Gout for 30 years getting worse

[Colin Purves]

Looking forward to learning from other gout sufferers and sharing own experience in the ongoing battle against gout.

I`ve probably had the condition for about 25 – 30 years. In the early years it would come and go but more recently has had a more crippling effect and seems to have set up camp permanently which has driven me to look for solutions.

Have been experimenting with different foodstuffs but nothing seems definitive. Stopped drinking beer or any alcohol for the past month or so and this seems to have reduced the severity of the gout but it`s still there, in particular, the left knee. At the same time have been taking Montmorency cherry juice at night along with one 200mg Ibuprofen. I assume it’s the Ibuprofen that gives a pain-free sleep. I remain to be convinced about the cherry juice. But I feel a sensation in my knee which I never felt before(could it be the uric acid crystals breaking up). During the day plenty of fluid is taken, in particular, water and am also drinking Nettle tea which I have read is good for clearing the kidneys, and that makes sense, as, from what I have read gout may clog up the kidneys.

I seem to be on the right track as previously had developed a permanent limp due to the severity of gout. Can now walk without a limp and with much ease but gout remains but not as it was. Past couple of days seems to have been a retrograde step as could feel the pain increasing but not to the extent it was and not crippling. Diet consisted of Pasta, Tomatoes, Bread Products, Potatoes, Low Fat Milk, Bananas, Rice Krispies, Nectarine, Orange, Butter, Water, Tea, Cranberry Sauce, Cakes, Chocolate, Crisps. Have to assume it was either one or a combination of those.

The battle continues.

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How long does gout last?

[Keith Taylor]

Hi Colin ( @colin-purves )

My first question is: “What does your doctor say about your gout?”

[Colin Purves]

Hi Keith,
Have never gone to a doctor, as have never been keen on taking medication. Always thought I could get to the root of the gout problem by making adjustments to diet and lifestyle etc.But there seems to be something more fundamental where gout is concerned.Is it all to do with diet and lifestyle or is there a medical explanation involved.I’m starting to think that if the adjustments I’ve been making are not having a major effect, then there may be no choice but to seek medical advice.

[Keith Taylor]

OK, Colin, I can understand that you would not go to your doctor about gout. Because you do not want to treat it as a medical matter. So, I can agree with you up to a point, as I identify 3 potential types of treatment.

In Questions for Gout Sufferers I consider medical, lifestyle, and herbal treatments for gout. Or, you can combine these for different parts of your treatment. In fact, I can see that you are doing this when you combine ibuprofen for gout pain, with diet changes.

But, you don’t have a safe plan. Because, as nobody pointed out, you seem to be ignoring the cardiovascular risks of long-term NSAIDs. So, please start by reading your ibuprofen label. Then, tell me what you think about those risks. After all, I’m here to help you decide what’s best for you, not dictate what you should do.

Most importantly, I want you to understand that gout control depends on uric acid control. As I said, there are 3 types of uric acid control. But, we can’t even begin to control uric acid until we measure it.

So, it might be that your medical records contain some historic uric acid test results. If they are fairly recent, that could be our starting point for permanently stopping your gout. But, if you do not have a recent uric acid test result, then you need a blood test.

Again, you have 3 options:
– A doctor or similar medical facility.
– Walk-in lab test.
– Home uric acid test kit.

So, I won’t waste time just yet explaining the pros and cons of those choices. Because I’d like you to rank them in order of your preference first.

Colin, I hope to learn more about your gout history and preferences soon.

[nobody]

Hi Colin,
It would be reckless not to try to get the root cause of your problem under control. Just ask yourself this: how do you think you’d fare without ibuprofen? Maybe you’ll be able to take ibuprofen for the rest of your life. But it is a dangerous drug to take on a regular basis. Maybe you’ll have to cut down or even quit at some point down the road. And then what?
We don’t know that you have gout but if you do, chances are you won’t be able to fix it by tweaking your diet. One problem is that the foods which trigger the pain are not always the foods that actually cause the problem. So you could make your problem more bearable while it keeps slowly damaging your body.
I strongly recommend you see a doctor, do the testing they’ll put your through and get a solid diagnosis. You won’t have to take medication just because you have a diagnosis. The point is to stop wasting your time and to obtain solid information about the problem you have and the solutions. This thing is, finding a good doctor who understands the type of thing you’re going through may not be easy.

