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Sorry I'm late to this topic. I hope you are OK now, cjeezy.
This one has me a bit confused. When the Biaxin warning was issued about not taking that macrolide antibiotic if you were taking colchicine, the warning was based (at least partly) on “Fatal Interaction between Clarithromycin and Colchicine in Patients with Renal Insufficiency: A Retrospective Study”. In that study, the authors state:
“If a macrolide must be prescribed with colchicine, azithromycin should be considered, because it is mainly excreted unchanged in bile and has no effect on cytochrome P450 metabolism and the P-glycoprotein transporter system.”
Clearly, this is NOT the case.
Anything that affects the liver is a risk. Whilst checking my references for this, I found a study earlier this year about potential problems with grapefruit juice –
The data suggest that GFJ may augment colchicine oral bioavailability. Due to colchicine narrow therapeutic-index and severely toxic side-effects, awareness of this interaction is prudent.
Though I'm not sure how much credence one should give to someone who abbreviates Grapefruit Juice to GFJ.
Note: Pomegranate Juice (PGJ?) and some other fruits will probably have similar effects.
Some people (Never Mix Biaxin (Clarithromycin) And Colchicine) hold a different view, but I suppose it depends how serious you view death.
Curiously, the search results that I mention on that page now fail to produce the original warning from July 2006. A deeper search reveals “Information for Healthcare Professionals: New Safety Information for Colchicine (marketed as Colcrys)”, issued 30 July 2009 which states:
During the drug application review, FDA identified two previously uncharacterized safety concerns associated with the use of colchicine (marketed as Colcrys).
First, FDA analyzed safety data for colchicine from adverse events reported to the Agency, the published literature, and company-sponsored pharmacokinetic and drug interaction studies. This analysis revealed cases of fatal colchicine toxicity reported in certain patients taking standard therapeutic doses of colchicine and concomitant medications that interact with colchicine, such as clarithromycin.
It seems that the FDA are now attributing the discovery of a fatal problem with Biaxin to those wonderful people who invented Killer Colcrys.
I wonder how much cash it took to bury the original report, or was it paid in holidays and other freebies.
I realize that, whilst I've made references to this sort of thing several times before, I've yet to do a comprehensive review of the issues around uric acid testing. Your figures would make a good starting point, but do you have the sources? I need contact details so I can investigate more thoroughly.
The essence of the problem is that labs have assessment ranges based on statistical averages. These high/normal low assessments are from a population that includes gouties. It is nothing to do, as far as I am aware, with machine calibration, though I need to confirm this.
Once you have had a gout attack, the assessment ranges are meaningless. The only ranges that matter are good, danger, and bad uric acid numbers.
There are too many issues to ever get a completely clear picture. Uric acid simply does not work like that. Fluctuations occur at different body sites, during the day, and from day to day. Fluctuations occur from the age and storage conditions of samples. There may be other factors, and you need to avoid micro-managing from single test results, and looking at trends. More about seeing the big picture rather than a clear one.
The golden rule for gouties is always seek a uric acid level below 6mg/dL. If you have undissolved urate deposits, aim for something lower until you get rid of the crystals. 3 is very good.
It does not matter what time of day you take allopurinol.
Neither does it matter what time you take colchicine, except that you might suffer adverse stomach related events, so it is probably unwise to take it just before you leave the house.
Hi, about the medicine, i took (zyloric) .. just one course.
And about the relationship between G6PD and uric acid, i have read it in a site as down …..
(Uric acid becomes elevated if it is produced too much by the body or the kidneys don’t excrete it out enough. Purine overproduction leads to high uric acid, and there are many things that cause this including: alcohol, red meat, seafood, fructose, obesity, certain cancers, psoriasis, G6PD deficiency, B12 deficiency, certain medications. Underexcretion of uric acid include: chronic kidney disease, lead poisoning, DKA, hypothyroidism, hyperparathyroidism, and certain medications.)
http://www.drjohnhong.com/blog…..id-stoned/
And No matter if there is relationship or not, i thought there are many reasons for 'wrist pain' as all knows, and many people has high level of uric acid and doesn't suffer from gout right ?!
my dr just measured my uric acid to tell me that i have gout, why should i believe that!!
i dont have any joints's pain in my whole body exept my wrist, i dont have Swelling, i dont have any symptoms just a normal pain in my wrist whenever i push it ( like doing pushup)….. got me??
