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Hi folks:
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I haven't been formally diagnosed with gout yet (haven't had a big enough attack for the joint fluid test), but I'm fairly sure I have it, as I have a fairly constant low level ache in my big toe.? I bought one of those uric acid meters, and now I'm a bit confused.? My readings range from 3.5 to 7, depending on what I've been eating and drinking.? If I eat little or no meat and don't drink any beer, it ranges from 3.5 to 4.5.? If I eat meat but don't drink beer it ranges from 4.5 to 5.5.? If I drink beer and eat meat it ranges from 6 to 7.?? I've never had a reading higher than 7, even after have 5 or 6 beers the night before.? I've been testing for about a month now,? twice a day (morning and evening), so I'm pretty sure of the pattern.? I've also noticed that if I've had beer the night before the UA level drops about 0.5-0.75 per day after peaking the next morning until it reaches bottom or I eat more meat or drink more beer.
?My original pain was on the bottom of the right big toe, which went away after about a week.? However, I've been left with a very low level pain on the top of the big toe right above the knucle joint, and there is a tiny spot there that is slightly tneder to the touch if I press on it.? That pain only goes away if my UA level is below 5 for at least a day.? It comes back within a day or so if I'm over 5.??
?My confusion is that I thought the UA level had to be above 7 or so for crystals for form, so I don't quite understand why it has to be below 5 before the low level pain on the top of the toe goes away, and how it comes back even though I don't get up to near 7 where in theory more crystals could form.?
I'm also thinking, from what I've measured, that my issue is that I can't excrete UA well enough, as opposed to my body making too much in the first place.?? I figure that because if my body made too much I wouldn't expect my UA to go that low on its own regardless of how little meat or beer I consumed.?? Since it goes low when I don't eat meat or drink beer that tells me that I must not be producing too much on my own.?
?I'm going to go back to the doc next month when I get home and am trying to figure out what I should be asking him for.? Is allopurinol the right thing for me, or should I ask him for something that increases the excretion rate rather than inhibitting production???
I'm also trying the baking soda thing, as I found that my urine was very acidic all the time (5.25 ? 5.5), and am taking about 1/2 tsp four times a day, which is enough to keep my urine PH at between 6.5 and 7.5. ?? That doesn't seem to be helping the toe pain, and I don' t know if it's inhibitting the UA from rising higher than 7 when I drink beer as I've been afraid to put that to the test so far.? Fortunately, even though I have high blood pressure, which is well controlled by a fairly low dose of lisinopril, the extra sodium doesn't appear to be causing my BP to rise (I have a cuff), so I guess I'm lucky in the respect that I'm not salt sensitive.?
?I'm afraid I don't think I'll be able to eat just rabbit food and drink no beer for the rest of my life, so I'm looking for something that will let me eat meat and drink beer at least in moderation.? I'm also not understanding well why I have low grade symptoms at UA levels in the 5 range.
Comments and suggestions welcome.
Well for a 'newbie' you sound like an old hand at all this!
Great that you have a meter and have got some useful results.
This doesn't mean you have gout, as we know -a needle sample would prove that possiblity.
In the meantime it strikes me that you have to accept that earlier beer sessions etc may have laid down enough deposits to trigger low level gout.? In this case, if true, you are already in the gout 'box' but can easily manage this with your approach. Under treatment flares occur at lower than 6mg/dl SUA.
Many sufferes wait far too long [as I did] before twigging the cause and that makes treatment more protracted, but after years of this -once Urate Lowering meds were used things came readily to hand with a few? minor flare ups on the way.Your choice is to micro manage this or go for meds if advised so.
[Often, only?after more than one attack]
Beleive me- staying short of an attack from hell is the main thing and very worthwhile aim- but don't let the knowledge of gout get to you more than needed. You sound very capable of coping from here on.
I get good results on 100mg of Sulfinpyrazone daily [there is a 500mg version!] after many bad attacks really became too hard to bear and given the? damage possible to joints etc. not worth tolerating, whatever your resistance to taking lifelong meds.
