I could actually straighten my posture from being hunched (and arms tucked in; I must have looked quite a sight).
Today is Day Nine and I have managed to use both hands to write this message to share my experience; catharsis? Of course (as well as talking to friends) but also to appreciate that I have use of my hands again. I know it has 'only' been nine days, but it felt like an eternity especially being wide awake during the night and not having the strength or balance to move from A to B or settle into a comfortable position once I got there.
I'm not out of it yet, but I'm close. I think a few days of continuing with my rehabilitation will the end of it; a bit like that period of time you need to learn how to walk again after sitting too long on the khazi. It has been a truly dreadful bout of pain and whilst physically it introduced me to pain and discomfort I have never experienced before, it also gave me a mental kicking too. But what was it? Why was I was in such acute pain? I had almost settled on gout, a nuanced level of metabolic arthritis which happens to people of my age. But can you get gout in your knee? Yes. In your wrist? Yes. Elbow? Yep, there too. The most common place being the big toe. Then I thought again when I realised I hadn't had a flare-up in either of my toes for quite some time. Deeper pondering concluded that my knees hadn't suffered too (not for the best part of a year). Certainly nothing more than a twinge in any of those areas. More digging on the subject matter to see if my shoulders were now the new sites in which this dreadful affliction would now be manifesting in led me to a piece on pseudogout. The symptoms fit the profile.
"Gout and pseudogout are the two most common crystal-induced arthropathies. Gout is caused by monosodium urate monohydrate crystals; pseudogout is caused by calcium pyrophosphate (CPP) crystals and is more accurately termed calcium pyrophosphate disease (CPPD)"
"Pseudogout causes pain, swelling, stiffness, and warmth in large joints. It most commonly affects the knees, but it can also affect the elbows, ankles, wrists, shoulders, or hands. Pseudogout attacks can be sudden, and the symptoms may last for days or weeks. Some people who have pseudogout don’t have any symptoms between attacks. In other cases, pseudogout can cause constant pain and discomfort. This chronic (long-lasting) pseudogout may seem similar to osteoarthritis or rheumatoid arthritis."
I'm not settling on my own self diagnosis as I do not know enough about pseudogout and I still don't fully recognise or understand my symptoms in terms of where the pain started and how it moved from shoulder to shoulder, and then pronated to my rib cage (while something similar was going on around both my wrist/hand area as well as my elbow). But it's the closest I can get to an explanation to what I've just experienced. To top the lot, when this was all beginning to kickoff, I was having a general checkup at the GP and was then told my BP was dangerously high and that I needed to start taking statins immediately. Thread on that here.
I confess, I don't like going to the doctor unless I feel really broken, and even then, if it feels like I'm getting better, I soldier on. I also don't trust some doctors in that I feel the right questions are not asked. This isn't helped by the high turnover of medical staff at my GP surgery. In short, I have gout. I have to deal with everything that I can to help myself. All the doctor can advise is the same as well as write me a prescription for drugs to deal with the pain or another for the preventative drug. More research is needed on pseuodgout, and if it is that, the treatments (especially in terms of pain relief) are the same. There is no hard evidence that diet is a factor in the development of pseudogout.
My research will continue, and if this b
d paid does show up again, I think I will pop in to see my GP.
Since that event, I've suffered a few attacks which have always been in the same area. The symptoms have always been the same however the levels of pain have ranged from still being able to walk on it to wanting to strike down on the area with a meat cleaver and do away with the affected toe.
About 10 years ago my knee swelled up during a beer jolly in Brussels. As funny as it was telling people that my knee had swollen up to the size of a small watermelon as a result of an unfortunate accident involving a tube of penis enlargement cream, that pain too (eventually) was also unbearable. In hindsight, carrying on regardless with the beer drinking was in ignorance as I did not think it was gout (probably a late reaction to a twist whilst playing five-a-side a few days earlier).
I found that I was more likely to suffer a flare-up in the hotter months of the year (simply not drinking enough water). However, over the years, no matter what I tried (even a stint on Allopurinol) an attack would eventually show up somewhere: big toe, ankle or knee. What made starting the preventative drugs was that I needed to wait for a period of around four-weeks - after being clear of an attack - before starting the course. I was rarely out of the weeds in that respect. Fast forward to about two-months ago and whilst watching my son play football I started to feel discomfort in my left shoulder which, as the time went on turned to intense pain and rendered my arm out of action within several hours. It took about three-days for the pain to subside and whilst there still was some discomfort and limited movement in the shoulder, I could return to work. Six weeks later, it happened again.
The second episode was - has, to date - probably been the worst pain I have felt overall. Pain from gout in the foot or knee can be incredibly painful and it has destroyed my soul a couple of times by breaking down my resistance to pain. At the time there is no pain worse; but, to a point, you can still hop along (albeit on crutches) to the toilet and even though you struggle to sit down and get back up, you eventually do (years of rugby training no doubt a factor in that). The acute shoulder pain felt worse, not because the pain was more intense, but because it was also affecting my neck and rib cage. It started in my left shoulder and after 24 hours, was also in my right shoulder. It made me feel completely helpless as there is no comfortable position standing, nor seated. Lying down was made impossible as I couldn't use my arms. As I waited for the ibuprofen to kick in, the pain just worsened and the discomfort (of not finding any position whatsoever) made the pain feel even worse. 36 hours without sleep did not help. I decided that if after 24 hours I didn't feel any significant improvement I would have to seek medical assistance.
