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Please note that @glenresearch had the courtesy to email me, asking permission, prior to posting this. I think they deserve some respect for that, so, if you are eligible, please contact them before tomorrow.
P.S. Forgot to say – thanks @red92xblue for starting an interesting discussion. My thoughts and opinions are just that – mine. I’d love to hear what others think.
It does not say the meters are inaccurate, it says the accuracy is questionable. That might seem like semantics to some, but you need to look at the context of home testing.
Most people I have heard from, including myself, have used home testing to help assess diet and other lifestyle changes. This study proves that home test kits produce consistent results. Therefore, it does not matter if results are overstated. You can still use those results to see if you are getting better or worse.
In every case that I am aware of, doctors will use their own results to determine uric acid lowering treatment dose, so the statement in the study conclusion(s) is misleading:
Since the two meters always overestimate the situation of a user, this may lead to unnecessary medication treatment.
The only time that is likely to happen is if both the following are true:
- Patients ignore prescribing instructions
- Doctors prescribe the correct dose in the first place
The massive failure of doctors all round the globe to get the second point right means that, at worst, home testing is helping to redress the balance. In reality, I believe the benefits of home uric acid testing, for those who want to micro-manage uric acid, far outweighs the spurious risks this study proffers.
I agree with Tavery, and I’d like to take the opportunity, albeit belated, to wish everyone a Happy and Gout-Free New Year.
@waterfall-manc, danger alert!
I’m guessing you are in the UK, and somehow linked to the wonderful city of Manchester. That means that your uric acid test results are probably in mmol/L and the value is more than likely 0.42 which converts to over 7mg/dL.
Short answer — get dosage increased to the max until tophi shrinks, then relax dose to achieve a maximum uric acid level of 0.30mmol/L (5mg/dL).
As I did, you might have trouble persuading your doctors about this. Just ask them to either check the latest recommendations from British Society for Rheumatology, or ask to be referred to a rheumatologist.
Sounds good. Please come back with your uric acid test results.
On Uloric or allopurinol, if the dose is correct, you should not need diet restrictions. But still try to eat healthy – you don’t want gout to be replaced with heart disease.
This does not make sense. I need more test result information to understand what is going on. Crucially, what is your uric acid history? One uric acid test result whilst you are taking uric acid lowering meds is hard to understand. All I can say is your uric acid is under control. If tophi are still growing when uric acid is down to 1.5dl/mg (assuming that is your test result scale), then you must have something more complicated than standard gout. In that case, only a rheumatologist can help.
As the links in the original post are all bad links, I have removed them. Because the links are to non-existent sources, I am unable to see why you believe human trials are likely in the foreseeable future.
The latest research study published for this project, Biomedically relevant circuit-design strategies in mammalian synthetic biology, makes it clear that this technology is in it’s infancy. Related research, Synthetic Genomics and Synthetic Biology Applications Between Hopes and Concerns notes that there are still huge ethical matters to resolve before we can think about starting human trials.
It’s easy to get excited about cutting-edge research, but please don’t let it blind you to the basic etiquettes of forum contributions. Excessive capitalization, cross-posting, broken links, and poor topic subjects will not help your gout, or anyone else’s.
You need more than just colchicine when gout is really bad.
Colchicine limits inflammation from getting worse, but does not reduce it. To reduce inflammation, talk to your doctor or pharmacist about a suitable anti-inflammatory. I prefer ibuprofen, but naproxen is also highly regarded by gout sufferers. Reducing inflammation does not always stop pain soon enough. For really bad attacks, you might also need a general pain blocking med, such as Tylenol (paracetamol). Again, talk to your doctor or pharmacist about an analgesic that is compatible with your chosen anti-inflammatory.
I found that this allowed me to walk, and gentle exercise is good to keep joints mobile.
See how to get gout pain freedom for more.
Yes, you should definitely tell your pharmacy to change the tablets. They have messed up. There is no reason for you to have to worry about this. You should be able to concentrate on getting uric acid down to 5 or lower. You’ll also need to consider pain relief until you get uric acid safe.
All pharmacies know that allopurinol comes in 100mg and 300mg. For doses that are not divisible by 300, they should supply 100mg. If they can’t change them, then they should split them for you.
Not making fun of you. Let’s say making fun with you. I’ve no problems with curcumin for gout. I prefer mine in a curry 🙂
Welcome @bryans, I’m glad you are finally tackling the uric acid after twenty years. I’ll work backward through your points.
