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Hi Leonard, welcome to the gout forum.
If you’ve had gout symptoms for 15 years, you have at least 20 years of uric acid crystals lodged in your body. These are everywhere, but more in the colder parts of your body, hence the elbow and finger pain.
There is no easy way, at the moment, to tell how long it will take to get rid of these, but we do know some facts.
1. At 4.5, you will not get any new crystals forming, and old ones will dissolve over the next few months. After 6 months, the frequency, strength, and duration of gout attacks will be significantly reduced. You should consider daily colchicine for a month or two, supported by other pain relief as advised by your doctor if the colchicine needs some help occasionally.
2. You can reduce the period of time it takes to get rid of uric acid crystals by getting uric acid lower for 6 to 18 months. Personally, I’m around 2, and I have been attack-free for almost a year now, with most tophi gone. See Lower Uric Acid Gives Faster Gout Cure for the proof if you need to persuade your doctor.
Leonard, I think you are on the right track, but you can tweak it to go faster with less pain. Please make sure you get liver function and kidney function tests with your uric acid test at the next appointment. Recent Uloric prescribing recommendations have made those tests optional dependent on gout patient’s symptoms, which is too risky as far as I’m concerned. By the time you develop symptoms of organ damage (which I must stress is extremely rare), treatment is more difficult. Why take the risk, especially as you have to have the blood draw for the uric acid test anyway?
Roger, I’m sorry about the difficulties you have experienced with asking your questions. I will not waste your time with excuses, but I will work my hardest over the next few weeks and months to make posting as easy as it can be.
I think your best course of action is to consult a rheumatologist who has experience with long-term gout.
I cannot assess the state of your urate load from a distance. Though you seem to have uric acid in your blood under control, it can take months, if not years, to dissolve uric acid crystals. Indeed, there are some wise people on this forum who doubt that you can ever dissolve them completely. I simply do not have the experience to know if this is true or not. I’ll be back in 15 years to explain my own experience of uric acid control.
My biggest worry is long term damage caused by uric acid crystals.
Whilst gout flares start in the joints, uric acid deposits grow slowly throughout the body. This means that cells, that should be repairing growing tissues, get caught up in the gout war, with two very serious effects.
The first is that bone, cartilage, and other tissue starts to crumble and die. This is the damage you can see on X-rays in prolonged untreated gout cases. (Please note that indomethacin and colchicine are not gout treatments in this context – they are forms of pain control that are commonly prescribed to gout patients.)
The second serious effect is the development of tophi – visible lumps of uric acid crystals mixed with dead white blood cells. I say visible, but these are often not visible to the naked eye, and only rare advanced technologies can spot them before the damage. As they grow, they cause physical disruption to organs. Kidney stones lead to kidney disease; cardiovascular deposits lead to stroke and heart disease; skin deposits lead to lesions and the risk of infection. In the past, I’ve shown pictures of tophi growing in the eye, and I have many other references to organ damage throughout the body. What qualifies as our most considered organ, for most men, is not safe, as startling pictures will reveal when I get round to posting them.
Roger, I’m not writing this to scare you, but as an explanation that gout affects much more than our joints, so a visit to a rheumatologist should be a priority for damage assessment and a treatment review.
To other gout patients who have a chance to control uric acid, but want to leave it for another day – you have been warned.
Please give your rheumatologist a big?:kiss:? from me.
Then take it back if he ever lets your uric acid rise above 5mg/dL.
As I wrote last week, considering the effects on gout of a single food item (or drink) is futile. You have to analyze your entire diet.
Alkaline water is a pointless expense that is oversold by companies making lots of money. There is no magic cure, but if you cannot tolerate allopurinol there are alternatives, none of which are easy.
First, you MUST discuss your concerns with your doctor. Elevated ALT is fairly common on gout medicines, but it has many causes. You really need to speak to an expert on this, as I believe the figure of 40 maximum is incorrect. It is good to be concerned, but it is bad to be over-anxious if there are no real problems. Allopurinol hypersensitivity must be avoided, but do not confuse the itching with natural reactions to dissolving uric acid crystals. An allopurinol hypersensitivity rash looks something like:
On your first post here, you mentioned febuxostat (Uloric). Check with your doctor or pharmacist if this is available now in Turkey (probably as Adenuric). If so, see if there are any schemes to help with costs similar to the patient assistance program in USA. Note that febuxostat is also associated with elevated liver enzymes.
You should also ask your doctor about probenecid, which works differently by helping your kidneys excrete uric acid.