Day three and some noted changes. The pain from my left shoulder had almost gone however, there was still much discomfort in my right shoulder which was affecting the right hand side of my ribs. Trying to cough to eject something that went down the wrong hole was extremely painful and whilst I've never suffered a broken rib, a couple of mates who have described similar symptoms. Leaning forward was painful, trying to lay down was very painful and getting back up from with action was even worse as the weight of my head and arm on my shoulder and rib cage made it unbearable. I felt paralysed. On day four my right wrist started to demonstrate some very gout-like pain and swelling and later into the day, my right elbow joined that party too. Days five and six were all about pain management (and trying to find a comfortable position so that I could sleep) and it was day seven before I could actually straighten my posture from being hunched (and arms tucked in; I must have looked quite a sight).
Today is Day Nine and I have managed to use both hands to write this message to share my experience; catharsis? Of course (as well as talking to friends) but also to appreciate that I have use of my hands again. I know it has 'only' been nine days, but it felt like an eternity especially being wide awake during the night and not having the strength or balance to move from A to B or settle into a comfortable position once I got there.
I'm not out of it yet, but I'm close. I think a few days of continuing with my rehabilitation will the end of it; a bit like that period of time you need to learn how to walk again after sitting too long on the khazi. It has been a truly dreadful bout of pain and whilst physically it introduced me to pain and discomfort I have never experienced before, it also gave me a mental kicking too. But what was it? Why was I was in such acute pain? I had almost settled on gout, a nuanced level of metabolic arthritis which happens to people of my age. But can you get gout in your knee? Yes. In your wrist? Yes. Elbow? Yep, there too. The most common place being the big toe. Then I thought again when I realised I hadn't had a flare-up in either of my toes for quite some time. Deeper pondering concluded that my knees hadn't suffered too (not for the best part of a year). Certainly nothing more than a twinge in any of those areas. More digging on the subject matter to see if my shoulders were now the new sites in which this dreadful affliction would now be manifesting in led me to a piece on pseudogout. The symptoms fit the profile.
"Gout and pseudogout are the two most common crystal-induced arthropathies. Gout is caused by monosodium urate monohydrate crystals; pseudogout is caused by calcium pyrophosphate (CPP) crystals and is more accurately termed calcium pyrophosphate disease (CPPD)"
"Pseudogout causes pain, swelling, stiffness, and warmth in large joints. It most commonly affects the knees, but it can also affect the elbows, ankles, wrists, shoulders, or hands. Pseudogout attacks can be sudden, and the symptoms may last for days or weeks. Some people who have pseudogout don’t have any symptoms between attacks. In other cases, pseudogout can cause constant pain and discomfort. This chronic (long-lasting) pseudogout may seem similar to osteoarthritis or rheumatoid arthritis."
I'm not settling on my own self diagnosis as I do not know enough about pseudogout and I still don't fully recognise or understand my symptoms in terms of where the pain started and how it moved from shoulder to shoulder, and then pronated to my rib cage (while something similar was going on around both my wrist/hand area as well as my elbow). But it's the closest I can get to an explanation to what I've just experienced. To top the lot, when this was all beginning to kickoff, I was having a general checkup at the GP and was then told my BP was dangerously high and that I needed to start taking statins immediately. Thread on that here.
I confess, I don't like going to the doctor unless I feel really broken, and even then, if it feels like I'm getting better, I soldier on. I also don't trust some doctors in that I feel the right questions are not asked. This isn't helped by the high turnover of medical staff at my GP surgery. In short, I have gout. I have to deal with everything that I can to help myself. All the doctor can advise is the same as well as write me a prescription for drugs to deal with the pain or another for the preventative drug. More research is needed on pseuodgout, and if it is that, the treatments (especially in terms of pain relief) are the same. There is no hard evidence that diet is a factor in the development of pseudogout.
My research will continue, and if this b
d paid does show up again, I think I will pop in to see my GP. Edited by Glassman on Monday 22 July 00:01
Jasey_ said:
I've always said if my gout gets any worse then I will need to give up lager.
If I had your symptoms I would have definitely given up the lager by now.
Have you made any significant dietary changes since your first attacks ?
Leading up to the first 'new' attack (in the shoulder) no. Leading up to the second episode, was trying out intermittent fasting. If I had your symptoms I would have definitely given up the lager by now.
Have you made any significant dietary changes since your first attacks ?
Sudden or radical diet changes can trigger an attack.
The difference between gout and pseudogout is that gout is uric acid crystalising inside a joint and pseudogout is calcium crystalising around the tendons and muscular tissue area of a joint. The pain is the same. Treatment (of the pain) is also the same drug(s).
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