1. Gout attack during uric acid lowering treatment.
Whether it’s Uloric, allopurinol, or anything else, including lifestyle changes, when uric acid levels drop, old crystals can cause flares. This is actually a good thing, though it doesn’t feel like it at the time. I was chatting with a lady yesterday about the pain of gout being worse than childbirth. After childbirth, you get a bundle of joy. After a gout flare, as long as uric acid stays at 5 or lower, you get the joy of gout freedom. The labor pains you are experiencing will be less if you get uric acid lower. More of that later, but I need to explain the epidural equivalent of gout treatment.
a) Take 1 colchicine every day for 6 months
b) At the first sign of a gout flare, take a second colchicine, but never more than 2 a day.
c) If inflammation is intolerable take gout strength (i.e. maximum prescription dose) of an anti-inflammatory such as indomethacin, ibuprofen or naproxen. Naproxen is highly regarded, but everybody has their own NSAID of choice.
d) If pain persists 2 hours after NSAID, take Tylenol or similar. Check with your pharmacist or doctor to be sure that the supporting painkiller of choice is compatible with chosen NSAID.I call it Pain Freedom. If you can’t play hockey with that regime, you don’t deserve to be on the field.
2. Getting rid of stored uric acid deposits is easy but difficult (I feel like talking in riddles today).
It’s easy because the lower you get uric acid, the faster old crystals dissolve. This piece of elementary organic chemistry seems to have escaped most physicians. They treat you until they’ve got uric acid down to something they are happy with, then leave you to your pain. Insist on the maximum dose to get as low as possible for as long as you can.It’s difficult because some crystals get bound up in masses of dead cells. These tophi can become pretty solid and might take years, or surgery, to get rid of. The good news is: they are unlikely to cause a gout flare, as the release of uric acid is slow.
The true answer to your question, after all my waffling, is that nobody knows. I can generalize and say the longer you have had gout, the longer it takes to get rid of old deposits. The higher your uric acid level before treatment, the more uric acid deposits you will have. As stated before, the lower you get uric acid with treatment, the faster you dissolve old deposits. That last one is the only one you can control.
I do not think a normal/average can ever apply because everyone is different. I had untreated gout for 17 years, got uric acid down to 3, and had no flares after about 3 or 4 months. I took daily colchicine for 2 weeks every allopurinol dose change, then as required, supported with other meds when necessary as per my Pain Freedom regime. No hockey, but plenty of pain-free dancing for joy 😀
Thank you @r-mcd. Those are impressive photographs, and impressive uric acid numbers.
I’m sure you are aware of my belief that a target of 5 is safest, though 6 is acceptable if personal circumstances dictate.
I do not want to sound negative about your efforts. I’m just wondering if there is anything else you can do to lower uric acid further.
It might be that your continued exercise can help, especially if it leads to gradual weight loss.
Other things that spring to mind are:
- Keeping warm, especially in extremities such as feet and hands
- More skimmed milk
- Alkalizing diet
These are just 3 things that popped into my head now. Does anyone have any more suggestions for lowering uric acid through lifestyle changes rather than meds?
Thanks for the update, @sidbarua. I think it’s best to focus on controlling uric acid from now on. About 3 weeks ago, your uric acid was below 5. That is the only way to control gout, but it can take several months to get rid of old crystals. The lower you get uric acid, the quicker that happens. It also depends how long you have had gout.
Have you been able to keep uric acid below 5? If so, it’s just a matter of patience. Attacks get less as weeks pass. I hope, like me, you wake up one day, and realize you haven’t had a gout flare for months.
That combination is interesting, but first let me try explain what I think is happening with the pain.
The fact you have tophi, tells me you have a substantial buildup of uric acid crystals. They will be throughout your body. Even in places where you have never experienced gout flares. Lowering uric acid to 6 should dissolve some of these, but as they dissolve 2 things happen:
- Partially dissolved crystals become exposed to the immune system, and might trigger a gout attack
- Dissolved uric acid raises the blood concentration and might cause the level to rise above the crystallization point, causing new crystals to form.
That’s 2 mights. Nothing is certain, but there are three important considerations:
- Lower temperature lowers the concentration point, so colder parts of the body, such as the feet, are more likely to be at risk, even with uric acid down to 6.
- As old crystals dissolve, the duration, frequency, and intensity of gout flares will fall.
- You can shorten the time you are at risk from gout flares with maximum allopurinol, then reduce to a maintenance dose once you have gone six months without a flare.