If you want to make things difficult for yourself, you might be able to control your uric acid by diet, but you have to be prepared for a restrictive regime of controlling all aspects of your diet, including food drink and exercise. Of particular concern, in order of importance are: calories; iron; animal purines; acid-alkaline balance.
Donna4878 said:
I am a retired 63 year old low income widow. I pay $1045.00 PER MONTH, [way more than I pay for any other monthly needs] for my health insurance it goes up every year by at least $70. I cannot get Medicare until I am 66.
Wow Donna, $1045 !!!
That is over 60% of my income! I am beginning to get the picture now. I pay a little over $200 (as tax and NI) — higher than last year, but how else can we rescue rich bankers and expense fiddling public servants? That covers all doctor and hospital visits. Beyond that, we pay for prescriptions – nearer $12 per item, but I was just rounding earlier when I said $10. Once I get my dose settled, I'll expect at least three months allopurinol on one prescription, so that brings the costs down.
The full UK situation is a little more complex. There is approx $1.60 on every pint of beer, and approx $4 on every bottle of wine, so my full tax bill starts looking a bit more like your health insurance bill 😉
I understand the USA situation better now. Don't be poor!
A tad too political for my aims here, but that is life.
As with gout care, if we want help with medical costs, I think we will have to band together, as I mentioned earlier.
Please see Normal Uric Acid Levels guidelines for latest information regarding normal levels of uric acid.
I do not know about the policies of these organizations. Maybe it's a good idea to email them. If they don't want the blood for donation, it would be nice to persuade them to take it anyway, maybe for research purposes.
Excess iron in the blood is a common cause of raised uric acid. It's virtually impossible to control this by diet, especially so as so many processed foods are fortified with this poison. Drawing blood has been shown to reduce uric acid significantly, but this will only be beneficial if iron tests reveal high numbers.
As ever with gout, it pays to have a good plan.
Proper diagnosis should include a review of possible causes of high uric acid. If high iron is diagnosed, then reducing it would be the best first option.
This controversial topic about Colcrys and gout advocacy is now closed.
Please see the American College of Rheumatology for gout advocacy issues, or the Colcrys Guidelines for colchicine issues. Start a new question in this gout forum if those pages do not give you the answers you need.
Whilst we are lining them up, please do not forget the uric-acid-raising-iron food industry
First, you must realize that PRAL is only indirectly related to gout, and is way down the list of issues you need to be concerned with. It is only of any value in the context of the severity of your gout including your uric acid level, and the state of your kidneys, and what medication you take.
Secondly, PRAL is not supposed to be used on individual food items (except to calculate your daily totals). You must list your total food intake and assess that. Both acid and alkaline foods are necessary in a healthy diet. If you have 25-33% acid foods, and the total is alkaline, you are on the right track, but you can only tell if you have achieved your goal by testing the pH of urine (6.5 to 7.5, but 7.5 is only achievable after many months).
Thirdly, and most importantly, PRAL is not the full story, and you must consider other nutrients. In particular, these cereals are highly fortified. I am particularly concerned with the amount of iron, which is very bad for gout. The cereal section of supermarkets is as big a gout trap as the variety meats (offal) section.
Finally, to answer your question, protein and phosphorous are the acid producing components of the PRAL calculation, and potassium, magnesium and calcium are alkalizing components. The Total cereal range is loaded with calcium as well as iron and lots of other nutrients. Marketing men will try to persuade you that these added nutrients are good for you – a little research proves that this is not always the case. Highly processed food is NOT the way to eat for gouties – many food additives have a bad effect on gout, so you should try to make food as natural as possible – oatmeal (porridge) is my choice.
Avoid heavily fortified foods with a host of additives. If an assesment of your diet indicates lack of a specific nutrient, then consider supplementing only the shortages or adjusting your diet.
new york1 said:
I read the pages on Goutpal concerning diet. It seems clear that if you eat alkaline foods you can occasionally indulge in acidic foods. Meats & game were listed as acidic and bananas were listed as alkaline. However, Beer was listed as neutral/alkaline. Isn't beer bad for gout and if I drink it shouldn't I balance it with other alkaline foods rather than acidic foods?
Please help me better understand the chart.
There are a lot of food lists on the main site, but they are simply there for reference purposes. They need to be used in the context of a proper gout management plan.
Food does play a part in gout, but that part is often overplayed. If you have a bad diet, then improving it might help your gout, but this depends on what is causing your gout.
