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Foot and Knee pain and swelling with truvada and sustiva
Feb 19, 2005

Dear Doctor, Last Friday I switched drug therapies from trizivir and viramune to truvada and sustiva. I woke up Sunday with pain and swelling in my left foot. I went to the doctor on Monday and he thinks it is gout (I'm 42 yrs. old) and has put me on an antibiotic and an antiinflammatory. It is now a week later and I see no change and it has now spread to my knee, which is very swollen. I went back to the doctor yesterday and he thinks it is still gout though the blood test for uric acid were normal. I am going to see an orthopedic doctor on Monday. My question is do you think this could be a side effect of the new drugs that I started on?

Response from Dr. Henry

The timing certainly is suspicious that one of the new meds may have triggered an unusual reaction but I have not observed those meds to precipitate an immediate extremitiy inflammatory reaction like you have indured. Joint or muscle pains have been rarely described with Truvada and even more rare would be an acute onset. For someone already tolerating Trizivir/Viramune to acutely develop a problem on Truvada/Sustiva is intriguing and difficult to explain in a satisfactory manner in the absence of any more details. Gout usually has some type of crystals in joint so tapping the most involved joint can be diagnostic (often a rheumatologist is a good referral to consider). KH

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