Colchine is very useful during the time you are at risk. There are different strategies. Some recommend one tablet daily with a second at the first sign of a gout attack. Others recommend as required, but again take as soon as you feel an attack might be coming on. Under my doctors advice, I adopted the preventative strategy for two weeks every allopurinol dose change, then switched to as required. If 2 colchicine didn’t tackle the pain, I supported with ibuprofen. Occasionally additional support prom paracetamol/Tylenol might be necessary.
Now, the interesting combination of Losartan and allopurinol. Losartan is always the best choice of hypertension med for gout sufferers, as it encourages excretion of uric acid through the kidneys (uricosuric). I’ve learned today, from “Effect of losartan potassium, an angiotensin II receptor antagonist, on renal excretion of oxypurinol and purine bases” that it also encourages excretion of allopurinol, and it’s active by-product oxypurinol. My interpretation of this effect on allopurinol is that it is not significant unless it stops you achieving uric acid of 5 or below. In your case, @doctalmadge, this not significant, as you are nowhere near the maximum allopurinol dose.
The other finding of this investigation is slightly more worrying. The report concludes:
the uricosuric effect of losartan potassium may increase the frequency of calculi in the urinary tract
The 2 ways to reduce the risk of kidney stones are increased water intake and alkalizing the urine. Increasing water intake up to around 3 liters per day is OK, but much more than that creates its own risks. Alakalizing is possible with baking soda (sodium bicarbonate) or potassium citrate supplementation, but the healthier option is alkalizing diet.
Understanding of diet and gout is changing.
Until recently, the focus has been on purines, and for the last few decades we have known that only animal purines affect gout significantly. Vegetable purines have little or no effect on gout. Other studies have shown that uric acid crystals grow slowly, so many have believed that diet cannot have an immediate effect on gout.
However, at least one study has shown that gout sufferers do get pain associated with eating certain foods. You have experienced this, and so have most other gout sufferers. Until quite recently, this was a mystery.
Even now, we do not fully understand the processes, but various investigations have proved that uric acid alone does not cause gout attacks. That explains why people can get horrendous tophi without any pain, but we do not know exactly why. The most likely explanation is that Free Fatty Acids (FFAs) cause signals to travel to our immune system and trigger the attack. This is under investigation as the most likely reason for food causing gout attacks. It happens that foods rich in purines are also rich in FFAs, so the purine gets the blame when it is probably the fault of FFAs.
Colchicine is the ideal gout medicine to prevent this type of pain until you get uric acid fully under control, with most old crystal deposits dissolved.
I’m a bit surprised by your meter readings. Do you have the machine set on mg/dL? Do you have comparisons with lab test results from blood drawn at your doctor’s?
Once again, @cujo nails it. 😎
Even an experienced doctor cannot tell gout just by looking. The same doctor couldn’t tell you are 8 weeks pregnant just by looking. Thorough testing by a rheumatologist is essential. Please do this as soon as possible.
Gout, in pre-menopausal women, is less common than after menopause, when chances are equal to those of men. I would describe it as uncommon rather than rare. There have certainly been enough cases of gout during pregnancy to warrant over 100 research studies.
I have not checked them all yet, but I’ve found 2 things:
- Gout attacks are normally less common towards the end of pregnancy
- Allopurinol is probably harmful to the unborn child
I’m grateful to you, @nikki109229, for prompting me to learn more about gout. However, I think you should be seeing a rheumatologist, because we can’t help you diagnose gout. Given your family history, you are certainly in a group where risk of gout is high, but that does not prove you have gout. There is a condition called sceptic arthritis that has many similarities to gout. Only a rheumatologist can differentiate these, and it is important that you get this checked as soon as you can.
100mg allopurinol for 4 to 6 WEEKS is OK, though it is even better to test after 2 weeks so that allopurinol dose can be adjusted to reach target uric acid level as soon as possible. Colchicine is a great preventative during the time it takes to get uric acid stable. It is unusual for this to be longer than 6 months, but 4 months is OK.
Dear kiteman,
I don’t know you as a person, but you came to me for help and advice. My default setting is that I care. I do not want my fellow humans to suffer needlessly. Personally, I delayed starting uric acid control, and I have caused myself damage. It is not as extreme as some of the situations I have mentioned. I overemphasized the threat of damage because I want you to act now, rather than wait until the threat becomes real.
It is nonsense to say that the only reason for your gout attack is physical injury. The trauma to your toe has triggered the gout attack, but that attack could not have occurred unless your toe was packed with uric acid crystals. Healthy people who stub their toe do not have to endure “a huge swollen foot and severe pain, a pain that has increased twofold every 12 hours ever since. Since Wednesday I have been unable to walk, sleep, or even eat at times.”