Gout is a good indication that your metabolism is out of balance. A properly balanced alkalizing diet can help restore some of that balance, but you still need to consider reducing animal purine and iron content. If you take urate lowering medicines, you do not need to worry about purine intake, but avoiding excess iron and avoiding excess acidifying foods is still relevant as they affect other aspects of health.
The food tables give endless opportunity for calculating diet options, but there is a much simpler approach. Before I describe that, you should understand the acid/alkali (pH – power of Hydrogen ion concentration) process.
Forget about direct measurement of food pH. That is only of interest to the canning industry. Forget about ash. That is only of interest to people who like to study ash. The key term, and the basis for the tables, is PRAL – Potential Renal Acid Load. This is a simplified formula, but perfectly valid for most food items. In fact, any calculation is only ever an approximation of the pH load on the kidneys – the true test is to measure urine with a pH test strip. Leaving aside the New Age claims of the miraculous effects of an alkalizing diet, for gouties the biggest benefit is that the alkalizing diet will lower the risk of urate kidney stones.
Now, all we are doing is counting hydrogen (or hydroxide) ions of total food intake. This is only juggling with numbers, and takes no account of how well balanced your diet is nutritionally. The danger is that you get obsessed with numbers, and forget to eat properly.
The simple approach is to take a 3 – 4 ounce portion of protein then balance your meal with twice as much vegetables. Fruity snacks between meals complete the deal. No individual food item should form such a high part in your diet that you need worry about it unduly. If you are in a place where spinach, asparagus or broccoli are likely to significantly alter your uric acid level then use a smaller plate or take allopurinol. If you are in a place where a couple of beers are likely to significantly alter your uric acid level then switch to wine or take allopurinol.
Unfortunately, there does appear to be an impact on fertility from allopurinol ( as discussed in an old topic):
“Medications that impair male fertility” indicates that both colchicine and allopurinol may impair fertility, but not libido or function.
Sigman M. “Medications that impair male fertility.” Sex Reprod Menopause 2007 May;5(2):11-16.
I firmly believe it is the doctors job to give you adequate uric acid testing.
If you really want to do it yourself, then see how to buy your own uric acid test kit. Please note that this is a scientific instrument, and you have to take a methodical approach. The hardest part is getting a consistent sample. It helps to practice getting the blood droplet before you test, but be prepared for inaccuracies for the first few tests.
The next bit is as hard for me as it is for you, but there is a strong association between gout and Body Mass Index (BMI). None of us likes to be told, but your BMI reading puts you just into the obese range (see calculator on my excess calories and gout page). The target for gout sufferers who want to remove the weight risk is the low end of the normal range – just over 9 stone in your case. Weight loss needs to be gradual, as the pounds you lose are a rich source of uric acid and rapid weight loss is a known gout cause.
Weight loss is probably the most significant non-medical intervention you can make. Avoid excess iron. Purine control might give the slight extra boost if you are still borderline after those two.
Other important lifestyle options are to gradually increase exercise capacity (a little more each day) and always stay hydrated with regular tea, coffee, skim milk and water. 500mg vitamin C per day reduces excess uric acid – I believe this is best from fruit and juice, but I haven't studied the logistics yet.
The diet control situation is tricky, as there are many other factors in addition to your previous meal. More uric acid comes from the natural breakdown of your own meat (i.e. your body), than from what you eat or drink. There are so many factors that can affect uric acid production it is difficult to be certain that a change in level (up or down) is due to something you ate today, yesterday, or a week ago. Also, non-dietary factors can come into play.
I am increasingly of the view that, if dietary control is possible, it must be a long term project, monitoring at least uric acid, iron, and Body Mass Index. Allopurinol can help in the short term, as lifestyle changes, especially weight loss and unfamiliar exercise, can produce sharp temporary rises in uric acid.
From your recent results, nokka, it looks like you are above the safety level, but only just.
If you think you can improve dietary control, then supporting allopurinol seems a good idea. Your diet and exercise regime should follow whatever you want it to be long-term. Of course, if you decide that you prefer to stay on allopurinol then you need no gout-specific lifestyle routines beyond those that are generally accepted as healthy.
Who else has tried the now famous metamorph brew? Over 1700 visitors have read this Natural Remedy For Gout so far!
I have yet to try it, but I'd love to hear other people's results.
New colchicne dosing recommendations suggest 2 x .6mg colchicine followed by one per hour for the next 2 hours.
If this doesn't work, the guidelines accept that the hourly dosing can be extended, though this is something that you should discuss with your doctor.
Vicatin (or Vicodin) is mainly paracetamol (acetaminophen / Tylenol). Be very careful with that one, as it can have serious liver effects. Some reports also claim that it interferes with uric acid test results, though that seems to depend on the test method used.