Do i have to take the medicine just in case of the high uric asid, to lower it down, if that's the reason i will….. But how come he ( the dr ) tells me that im going to lose my kidneys or ……. .
by the way im 25 years old.
Thanks for your patience
From the FMF board:
This is the colchicine made in Canada by Odan Pharmaceuticals, Montreal, Canada.Colchicine can be ordered from the following Canadian drug company WITH a prescription and you can get a 3 month supply. Make sure your doctor will give you a script for 3 months and refillable 4 times, so you can have a year's supply without getting another prescription. They will tell you HOW to have your doctor FAX the prescription to them.This is the best price I have found and it IS in USDOLLARS. Also as I understand it, they will give you something that you can turn into your insurance company who should refund to you, the cost they will cover and this is supposed to include Medi-care as well. Since some of us need 180 tabs per month, we will have to buy the 200 tab bottles because they will not ship in anything but the manufacturers bottles, so make sure your doctor understands this. Instead of the script reading 180 it will have to read 200 I think. Directions could probably read 2 to 3 tablets as needed per day.Patients in New Jersey can NOT receive these medications. Must be some rule that the state has – I don't know.See:Colchicine (Colchicine)
Manufactured by Odan0.6mg 100 $41.55 Colchicine (Colchicine)
Manufactured by Odan0.6mg 200 $66.41 Colchicine (Colchicine)
Manufactured by Odan1.0mg 100 $64.98 Colchicine (Colchicine)
Manufactured by Odan1.0mg 200 $113.65 All prices are quoted in $USD. Credit cards will be billed in $USD. The quantity will indicate the quantity in the manufacturer's sealed package. We will only ship in the manufacturer's sealed packages. So that we can help you better, please tell us exactly which medicine you have been subscribed.
Also, assuming that you are G6PD deficient, what is the link that you have found between G6PD-deficiency and high uric acid? As far as I am aware, there is no such link.
Going to 300mg allopurinol should increase your safety margin and also dissolve existing crystals faster, so generally a good thing. You can always drop back to 200 later.
The danger with a dose that is not quite enough is that your uric acid drops to the kind of figures you reported earlier (4.1 – 5.9). 5.9 is certainly enough to dissolve crystals, but that dissolved uric acid goes into your blood stream before it gets excreted. The effect will vary from person to person depending on how well you excrete uric acid, but the immediate effect has to be an increase in uric acid.
Allopurinol has slowed your production of uric acid, but it can do nothing for uric acid that comes from dissolved crystals. If it rises high enough then it is possible that new crystals could reform. It is certainly enough to slow down the dissolving process, so the crystals start to dissolve, the protein coating that was hiding them from the immune system drops off, then they stop dissolving and the immune system attacks again.
The only other thing I can think of is to do the 24 hour urine test and check your uric acid excretion rates. If they are low, then a combination of allopurinol with a uricosuric such as probenecid should help.
Finally, just in case anyone is wondering what zip2play is referring to – click this for more about “obscene FDA ban on generic colchicine“
Don't loose focus guys. Keeping uric acid below 6mg/dL is the goal. Ignore twinges until you have had 6 months below 6 with no gout attack.
If you have only just started allopurinol (or other uric acid lowering treatment), then gout flares must be a possibility. Painkillers will work in exactly the same way as they did before you started lowering uric acid.
If you are not taking preventative colchicine then treat the pain as you did before.
If you are taking daily preventative colchicine, then it will mitigate the flare. If you really cannot stand the pain, then go on the hourly colchicine regime, or talk to your doctor about additional pain relief.
This has been duplicated. Please discuss on the original gout remedy report topic.