The very fact that such severe pain and discomfort has happened to you, tells me you are suffering. There is a history in gout management of offering the choice of uric acid control, or just managing the pain of gout attacks when they happen. Pain control is easy. Uric acid control is quite easy, but takes a bit of effort. Lazy doctors will opt for pain control. Recent understanding of the true dangers of gout mean that pain control alone is not an option after the second attack. But the message has not reached most doctors yet.
I read gout research every day. Many doctors would find this impossible if it interferes with golf plans. They fall back on the outdated gout information they learned years ago in med school.
There is absolutely no doubt that gout is a progressive disease. Left untreated, it will do all the damage to joints and organs that I mentioned earlier. Like a repentant sinner, I realize that I left uric acid control longer than I should have, and I do not want anyone else to suffer. Fortunately, I only caused some joint damage, but I know I put my heart, kidneys and other organs at risk. I delayed treatment, but I know I was wrong to do so. If my doctors had better awareness, I would have been persuaded to start treatment sooner. Instead, I spent years doing gout research, until I knew that the risks meant I had to act. Most doctor do not understand the risks, so you get bad advice.
Simply put, I want you to understand the risks, and decide what to do knowing those risks.
I can help you with dietary advice that might control your gout without pharmaceutical intervention. I’m not prepared to comment on anything in your last paragraph without knowing your uric acid number. It is absolutely impossible to control gout by diet, and other lifestyle changes, without tracking uric acid.
Actually, I will make one comment, as it is not to do with diet. “doctors have frowned upon me taking things like Allopurinol with my level of uric acid/gout because they believe the side effects to outweigh the pros at this stage” is total bullshit. I am prepared to explain why.
Let’s agree to go for dietary control. Without knowing more about you, it is probably the best option. Before I can help you, I need to know what your uric acid number is, full details of what you eat and drink, including any dietary supplements, your height, your weight, your exercise routine. Please take some time to post as much lifestyle info as you can, and I will respond with as much helpful advice as I can. At this stage, as I don’t know your uric acid number, I’m not sure I can fix your gout, but I promise you, I’ll give it my best shot. You can start this with a daily post of everything you ate and drank the preceding day. Add the other info as you get it.
Kindest regards
KeithPS. Gout is not an infection. Uric acid is not a poison. I’ll try to explain that during our dietary project to fix your gout. Remind me if I forget.
Please advise the name and address of your rheumatologist. I will contact the appropriate authorities to try and get him struck off, or at least get some education.
It doesn’t really matter if it mirrors other gout patient’s experience. It is wrong. In 2013, if anyone thinks they should delay uric acid lowering treatment, they are wrong. If that person is a professional healthcare worker, they are negligent.
Please say who it is, so we can educate or stop them harming more gout sufferers.
Sorry, I didn’t realize you have kidney disease. That really complicates gout. Best to consult a rheumatologist, but choose one that has experience of managing gout in a patient with kidney problems. Many gout treatments can help diseased kidneys, but this has to be managed on a case-by-case basis, as the cause of kidney disease will be very important.
When you get a good rheumatologist, they can also guide you on fluid intake. Around 3 liters is for people with normal kidney function. I’m not qualified to give medical advice, but I do know what works for most people. I’ve assumed you are a regular gout sufferer, and I never thought about complications from kidney disorders until now. My bad for assuming regular gout. Your bad for not mentioning your kidney problems in the original post. Please let me know what your rheumatologist advises so I can give better help to other kidney impaired gout sufferers in future.
If your doctor says uric acid is normal, rather than telling you what the number is, you should find a new doctor, or at least train the one you’ve got.
Uric acid does not need to be “unbelievably elevated” to kill or seriously damage you. It just needs to be over 6.8. That is the maximum level if your joint temperature measures OK (98 F, 37 C). As you get older, joint temperatures tend to drop, so anything over 6 is definitely not safe. Between 5 and 6 is a gray area.
Unless you have other medical problems that cause you to accept the gray area, you must aim for 5 or below.
Having a uric acid level of 9 is not that much different from 7. You might get an extra couple of years, but 7 will still lead to crumbling joints and organ damage. Uric acid crystals will grow every day. Gout attacks will get more frequent, more widespread, and more painful. Why put yourself through that, just because your doctor is misinformed.
Here are the two important points:
- Normal uric acid is meaningless.
- After painful gout attacks, comes joint erosion, followed by organ damage from uric acid crystal deposits. Is that what you want?
The gout attack from a toe injury is a profound early warning of painful years ahead. The older you get, the harder it is to cope. Why not fix your gout today?