[d q]

Both the above answers are spot on. It is imperative you see your doctor to get a diagnosis or an expert opinion first. A diagnosis may not happen after the first visit but at least get the testing in progress. From there onwards it’s a question of working out the best course of action.

[Colin Purves]

Have finally succumbed to the sensible idea that a Doctor has to be involved in treating/understanding better the condition of Gout.
Consulted with Dr. on Monday 14/8/17 as to my concerns about what seems to be perpetual Gout. Three blood vials were taken and was immediately prescribed Ibuprofen (400mg),and to take one three times a day which I have done and to be fair there does seem to be better mobility in my knees.Dr. commented that the 100mg Ibuprofen that I was taking once before bedtime was insufficient to do the job properly.
Dr. phoned on wednesday to confirm Gout is there and prescribed Allopurinol (100mg) to be taken once daily and to continue taking the prescribed Ibuprofen.Picked up prescription today 17/8/17 and have taken first Allopurinol.
Blood tests also revealed that I have sticky blood,over production of red blood cells.Dr. suggested that could be the reason for the Gout and next step is to visit Haematology Dept.for further blood tests and to establish the reason for the sticky blood.
While all this is going on I`ll be keeping clear of high purine foods as I have been doing and taking the Montmorency Cherry juice.

[Colin Purves]

Thanks for all previous comments.Should have also added, that although I’m not comfortable with medications and high dosage Ibuprofen I’ll adhere to the Doctors advice as a short-term fix until more is revealed as to the root cause.
Made a typing error as to 100mg Ibuprofen.It was 200mg.

[d q]

Over production of red cells is most definitely one of the causes of gout and quiet possibly the only reason you may be experiencing gout.

When you produce more red blood cells, more red blood cells will go through their usual lifecycle. Once they complete their lifecycle they are recycled and uric acid is released from them (the dead cells). If you have a high rate of production, naturally you will have a higher rate of cell turnover and this itself will cause uric acid to rise.

Do you have your Full Blood Count results to hand? More specifically your haemoglobin as this is a good indication as to why you may be over producing red cells. Check to see if you have your bilirubin results too.

In any case let us know what your haematologist says.

[Colin Purves]

Thanks dq,
Wouldn’t have known to ask for Full Blood Count, Haemoglobin, and Bilirubin results.Hopefully, don’t have to wait too long for appointment with Haematologist.

[Patrick]

Hey Colin,

I’m a little late to the thread but I have read it in its entirety. Glad to see you went to seee a doctor instead of self diagnosing. Now you have an answer, and this will start to lead to a plan, like Keith suggests.

You say you have been a Gout sufferer for over 30 years but in reality, it might be even longer. You probably have been a Gout sufferer for 30 years, but may have been a Gout patient for even longer.

I know you are leery about taking medications, but starting to tackle your Gout with 100mgs of Allopurinol WITHOUT the safety net of Colchicine can be tricky, especially for a long suffering Gout patinet like yourself. Your body is trying to rid itself of over 30 years of Uric Acid crystal build up in your joints. Allopurinol, in conjuction with Colchicine is a normal “tag team” combination for new Allopurinol users.

You might want to ask your doctor about it, before you experience your first major, post Allopurinol, flare up. You won’t regret it. Good luck, brother

[Colin Purves]