Keep the joint warm at all times – long johns, tights or a bandage all work, but make sure it is loose – restricting blood flow is not good for gout. I also find that keeping the joint raised above the heart is useful whilst resting, but try to get some exercise if you can as this seems to shorten recovery times.
The worst should be over in a couple of days. It is vital to get on a uric acid lowering program to keep your uric acid level at 5mg/dL or below.
trev said:
Post edited 11:19 am – July 28, 2009 by trev
A question that affects me in deciding to start this drug is:
Why ,once started, can't it be stopped?
If reactions occur to the drug it's recommended to stop it- so why can't it be used for a few months and then the patient SUA checked to see if lifestyle changes can hold the position steady?
Alternatively, if long term side effects are not wanted- a break taken to assess how the body restabilises around any worrying trend.
Oops!- this should have been in a 'Cure' thread
It is not true to say that allopurinol cannot be stopped, it is more true to say that uric acid monitoring cannot be stopped. I.e. once you have successfully reduced uric acid below 5 or 6mg/dL, and kept this down without a gout flare for 6 months, then you have a sound basis to experiment with reduced dosage.
In “Long-term use of allopurinol in the treatment of gout”, Kersley cites 2 out of 54 cases where allopurinol was discontinued. He suggests that:
[where uric acid] is only a little raised, a watching brief may be preferable to persuading the patient to undertake indefinite medication.
However, and Zip2play is gonna love this, he continues:
We still come back to the old saying that the success of anti-gout treatment depends on the doctor-patient relationship engendered by proper explanation of his disease to the patient.
I'd say it is a question of managing your uric acid until you have been free of gout pain for 6 months, with a stable uric acid level. Reduce the dosage, possibly to zero, but keep checking to make sure it stays down at the very low 6 level.
Nice reply, Tavery
All I would add, Samm, is that you really have not told us what you have experienced so far in terms of medical diagnosis. Family doctor or rheumatologist?
Gout can certainly affect every joint, but this is normally preceded by a many months, usually years, of increasingly painful and widespread painful, swollen joints.
Gout is extremely easy to diagnose, if severe enough to cause the symptoms you are suffering. A rheumatologist can examine fluid drawn from the joint (joint aspiration or athrocentesis). Analysis of that fluid will reveal, or deny, gout, pseudo gout, septic arthritis and other conditions. If this is available to you, then go for it, but I think the traditional test from a rheumatologist will serve you well.
This topic is now closed. Gout is definitely systemic. It can affect your entire immune system. Uric acid can spread throughout the body, where it will cause damage to all joints and organs if left untreated. My probenecid page specifically mentions “lowering of systemic uric acid,” but this also applies to all uric acid lowering treatments.
Ah Zip, you’ve stolen my thunder on Flying Spaghetti Monster, so I’ll use my noodle and introduce you to Frequency Specific Microcurrent. It’s related to the TENS machine / low level laser that I know you are so fond of 😉
Though the swelling is fairly slight, taken together with the fact that your Dad has gout, and it is often hereditary, I'd say there is definite suspicion of gout. Of course, as you surmise, I'm no doctor, so it could be something else.
That is really why I recommend the joint aspiration (arthrocentesis) test – because it should be conclusive. According to Courtney and Doherty (Joint aspiration and injection and synovial fluid analysis):
Joint aspiration/injection and synovial fluid (SF) analysis are both invaluable procedures for the diagnosis and treatment of joint disease. … detection of Synovial Fluid monosodium urate and calcium pyrophosphate dihydrate crystals, even from uninflamed joints during intercritical periods, allow a precise diagnosis of gout and of calcium pyrophosphate crystal-related arthritis (pseudo gout).
So they clearly believe that once crystals get into the joint, they can still be detected after swelling has gone down.
Yes, there is a home blood uric acid test kit available.
VBAssassin said:
Now why couldn't the doctors on the NHS tell me that!?
Ah, didn't realise you were in the UK. I only got proper diagnosis after going to Accident & Emergency. Even then it took 4 days. It seems that arthtocentesis is very much a last resort. Pity really, as this is the only definitive test that will rule out other conditions like pseudo gout or septic arthritis.
Uric acid tests are more useful for managing gout once it has been confirmed, and less reliable for diagnosis. There are two problems:
- Uric acid in the blood can fall during a gout attack – uric acid leaves the blood when it forms crystals in the joints and body tissues.