[Sorry if that sounds like a rant, but my blood boils when I see normal uric acid. Dangerous nonsense, that has damaged more gout patients than anything else.]
I’m not sure about NSAIDs effects on kidneys. Remember, I’m not a doctor. I see my role as helping you understand what your doctor tells you, and also helping you to know what questions to ask your doctor.
Therefore, ask your doctor if your kidneys are at risk. Also, ask why colchicine has not been prescribed on a preventative basis for a few months until you get uric acid stabilized. At one tablet per day, with an extra tablet, if you experience an attack, it is the best way to control gout attacks during the early stages of uric acid lowering treatment. Colchicine is safe at up to two tablets per day. Except for the USA, where it is sold as Colcrys, it is also very cheap.
Anyone who is suffering should read my gout pain freedom article. In this day and age, the only reason for enduring gout pain is medical neglect. 👿
Go for Pain Freedom immediately. You don’t say what NSAID dose you’re on, but it should be maximum prescription strength. Anti-inflammatories alone are rarely enough for a severe gout attack. Ask your doctor or pharmacist for a pain blocker that is compatible with whatever NSAID you are taking.
This is your final warning to get uric acid down to 5 or below. Your gout is only going to get worse if you do not get uric acid controlled. At the moment, I can understand if you just want to fix your pain, but please don’t start 2014 without uric acid lowering treatment.
Paul, if I were you, I’d arrange to see a rheumatologist. Everything you say makes me think your gout should be under control, yet you still have pain. There are only 2 explanations for this.
Either gout is not under control, or you have another health problem besides gout. A rheumatologist can investigate these possibilities and hopefully provide some effective treatment.
Uric acid crystals grow slowly, and often go unnoticed. When they dissolve, it is usually fast. Partially dissolved crystals often trigger gout attacks in areas that have previously been unaffected. The other point is that gout attacks during uric acid lowering treatment are often quite widespread, whereas gout attacks during untreated gout are usually only in one or two joints.
Please stick with it. The gout attacks will get less frequent and less painful. Drinking skim milk might help get rid of uric acid as it dissolves, but all fluid intake helps. Don’t go overboard with fluid intake – 2.5 to 3 liters is OK unless you are sweating a lot. Keeping warm is also recommended.
I don’t know how long you’ve had gout.
I don’t know what your uric acid level is.
I don’t know what your uric acid blood test history is.
I don’t know if you have any visible tophi.
I don’t know if the pain you are currently experiencing is gout, or something else.
I don’t know why you have been prescribed diclofenac, as other NSAIDs such as naproxen, indomethacin, or ibuprofen are generally considered to be more effective for gout pain.
I don’t know what “other gout type anti-inflammatories” means.
I don’t know who told you they would interfere with Uloric
I don’t know why you are hesitant to switch from a new drug to one that has been field-tested successfully for decades.
All in all, I don’t know much at all.A rheumatologist would probably know all these vital facts, or find them out, then reach a conclusion.
You do yourself an injustice @cujo. You seem to know all the right things to say, and you say them in a few lines instead of going on and on for paragraph after paragraph.
I don’t believe you should ever think about reducing allopurinol until you have gone at least six months with all the following:
- No gout flare
- No visible tophi
- Uric acid never higher than 5
Having said that, I’d get a rheumatologist’s advice on the liver function results. The thing about knowlede is “a man’s gotta know his limitations”
Thanks for the numbers @jobu. Don’t forget that managing gout is not just about stopping gout flares. As uric acid deposits grow, they destroy your joints. That usually starts with tendinitis, but eventually bones crumble. Then tophi spread through soft tissues, damaging skin, kidneys, heart, and eventually all organs. As your results say, therapeutic target is less than 6. To account for daily natural fluctuations your target is 5.
Again, I second @cujo’s helpful comments, and I’d like to add my own about gout being “under control”
With gout, under control does not mean free from pain. Under control means uric acid lower than 5mg/dL. This is crucial, because higher uric acid levels give an increasing risk of uric acid crystals forming. These crystals interfere with your natural joint-healing processes. This leads to joint damage before it leads to gout flares. By the time you experience a gout attack, your tendons, cartilage, and even bone, will be damaged.
In practical terms, you must increase your allopurinol dose to get uric acid below 5mg/dL (0.30 mmol/L). As @cujo says, it will take months to dissolve uric acid deposits. During that time, you need pain relief. The best pain relief is colchicine at the first twinge, or as a daily preventative for a few months. Support colchicine with anti-inflammatory medicine if necessary.