I would say the 2 ingredients are gullibility and your money.
I know this doesn't answer your question, but all the information that you need about natural remedies are on this website and GoutPal.com. There is no need to spend any money, and nobody – including most doctors – know more about gout than the collective wisdom of the contributors here.
A good starting point is my article on home cures for gout, and some of the comments.
I am happy to investigate any “remedy” that you are tempted to spend money on before you spend it. All the discussions that we have about any product or service are done in these public forums, so anyone can comment – including the vendors.
The best home remedy, other than 3 liters of water per day, is Black Bean Broth. Please note that I have not tried this yet, but it has received nothing but praise from other contributors. Also please note that this will not, as far as I am aware, reduce uric acid.
Getting uric acid below 6mg/dL should be your absolute priority iin life.
This is just a start. Please come back with any questions you have about the information I have pointed you towards (or any other information on this site or any other). We all have your best interests at heart and look forward to finding a way forward that is acceptable to you.
Let's not bicker amongst ourselves.
The FDA has clearly made a mistake here, and we need to unite in getting that decision overturned. It is important because (as far as I know) it is the first instance of a generic being given exclusive manufacturing rights. If this is allowed to go forward, who knows where it will end.
We must find ways to overturn that decision, but in the meantime, people need an effective source of affordable colchicine.
That is what this part of the forum is for. There are plenty of other places here to discuss the merits or otherwise of the FDA decision.
Please keep this forum for discussing supplies of quality assured colchicine delivered to US addresses.
Just Found Out Final said:
Thanks for all your posts. My Uric Acid level was 7.5 and he told me that 7.6 was considered high.
I'd say Very High. 6.9 is high. Standard crystalization point for uric acid is 6.8 at normal blood temperature, lower in the extremeties and cold conditions. There is a mystery substance that allows some people to tolerate higher uric acid without gout (we jealously snub those people)
Maybe it is just genetic, I just thought it was strange that every website that I found said it was more common in older men.
More common doesn't mean exclusive – you are just goutier than most women of your age, probably from genetics but other environmental and medical factors can afect uric acid levels.
Estrogen lowers uric acid production, and menstruation excretes both uric acid, and iron – a highly suspected culprit of excess uric acid production. Men have none of these benefits, and the age connection may well be accumulation of iron and other uric acid stimulating metals.
WBC is White Blood Cell count, but I have yet to learn the significance of the numbers – it is significant because this is an important part of the immune response that is gout. Unfortunately, cell microbiology study is hurting my brain.
Yours is a case for more testing, as uric acid in the blood can fall as it crystalizes into the joints and tissues.
As you are a colchicine taker, please support the colchicine campaign. You have a great opportunity to discuss this looking crisis with your rheumatologist and see if we can get some of the professional ranks on board.
Thanks for all your posts. My Uric Acid level was 7.5 and he told me that 7.6 was considered high.
What started this whole thing was pain in my ankle. I have had tons of ankle injuries due to gymnastics, dance, and cheerleading but nothing recently. I went in and they took xrays and of course didn't find anything.
The doctor asked me if anyone in my family had RA and I told him yes my mother. He said he was going to let the Radiologist look at the xrays and if he didn't find anything he would get me back in for bloodwork.
He told me that it could very well just be genetic and asked me if I ate alot of red meat, or drank beer. Well I live in Texas but i don't think I really eat more red meat than anyone else and of course I drink beer. He didn't really act like it was something in my diet causing it because I eat pretty healthy overall and don't drink in excess.
Maybe it is just genetic, I just thought it was strange that every website that I found said it was more common in older men.
Yes, the “back to square one” idea (if it came from something I wrote) alludes to the game of correctly lowering uric acid.
In this game, you get points for every day that your uric acid is below 6mg/dL, and lose points every day that your uric acid is above – one point per mg.
Each game starts at square one (start of urate lowering therapy day). Each square represents one day, and you win points as above. Before you start, you set your Target Uric Acid Number.