Consulted with Haematologist today.He thinks the Gout and over production of red
blood cells are not related.I had so many questions to ask that I forgot to ask about d.q.s previous suggestion that the breakdown of the dead cells leads to the release of uric acid,but that question is top of the list for next visit.
2 courses of action were suggested.Medication to control the over production of red blood cells or to take a pint of blood off on a regular basis.He suggested taking a pint of blood off as a starting point which I prefer.I can`t help feeling that this might help to alleviate the Gout to a certain degree,whilst the Allopurinol continues to do its work.
I read the Ibuprofen leaflet as suggested by Keith.It clearly states not to continue dosage past 10 days,so have cut down dosage after 10 days from 3 per day to 1 per day and hope to come off altogether as pain subsides.Have started drinking Celery seed,perhaps this will help.
The Allopurinol seems to be working.Where my feet were previously on fire,the past few days my feet are cool and my shoes feel as if they are a size too big.Knees are not as hot as they usually are and red blotches on the knees which were a permanent feature are lightening and mobility improving.
Cant help thinking that perhaps an increase from 100mg Allopurinol to stronger dose might speed up proceedings.
In any case,I think i`ve been naive to think the Gout could be remedied in a matter of weeks or months.As Patrick suggested there could be a massive build up of Uric acid crystals over time which may take some time to break down.
Next visit to GP will ask for comparison of Uric acid level,Haemoglobin,Full blood count.
Awaiting also results of Blood test for JAK2 gene,and Erythropoietin in relation to red blood cells.
Heading for Phlebotomy hopefully next week.
Hope I`m not deviating from Gout issue but nothing has been proven as yet,that the Gout and Overproduction of red blood cells are not related.
Continuing to avoid high purines,alcohol.Drinking plenty water,nettle tea,celery seed,cherry juice.Eating cherries.Cutting down on sugar.

[Keith Taylor]

Thanks for the update, Colin. You’ve added some interesting discussion points.

Blood draw
There’s strong evidence to suggest that drawing off blood helps gout by reducing iron.

Allopurinol and gout pain
Allopurinol removes the cause of gout pain (excess uric acid) but this takes a long time. Also, it only works when uric acid is below 6mg/dL. So, you might be right to suggest an increase in allopurinol dose. But that has to be guided by blood test results. Never by gout symptoms. Because partially dissolved uric acid crystals can cause gout flares.

Note that gout flares that happen when uric acid falls towards 6 tend to be less intense and shorter period than gout flares from growing crystals. Also, the further you get below 6, the sooner this burden of old uric acid crystals that Patrick refers to will dissolve.

[Colin Purves]

Thanks Keith for the links to drawing off blood helps gout by reducing iron and burden of old uric acid crystals. These are very interesting.
Just to briefly throw in to the mix.I had been trying to donate blood to the blood transfusion service over the past couple of years,but was always turned down because my blood iron was outwith their criteria,i.e. too high.Instinctively I had thought that a regular donation might alleviate the gout somewhat but had no proof that it would.
The second article certainly gives a better understanding of the Urate Burden in that,even though gout comes and goes,it never really goes away,and something I hadn`t contemplated was that the urate burden could spread beyond the joints and into the organs.
Will be asking for uric acid figures from previous bloods on next visit to GP,so as to compare with 6mg/dl.

[Colin Purves]

Consultation with GP today reveals comparison of Urate levels.
14th August 0.48mmol/l
31th August 0.41mmol/l.
To convert to mg/dL I read that a factor of x18 has to be used, but I stand to be corrected.That would then read:-
14th August 8.64mg/dL
31th August 7.38mg/dL
If my calculations are correct that means a 15% reduction in Urate in two weeks.
I have no idea whether this is a significant reduction in two weeks or not,but I feel any reduction must be progress.
I believe the normal range is 3.96mg/dL to 7.74mg/dL. So it looks as if i`ve just sneaked under the upper limit.
GP recommended that the dosage of Allopurinol now be upped to 2x100mg per. day.
GP still thinks Gout is a consequence of over production of red blood cells.
Hemoglobin level 21.9. Obviously too high.
Wont learn anything more until visit to phlebotomy to get blood drawn off and to see if this further alleviates the gout.

[nobody]

Based on the molar mass, the factor should be 16.81 (do tell if I picked the wrong molar mass or something!). So by my count your values in mg/dl are 8.07 and 6.89.
0.41 mmol/l is well within the normal range but the normal range is irrelevant. The value is still too high for a gout patient which means the allopurinol dose should indeed be increased if you are tolerating it well.

Since you’ve had high uric acid for a very long time and just started allopurinol, dissolving crystals could well be propping up your test values. In that case, test values would trend down over time even if you didn’t change your allopurinol dose.
In my experience, test values can have a lot of noise in the 0.3-0.5 range even when you aren’t taking drugs so I wouldn’t make much of a single valu and I think you need more than two tests to know what’s really going on.

A warning: increasing your allopurinol dose quickly could also temporarily increase your risk of going through a violent attack. It’s for a good cause because in the long run you’ll be better off for the dose increase. But be prepared.