Thanks for the response.? I'll have to look up some of the drugs and see which ones I want to talk to my doc about.???? I think it would be better if I did what I could to keep my reading below 5 if possible.? I'm stll thinking my problem is too slow excretion as opposed to too much
production, as I would think I would never have these very low readings
even eating only rabbit food if my body was producing too much.?When you say that attacks can occur under 6, do you mean when the crystals re-dissolve?? I thought about that, but then I'd think I would have more pain the lower my UA reading went, under the theory that the lower it is, the more likely and more quickly the existing crystals would be to start disolving.?? However, in my case I have very low grade pain on the top of my toe at readings as low 5 to 5 1/2, but none at readings lower than that.?? That's part of what I'm trying to get my arms around. ???
Lets cut to the chase 😉
If you get a proper attack [from Hell] you will pray for a few twinges as relief, many here?would agree.
If we knew all the processes properly, as to how urate removes or deactivate, we may stop it better in the first place. The blood indicates a mean level of SUA, not strength of urate depositions, unfortunately!
To see the body simply as a repository is not good enough- it's more a chemical factory under seige by all and sundry.
Bottom line- decide on how much pain you want and factor in the treatment to keep you safe before that kicks in!
In the meantime you can get advice on the likelyhood of your condition being something else.
Colchicine usage is an A1 indicator for gout, if successful in easing, and though a fluid sample would be great, short of an attack or two- it's better? to catch this one as ?early as you can. Some time in 'no-mans-land' may be unavoidable.
There are few guarantees with untreated gout except pain and worry, I'm sorry to say.
I think I'm going to ask my doc for some medication to lower my UA and see if it works, both as measured by the UA meter, and subjectively on the low level pain.? Last time I was there, in January when this first happened, he gave me indomethacin instead of colchicine, just in case I got a full attack, as he said he didn't like colchicine.? I haven't tried taking it to see if it gets rid of the low level pain.? If it does, will that prove anything, or is it just colchicine which is that selective on only gout pain?
Colch: Given you have an SUA meter and take an interest in what is happening- it could be worth a try.
Colchicine is an old medicine and has a low threshold for causing serious side effects. I don't think there's much in the literature about how to monitor low level?doseages, as it's all over in a day or two,?when used? as an attack stopper in larger amounts.
I doubt you would need a heavy doseage and a 2 a day regime has been used to inhibit attacks- as I remember.
I wouldn't like to take it for longer than a week or so, anyway as it can suppress the immune system too.
This is probably why your medic doesn't do it!
Your situation seems half way- so it's the old trial and error, if you do try some Colchcine. many find themselves in this situation in early days gout.
If your twinges stay manageable,?you can adjust diet, water & alcohol?etc -but, in the end, a big attack will decide a lot for you, given the pain. You could avoid this for a long time, if lucky.
maybegout said:
I think I'm going to ask my doc for some medication to lower my UA and see if it works, both as measured by the UA meter, and subjectively on the low level pain.? Last time I was there, in January when this first happened, he gave me indomethacin instead of colchicine, just in case I got a full attack, as he said he didn't like colchicine.? I haven't tried taking it to see if it gets rid of the low level pain.? If it does, will that prove anything, or is it just colchicine which is that selective on only gout pain?
Colchicine is not selective for only gout pain. It works by stopping rampant cell metabolism which is a feature of gout, but also other inflammatory diseases such as Familial Mediterranean Fever. In the case of gout, white blood cells are going crazy as a reaction to uric acid crystals. Half-poisoning your immune system with colchicine soon knocks it back to normality. Don't forget that it inhibits all cell metabolism, not just white blood cells, so overdosing is definitely not a good idea, though it would stop gout permanently, along with everything else.
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As for treating your symptoms, it proves that treating gout without a definite diagnosis is futile. The only way you can have gout attacks with such low uric acid readings (assuming the meter is reliable, and the sample size correct), is from old crystals dissolving. If this is the case, there will be plenty of crystals floating around in all your joints to provide fluids for testing. And you would be exceptionally rare in not having symptoms in other joints.
Low grade inflammation is a symptom of many health conditions, which may be aggravated by excess protein and/or alcohol coincident with the rise in uric acid levels. Proper inspection by a rheumatologist is your best option to diagnose what is really happening in your joint.
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