- Labs often report values as normal, when they are in fact too high – you must insist on a numeric value, not an uninformed interpretation. There are 2 common scales – mg/dL and μmols/L, with occasional scale variations. Anything much above 6mg/dL (6mg/100ml), 360 μmols/L (3.6 mmol/litre), is a cause for concern.
Though many people have reported pain relief from cherries & cherry juice, and also black bean broth, this is less important than managing uric acid levels.
I am not aware of any research since the two studies that I refer to in Laser Therapy For Gout Gives Instant Pain Relief.
Has anyone any personal experiences to report?
Why an earth would anyone go anywhere else? 😉
Seriously though, I find it best to judge sites by how well they reveal their sources – something I have not always been perfect at, but I am working on it.
One of the best sites is PubMed, which reports scientific research. The science is not always perfect, but at least there is factual data.
One word of warning though – many studies are statistical in nature, and statistics rarely consider the most important thing – you!
You are an individual, not an average of a selected study group.
Perhaps the best source of gout information is yourself.
apcoach said:
Thanks for the link. Just curious about how often you give blood and the impact of doing so for you personally.
I am certain that the amount of blood would vary from person to person.
In the experiment that revealed that blood loss can improve gout, blood was taken almost to the point of anemia. I doubt that a blood donation service would take that much, but it might be worthwhile discussing it with them.
I agree with metamorph that the finest reason for donating blood is to help those who need it.
Logically, excess iron is almost certainly down to a dietary imbalance, so is best fixed by adjusting the diet.
apcoach said:
On the topic of iron, i am intrigued by the idea that giving blood could benefit gout sufferers by lowering the blood's iron count. is that a major topic that has been discussed on this forum? is there any evidence to support that hypothesis?
A most interesting final paragraph in that report:
Rather than preventing generation of a remarkably beneficial iron chelator and antioxidant [uric acid – my italics] with allopurinol or increasing its urinary excretion with probenecid, perhaps a more rational treatment for hyperuricemia might be not only the avoidance of highly absorbable iron in red meat, but also regular voluntary donation of blood to decrease the relatively elevated body iron stores of men and postmenopausal women, thereby balancing decreased uric acid production with antioxidant needs.
I've spent some time looking at this, related research, and natural chelators in diet, e.g. green tea and coffee.
I have not yet drawn this altogether in publishable form, but the evidence seems overwhelming.
Excess iron encourages more uric acid (from the aforementioned report).
Please see Gout and Iron Revisited and Alternative Treatment For Gout ? Blood Letting.
Given that meat is iron rich, and dairy products, through the calcium content, I believe, are natural iron chelators, I begin to question the conclusions of some famous gout and diet statistical studies.
Also, coffee is a good iron chelator. Can this explain the link between coffee consumption and reduced gout?
Charliehorse said:
I am going to investigate Febuxostat soon as it has been approved in Europe.
Febuxostat now has FDA approval. It is released as Uloric.
Giovanni said:
Thank you for this website. It is very informative. Have you read about the newest treatment for gout which is waiting FDA approval? Fubuxostat?
Febuxostat now has FDA approval. It is released as Uloric.
Just reviewing some of my uric acid notes when I spotted that you don't seem to have had a long enough period of time with low enough uric acid.
Latest recommendations are that uric acid should be maintained below 5mg/dL:
Initial long-term treatment of recurrent uncomplicated gout normally should be with allopurinol starting in a dose of 50–100 mg/day and increasing by 50–100 mg increments every few weeks, adjusted if necessary for renal function, until the therapeutic target (SUA <300 µmol/l) is reached (maximum dose 900 mg)
These are British Rheumatologist Society recommendations, but I believe American rheumatologists follow similar guidelines.
Once you've had a 6 month period with no gout flares, and no visible signs of tophi, it is possible that all existing uric acid crystals have dissolved. In such a case, it might be possible (under advisement of your doctor) to relax dosage slightly to maintain levels in the 5 – 6 mg/dL (300 – 350 µmol/L).
Get the new bastard trained 😉
It's gout!
I should be more circumspect and say “Get the gout diagnosis confirmed by proper analysis of fluid from the affected joint – usually by a rheumatologist“
But it sounds exactly like gout to me.
Please save yourself years of trouble by getting treatment to lower uric acid. In my experience, you will have to take charge, unless you are lucky enough to have a doctor with good gout experience.
Most miss the point that you must maintain uric acid levels below 6mg/dL for at least 3 months without gout flare, then below 7mg/dL for life.
This takes some serious management because uric acid must be tested frequently and treatment adjusted accordiingly.
As I've said before – anything less is a complete waste of time and money.