[Colin Purves]

Thanks nobody.Trying to learn/understand everything about Gout.One thing seems
certain,is that its a long road.
Next blood test for Urate level scheduled for 2 months.

[Colin Purves]

I hope others don`t mind me updating on progress or non-progress as it may be from time to time. It certainly helps me to get things down on paper so to speak,and there is always the possibility that others may be suffering from the same conditions,i.e. Gout and overproduction of red blood cells.

Gout has now manifested itself in my right thumb with a vengeance.This is the second day and its difficult to tell if its just getting started or if it has peaked,but the thumb is swollen,red,mis-shapen and very painful.I was surprised and at the same time intrigued as to why the thumb,when i`ve never had gout in my hands or elbows,only feet and knees.The first finger also has a small white lump(Tophi?) developed in the top joint near the nail.Definition in knees continuing to improve(minutely) and feet sometimes cool when previously were on fire .Continuing to take 2x100mg allopurinol per. day.

In relation to the over production of red blood cells,this now has a name(Polycythaemia Vera)PV. All literature that I have read so far,all mention that Gout is one of the symptoms of PV.
Incidentally PV apparently is only discovered on a routine blood test and is a rare condition.
Drawing off of blood is starting point of treatment,So far i`ve had 2 pints taken off on 2 separate occasions over the past 2 weeks.Objective is to reduce haemoglobin level.

[urankjj .]

Wow! Your description of your finger gout makes me shudder As I have had the same affliction in my middle finger, last joint just below the nail. Because of the incredible pain. I actually had to go to the E-R for analysis. They’re conclusion was a bone infection, then treated with a plethora of unneeded antibiotics, which did nothing because it was gout related tophi that they saw as a bacterial infection.. That joint is still misshapen, but I have had no day to day issues with it at all. I have been gout flair-up and attack free for 6 months now through supplements and diet, (no meds). I will post more on that very soon. Stay healthy…

[Colin Purves]

As you say urankjj, its an incredible pain,hellish even.Good to hear you`ve been attack free for 6 months.Long may it continue.
This is 7th day of gout flare up in my right thumb and first finger.Normally from previous experience gout flares last between 7-10days.Swelling and redness have gone down slightly but now hand is badly swollen and spreading to wrist.Had to go back on to 3x400mg Ibuprofen a day to alleviate pain.
I was curious as to why, after all these years of gout sufferage in the feet and knees should it now appear in the right hand and after starting on a course of Allopurinol.
Started to read some stuff on Synovial fluid joints and in relation to uric acid.
One opinion was,that if we think of the Synovial joints(toes,knees.fingers etc.)as temporary parking areas for uric acid deposits as uric acid moves through the bloodstream and out through the kidneys.And then the body later tries to deal with the uric acid that`s been parked up in the synovial joints.But if the blood is continuosly overwhelmed with uric acid and the body is then unable to dispose of the uric acid previously parked up does it then follow that one or more of those joints become full to overflowing resulting in gout flare.
On Allopurinol,I read that it doesn`t necessarily get rid of uric acid but prevents or inhibits the production of new urate.So why do gout flares occur when no new production of urate.Is it because the old uric acid parked up in the joints can now release.
To further complicate,I wonder what, if there is one,a trigger for release.Could it be trauma to that joint or something else.
Phew,that was a speel.
Just a novice here on a learning curve trying to understand more on gout.

[nobody]

Yes, allopurinol inhibits production and does not eliminate existing uric acid. If you take enough allopurinol (it’s not clear that you do), it’s only old deposits which can give you trouble.
People who have had gout and high uric acid for many years often have a great variety of deposits.

My understanding, partly based on guesswork and therefore highly suspect, is that taking enough allopurinol to radically alter the amount of uric acid in your blood is likely to make many previously stable deposits unstable. In some cases, they’re going to be inherently unstable and in others physical activity or accidents are required for the instability to become apparent.
In addition, when your immune system starts to get worked up about uric acid but doesn’t find obvious targets, it’s going to notice deposits which would otherwise would have remained under the radar. Taking allopurinol is likely to create situations in which unstable deposits excite the immune system but are dissolved into the blood before the immune system’s excitement is exhausted, effectively setting it on a search-and-destroy mission.
The larger and least stable deposits are likely to be in the foot rather than in the hand. It seems it’s not uncommon to get gout-like symptoms in ridiculous places after radically lowering uric acid. Hands don’t rate as ridiculous as they are a fairly commonly affected area. I got hand symptoms after changing my diet which only resulted in a relatively small decrease in uric acid.