Round 1 involves lowering your uric acid level to Target Uric Acid Number (somebody think of a better phrase that gives a good acronym please)
pause
OK Planned Uric Acid Level.
Once you maintain PAUL for 2 consecutive tests, you progress to round 2
Round 2 involves maintaining PAUL for 6 months without a gout flare. Everytime you get a gout flare you start counting 6 months again. You must take a uric acid test at least every 3 months and if you rise above PAUL by more than 1 mg, you start your 6 months again. (different regions have slightly different rules).
Round 3 continues forever, but if you ever have a gout flare you go back to square one.
You do not lose your points – you still have the benefit of all those urate free days – but you start the game again.
[yes, I know there's a deliberate mistake]
I feel an indepth study of gout and exercise coming on, but I'll resist for now.
Simple, unresearched, view off the top of my head is:-
- As zip2play says, strenuous exercise is a known uric acid producer, but allopurinol should reduce this, at least in part
- Long term exercise lowers uric acid production. I do not know if allopurinol affects this.
- Conclusion – as long as you do not exercise immediately before bedtime, then exercise should be beneficial.
Now watch me fall on my face when I check the allopurinol, exercise and uric acid studies.
ruff12two said:
The symptoms remain the same, with no improvement! Not sure what else can be perscribed to reduce the swelling?
Some things that may help (in no particular order):
- Ice pack – just for 10 minutes, then get back to temperature with a warm towel because…
- Avoid cold – keep extremities wrapped to avoid temperatur drop.
- Exercise – gentle walking or swimming, but…
- When not mobile, try to rest with affected joints above the heart
- Keep hydrated (more water also helps encourage more short walks )
- Avoid tight shoes and socks
- Avoid restrictive posture that slows bloodflow
I agree with cjeezy. Most of your symptoms sound very gout-like, but we cannot rule out damage related to the toe fracture. The foot is extremely complex, and damage to another bone cannot be ruled out. The reality is, that getting a perfect diagnosis is almost impossible, and if scans do not reveal a physical problem then medics will assume gout.
The colchicine test is not a perfect diagnosis for gout, but it is probably your best chance.
A warm wife? A sleeping bag?
Oh bugger, Mrs GoutPal just caught me typing that and thinks they are one and the same.
zip2play, you really are a mine of the most fascinating information.
I had never heard of Lyme disease. Now I know that Lyme disease is actually classed as one of the forms of septic arthritis.
Furthermore, there are some forms of septic arthritis that do respond to corticosteroids, but this is dangerous ground for the inexperienced as there are several indications that steroid injections risks outweigh the benefits when infection is present. And I thought gout was complicated!
Thanks Gout Pal…. I think that I can only wait till I have all the facts put together via the MRI,Kidney specialist, and follow up with the Rhumatologist Oct 1. I will let you know what washes out.
I'd be thinking more lawyer than doctor at this stage.
Calcium crystals indicate pseudo-gout. It needs investigation for an underlying condition that is causing it. It is perfectly possible to have this, and gout at the same time. However, you would need supporting evidence of urate crystals (and blood uric acid above 6.8 at some point, though not necessarily all the time).
Gout diagnosis can be tricky, and though analysis of the joint fluid is the best commonly available test at the moment, it still needs someone with more than half a brain to interpret the results.
Complex cases can involve not only gout and pseudogout, but also other conditions and forms of arthritis. One of the standards is to look for any indication of septic arthritis or other bugs. If they are present the absolute last thing in the world that you want is a steroid shot – giving it to the bugs is like giving spinach to Popeye.
Sorry this is not very positive, but I am struggling to suggest what to do next. The first thing is to find out exactly why allopurinol and Uloric have been prescribed. If they were done on the back of a properly diagnosed uric acid problem, then you have at a minimum got gout and what sounds like pseudogout together. Continue with the Uloric and keep a detailed record of your uric acid numbers. If they were done on the back of a guess and confusion with calcium crystals then there is no point continuing the Uloric.
