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Forum Name: Rheumatology Topics

Question: Gout, pretnisone, and alcoholism


 gages1982 - Fri Dec 28, 2007 7:49 pm

I have a patient, in a short term residential facility for substance abuse, that has gout. He was prescribed pretnisone prior to arriving to treatment. He was told he couldn't have this, and that he could have what the doctor was offering him instead. He was taken to an outside source, and the source stated that he should have been given the pretnisone, and he was started on this. Due to his not being given this his gout spread and intensified through out his body. He left and began drinking again on this. This time he continued the petnisone, and I was informed I do not understand the risks associated with pretnisone and alcoholics in recovery. What are the risks, and why would the gout spread with out this? Also, was this malpractice to not give this to him and to allow the gout to spread? Are there alternate ways to stop the gout from spreading? If this is malpractice, what actions do I need to take or can I take in order to handle this issue?
 Dr. Chan Lowe - Sun Jan 06, 2008 10:46 pm

User avatar Hi Gages1982,

I cannot comment regarding issues of malpractice since I do not know all the facts and this forum would be an inappropriate place for such discussions.

I can tell you some about gout, though. Gout is a condition where uric acid crystals form and deposit in various places, most commonly the joints-particularly the big toe joints. These crystal deposits cause tremendous inflammation and pain.

Treatment depends on the phase of the illness. During an acute pain episode, treatment is with anti-inflammatories such as high dose non-steroidal anti-inflammatories (NSAIDS such as ibuprofen, etc.). Prednisone would act as an anti-inflammatory but does not provide pain control so it typically is not favored over NSAIDS.

In between attacks, treatment is aimed at reducing uric acid levels to prevent crystallization and attack occurrences. This is often done with a medicine called allopurinol.

I am not familiar with any difficulties with prednisone and ethanol. However, I am not an addiction specialist so there may be issues with prednisone and recovery that I am not aware of.

I hope this helps some. Best wishes.

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