7-10 days is too long. You can have even longer attacks without treatment but in my opinion, long-lasting attacks a sign of inadequate treatment. And if you can tolderate aggressive pharamaceutical treatment, you might be able to reduce your attack duration to hours instead of days.
Have you discussed colchine or corticosteroids with your doctor yet? That might spare you trouble and reduce your need for large doses of Ibuprofen which can cause nasty side-effects if you use it for too long.

[Colin Purves]

Certainly makes sense nobody that previous deposits become unstable during the taking of Allopurinol and that perhaps physical activity or accidents can be a trigger.I`ve been a keen goer to the gym for the past year(twice a week),mainly the cable machines,with the hands doing most of the work,so it is possible that this could have caused the uric acid deposit instability/release in the hand.Needless to say the gym work will have to wait a while and also have a rethink.
Haven`t discussed colchine or corticosteroids with doctor yet,but will do,as you say,nasty side-effects can occur if large doses of ibuprofen used for too long.

[urankjj .]

I guess I’d better quickly chime in here.. You guys seem quite a bit more knowledgeable than myself on the mysteries of gout and it’s treatment, and that’s why I love this site. It’s a great source of learning on the subject. Anyway I had resent bloodwork done, 9-20-2017, and my uric acid was a whopping 8.0. Up from 7.6 and 6.9 over the last 7 months.?? But no flare-ups or attacks of any kind in that time frame. I have radically changed my diet. No meat, (animal flesh of any kind), and no high fructose corn syrup. And now drink only water, coffee, and beer, in that order. Supplements have been, L-malic acid, 600 mg cap and apple cider vinegar,450 mg cap, per day over that same time period. My question is the same as yours. Why have I had no attacks or trouble after having them regularly for the last 8 years, and currently having that high of a UA count. ? I wish I had that answer but I don’t. Is it the supplements ? Is it the diet? Is it both ? Don’t know…. What I do know is that I have been gout attack free for 7 months now, so I’m just going to keep on doing what I’m doing and stay on that road to see where it leads . Good luck to all….

[nobody]

Coincidentally, 8.0 has been my highest symptom-free and pharma-free test result since I first developed gout-like symptoms. I wasn’t taking any of the supplements you take.
It would be intersting if your symptom-free test results got much higher but I fear you won’t remain symptom-free much longer.
There’s not much difference between 6.9 and 8.0. Have you had enough test results to make a reasonable estimate of how noisy they are? My pharma-free results have been as low as 5.3.

It is common for gout sufferers to have long symptom-free periods. I don’t know of any demonstrated trigger or enabler for these periods.
When you have no symptoms while your UA is well into the danger zone, that suggests your immune system is currently not bothered by UA crystals. And we know that anti-UA antibodies contribute to UA crystalization in the same way that clouds are seeded by tiny particles. So you immune system being relaxed about UA crystals should enable higher amounts of UA to be retained in the blood. Trouble is, if the amount of UA gets high enough no help is needed for crystals to form and your immune system will sooner or later attack them if you are prone to gout.
There are other factors which inhibit crystallization such as high ambient temperature and (apparently) low amounts of iron in the blood.

Another reason for the amount of UA in your blood to rise would be a decreased ability to eliminate it. That doesn’t seem very likely unless you are slowly increasing your alcohol intake or something. I assume your supplements do not damage the kidneys.

[Colin Purves]

It gets more interesting and intriguing.Does this mean that in your case urankjj and having been gout free for the past 7 months that perhaps the areas of the body that typically store UA deposits had reduced to safe levels posing no problem,and that in light of the recent urate level reading of 8.0 those same areas have slowly started to accumulate UA deposits and perhaps become full to overflowing, posing risk of gout attack.Glass half full scenario.I sincerely hope you don`t get another gout attack urankjj.

[urankjj .]