It is a little hard to track all the details, but I get the impression that the Rheumy is on the case with the calcium crystals (sorry, but this is way outside my knowledge – I just know that it isn't gout). If this is so, then push for proper explanations and details of treatment options. The orthopedic doctor should be shot or sued (disclaimer – unless there is something suggesting gout that I'm not aware of).
One point that worries me a little is that I've just learned that a DO is a Doctor of Osteopathy. Nothing wrong with that, but does she also have Rheumatology qualifications? Osteology will not help with gout or pseudo-gout.
Hi Just,
Firstly, forget food for now. If food is an issue (and it is a BIG IF), you can sort this out later (with our help of course), but for now you must concentrate on your uric acid numbers.
I am unaware of a link between gout and rheumatoid arthritis, but gout can cause osteoarthritis as uric acid deposits eat into your bones. That is why you need to control the uric acid.
Have you discussed uric acid control with your doctor?
I'm glad you got a proper diagnosis at last.
You've got over 6 months of uric acid crystals in your joints, so keep going back to the doctor every week or 2 to make sure the allopurinol is lowering your uric acid below 6mg/dL.
You might need pain relief during the first few months of allopurinol treatment – colchicine is best.
Keep us informed of your progress.
I knew I should have just deleted that first post!
The first post is bollocks for the same reason that the page that zip2play mentions is bollocks – they completely misunderstand the issue and use false science to promote products.
I should have added a link to my PRAL page to help clarify the truth, though I note that even that page doesn't do the subject justice – another one for the to do list.
The key is POTENTIAL in Potential Renal Acid Load. Some substances, when digested, will put a potentially acid load on the kidneys and for others the effect is alkaline. The PRAL calculation simplifies the effect – it has some shortcomings, but is a fair approximation. Net Endogenous Acid Production is a better measure, but more complicated and it relies on measuring daily food intake, not individual foods (another project which I hope to do before I'm 60). Anyway, irrespective of how you measure it, or if you simply test the pH of urine a few hours after eating, it is all about how the body reacts to certain minerals, bicarbonates, and amino acids from proteins.
I have not set my mind yet to fully understand how eating a lemon can make your piss less acid (it's to do with the citric acid bit being quite weak and outweighed by other nutrients like tasty calcium, magnesium, and potassium), but I've seen enough believable evidence to accept that it is true. Some of the health claims then become outlandish, but that part of human nature remains ever strong.
Protein produces an acid load. Nothing can change that, though if you eat sensibly, the alkaline producing minerals will balance it.
It has absolutely nothing to do with the pH test of the item in question, which is where the garbage pea protein product comes in. It has absolutely nothing to do with burning the item in question and testing the pH of the resulting ash, which is what I suspect is the source of the data in the garbage page linked to by zip2play, though I doubt the authors know that or understand it.
So whether it's new-age or not, 95% is nonsense. The clue is always in stupid lists, with no explanation, that list protein as alkalizing. It makes as much sense as doctors prescribing allopurinol without testing uric acid levels.
Of course, it is not the only subject that has fueled Internet myths, but it does seem that the acid/alkali issue is one of the worst offenders.
zip2play said:
(I think there is something to the gout attacks in early Fall but I have never seen anything about its seasonality in print. I've got a similar phenomenon…migraine attacks in April and October.
)
I've had a quick look at gout and seasonality. Some reports show slight increase in Spring (US and Europe). A recent UK study reports higher incidence in Summer. None of the variations are outstanding, though they are deemed statistically significant.
At the moment, my view is that the most likely explanation is an individual's changing eating and lifestyle patterns. Probably a complex set of factors such as higher risk of dehydration versus lower risk of cold triggering gout etc, etc.
I'll keep looking, and report back if anything significant emerges.
Ah, the great colchicine dosing debate. This one could run, and run…..
But seriously, the high dose regime to kill the acute attack is fine. It is NOT fine to ignore the long term, which as zip2play quite rightly says, needs uric acid lowering treatment. The only way to manage gout pain is to manage uric acid numbers.