@ Colin Purves. I can not answer that question, I wish I could.. My hope is that regular intake of malic acid is dissolving the excess uric acid that my body can’t handle, before it has a chance to accumulate and cause problems. Can that process actually take place in the human body. ? If that is the case then one would think that it would result in a lower UA blood count, not higher ?. If it is effective. is long term use of malic acid safe ? Intriguing yes. A lot of unknowns for sure. For me, one gout-free day at a time.

[Colin Purves]

Some good points urankjj. If, as you say malic acid could be dissolving excess UA then why not a lower UA blood count.Could that then mean that your body is able to tolerate UA level of 8.0 thus far and that perhaps the UA deposits are not yet full to overflowing, and will malic acid maintain that level or less.Be interesting to see what further UA blood counts reveal.Certainly plenty of unknowns .Long may your gout free days continue.

[Colin Purves]

Update to UA level.
14th Aug.2017 – 0.48
31st Aug.2017 – 0.41
21st Nov.2017 – 0.29
Spoke to Dr. today and confirmed latest UA level from bloods 0.29.If converting to mg/dl and using 16.81 conversion factor as provided by and thanks to forum member nobody then these would read.
14th Aug.2017 – 8.07
31st Aug.2017 – 6.89
21st Nov.2017 – 4.875
Discussed with Dr. as to whether upping the dosage of Allopurinol would be an option,Dr. said to continue on 2 x 100mg and come back in 2 -3 months for further UA test.
In regard to gout flares there have been a couple of hellish episodes which nobody had warned of,however,as I have learned and mostly from this forum
the gout flares will probably be caused mostly or partly due to UA deposits
which have built up over the years.With that knowledge this means there is light at the end of the tunnel.
The other condition which was diagnosed at the same time as Gout,that is sticky blood(Polycythemia)and which Dr.thinks has caused Gout,have now received Haemoglobin and Haematocrit results.These were obtained by taking off
600 millilitres on a weekly basis.
28th Sep. 2017 – HB 22.3 HCT 0.682
5th Oct. 2017 – HB 20 HCT 0.602
12th Oct. 2017 – HB 19.3 HCT 0.586
19th Oct. 2017 – HB 18 HCT 0.56
26th Oct. 2017 – HB 17.5 HCT 0.539
2nd Nov. 2017 – HB 16.3 HCT 0.506
7th nov. 2017 – HB 14.9 HCT 0.455
At this point i`ve been told there is no further need to take off further blood as results are where they should be,and now await further discussion
with Haematologist.It was suggested by the Phlebotomist that the improved viscosity in blood(moving through the body more easily)due to blood draw offs
could well be beneficial to alleviating the Gout.This makes sense.Another plus was my blood pressure is now more in line with where it should be.

[nobody]

Depleting your iron stores (bloodletting should do that) could also alleviate gout.

So your SUA tested at 0.41 on 100mg allopurinol and 0.29 on 200mg? The drug seems to be working but another uric acid test will be required to confirm that your latest result isn’t a fluke and that UA-lowering treatment is a success.
I’m not aware of any hard evidence that lowering your uric acid further would be beneficial. It would make sense if it was marginally beneficial but has so far as I know only been shown to be beneficial when people have visible tophi.

[Colin Purves]

As you say nobody,the drugs seem to be working and lets see what happens at
next uric acid test in 2 to 3 months.
Dr. seems to think it may take about 6 months to settle down.

[Colin Purves]

Something that continues to puzzle me in regard to Allopurinol is that,if it is described as an inhibitor of UA then does this mean that only some of the new production of UA is prevented and I wonder what percentage that could possibly be or could that only be ascertained depending on how much purine related foodstuffs are ingested.In my own case I dont eat meats or any fish related products and hardly drink beer or any alcohol and drink plenty water,about 3 litres per day.
I know that old UA deposits are steadily breaking down and which are contributing to frequent gout flares,but I do wonder if I am continuing to add fuel to the fire by consuming further foodstuffs that could also be contributing to ongoing gout flares,or am I getting a little paranoid and should just put it down solely to old UA deposits working there way out the system.

[nobody]

Yes, only some of the UA production is prevented. Putting a number on it would be extremely challenging but you could prevent more production by taking more allo.
Sure, in principle you could slow down your treatment by frequently eating loads of stuff you shouldn’t be eating. Realistically though? It seems you’re being careful enough and 0.29 is a value low enough to give you a decent buffer against eating the wrong thing.
It’s not just food that affects UA by the way. Fasting wouldn’t help. And one of the recommendations for gout patients is to refrain from seriously strenuous exercise.

That said, food has many effects. Old deposits don’t cause inflammation automatically. Your immune system has a role to play and some foods could affect it in various ways. Certain fats for instance might promote flares.
If you notice that some foods seem to trigger flares, you could try eating something else for a little while and see if that helps.
But if you haven’t run into anti-inflammatories side effects yet, there’s little sense in obsessing about that stuff. While the problem sorts itself out, you could perhaps just take a pill to nip your symptoms in the bud whenever you feel warning signs. Now that your UA seems to have been low for a while, you are less at risk of abusing such pills.

[d q]

@Colin – building up on nobody’s responses; I think the focus should be on reducing your uric acid levels and maintaining a healthy diet. Keep as close as you can to the line and try not to deviate from it. Too much obsessing on food will only cause you to go mentally feeble. Trust me, been there.

How is your blood condition these days? Another way for reducing haemoglobin is to drink plenty of water as you do but be careful with this. Do not believe the hype that gallons of water will flush and flush uric acid. It does help a lot but as with anything there will be a ceiling to the benefit. Excessive water also causes your sodium levels to drop and you do not want this as you need salts in your blood. Moderation is the key.

Keep us posted.

[Colin Purves]

Thanks nobody and d.q for your valued input.

In regard to UA level d.q. another UA blood test is scheduled for about 2-3 months from now. Happy of course that it’s dropped from 0.41 to 0.29.Trying to maintain a healthy diet. Start in the morning with 1 to 2 pints water before breakfast.I believe this is beneficial not just from a gout perspective but can flush out toxins. In total, I never exceed 6 pints of water in a day. Don’t eat meats, fish or fish products. The rest I think from what I’ve read is largely guesswork as doesn’t seem to be anything definitive out there. But as you say moderation could well be the key.

In regard to blood condition,I attended Haemotology dept. to get 600 milliliters
of blood taken off on a weekly basis.This brought Haemoglobin level down from 22.3 to 14.9, and Haematocrit level down from 0.682 to 0.455. This is where they wanted it to be, and await discussion with Haematologist.I looked rather wan and pasty-faced after all that blood draw, as opposed to a usual facial complexion resembling something like a burst tomato.

All in all the gout remains having some nasty flare-ups, and a particularly nasty flare up at the moment in my right knee which was previously docile and has ballooned horribly immobilizing the bend in that knee.From my own experience gout flares usually build up and then peak between 7 to 10 days before subsiding. This is the 7th day so hopefully it has peaked.
On a positive note, Dr. seems to think it will take about 6 months for the overall gout condition to settle. But I’m prepared for longer than that as I know I’ve probably had about 30 years of UA deposits tucked away.

[d q]

Hello Colin, good news about the blood situation. Keep an eye out on your platelet counts too. It also helps to take Vitamin E as this acts as a mild blood thinner and will help with blood flow. Consult your haematologist about this first though.

Out of curiosity have you ever had gout attacks in your toes?

[Colin Purves]

Hi d.q., Yes certainly happy about current blood situation.When next consulting with haematologist will ask about platelet count and Vitamin E. Didn`t know it acted as a mild blood thinner.

Majority of gout attacks have been in the toes,and feet generally especially in the earlier years,and only developed in the knees in the past couple of years.
An interesting observation only recently and just after completing the blood draws was a gout attack on the toes on the left foot and mainly in the smaller toes, was that, after keeping both legs off the floor either by lying on the bed
or on the sofa which gave welcome relief and then when lowering the left foot on to the floor it was as if there was an enormous rush of blood to those toes which I can only describe as a horrible excruciating pain which prevented me from putting that foot fully on the floor,but after waiting for a few minutes it subsided somewhat.
It immediately came to mind,could this be anything to do with the blood draw offs making the blood thinner and subsequently the blood getting round the body a lot quicker than it would normally have done.
I`ve had gout attacks over the years but not in the same manner as that one.

[Colin Purves]

Update to Blood UA level.
14th August 2017 – 0.48 mmol/L
31st August 2017 – 0.41 mmol/L
21st November 2017 – 0.29 mmol/L
25th January 2018 – 0.28 mmol/L

G.P. Reckons Gout now under control and to continue on 2 x 100mg Allopurinol
per. day and call back in one year for further blood test.
Certainly happy the way things are going in relation to the Gout, although I
think there is still some way to go in regard to the breaking down of old UA
deposits.Still some obvious red blotchy areas on both knees and smaller toes
on left foot.Less reliant now on Ibuprofen as pain now moving into discomfort zone. Was down to 1 x 400mg Ibuprofen per. day(last thing at night).Now able to stretch it to 1 x 400mg every second day with target of taking only if and when required.

[Keith Taylor]

Fantastic news, Colin! I love the fact that you are achieving gout recovery and have less reliance on ibuprofen. Also, you seem to be on the right dose of allopurinol to keep your uric acid safe.

But, you are right to “think there is still some way to go in regard to the breaking down of old UA deposits”. Because it usually takes several months to dissolve old uric acid crystals. However, if you keep a note of when you need to take ibuprofen, I expect you will see longer time between gout symptoms. Also, less intense attacks.

Then one day, you wake up struggling to remember the last time you had a gout attack. That’s when you know gout is truly a thing of the past. But always continue to get annual uric acid tests. Then you can be sure that your allopurinol dose continues to be right.

[Colin Purves]

Thanks Keith.The link to it usually takes several months to dissolve old uric acid crystals is particularly interesting,in that it gives a useful reference point.The sharp drop between 3 – 6 months is where I am(based on start of Allopurinol), but closer to 6 months. I can confirm that I have felt a marked improvement in Gout symptoms in recent weeks.
Finding this forum and its knowledgeable contributors has kept me largely
informed about aspects of Gout that I could not have imagined.
I look forward to that day Keith, as you say,Then one day, you wake up struggling to remember the last time you had a gout attack. That’s when you know gout is truly a thing of the past.

[csrv598]

What a fantastic website!! I’ve learnt more in the ten minutes reading through this forum than I have from doctors and trawling the internet.

I’ve been suffering with gout for a few years. Flare ups usually occurred in both hands and the wrists, but I’ve also had them in my shoulders and two excruciating episodes in my big toes.

I was finally prescribed Allipurinol (minimum dose), but I did still keep getting flare ups, so my dosage was doubled in April last year. A week after I started on my new dosage I had flare ups in both my wrists at the same time!

Since then I’ve had other flare ups, but they’ve not been as painful as before, and they don’t last as long. So, having read through some of the posts on this site, that is due to old Uric Acid crystals settling in my joints? If that is the case, and if Allipurinol stops new UA crystals forming then what I eat and drink shouldn’t have any effect on the gout, or have I misunderstood the contents of the posts. Obviously, I’ve not read all the posts yet!

If that isn’t the case, then is there any way of finding out what foods trigger one’s gout i.e. how long after you’ve consumed the food/drink does the flare up start?

Another question is, is it worth getting a UA meter?

Thanks in advance for anyone who would like to answer my questions.

[nobody]

If you take enough allopurinol, what you eat and drink won’t matter (within reason).
But being careful with what you eat or drink might allow you to take smaller amounts. It’s not an inoccuous drug. In order to know how much allopurinol might be appropriate, it’s best to get your blood tested professionally more than once.
While you are still experiencing symptoms, it often makes sense to make more than the maintenance dosage you might need to take for the rest of your life. And while you are taking a more than necessary, food and drink matters less.

If you do not know how good your body is at getting rid of uric acid, I would recommend drinking lots of water, avoiding alcohol and taking care to eat enough veggies as long as you are experiencing symptoms because your body’s capabilities could theoretically be overwhelmed by old crystals regardless of how much allopurinol you take.

Inasmuch as foods affect uric acid, it could take a very long time for what you ate to cause a flare. But allopurinol should take care of that.
Foods can also trigger flares through the immune system rather than uric acid but that should be a relatively rapid process (hours, or even less than an hour if the flare had already started). And once the uric acid crystals are gone, there will be no more gout flares regardless of what you eat.

[Author]

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