Mini gout flare whilst on Allopurinol

[Gout Patient]

Hi,

Starting a new topic as requested.

I was diagnosed with gout about 6 weeks ago, in my left foot (not the big toe, but more on the left of my foot). It was so painful, at first, I thought I had broken it!

Anyway, blood tests confirmed gout. I took Naproxen for about a week until the swelling had subsided, then Allopurinol for about the last 3 weeks (200mg per day). A second blood test (about 10 days ago) confirmed the uric levels were falling and are now at the high end of normal.

I now have the figures from the GP:

8 July: 526 µmol/L
28 July: 309 µmol/L

That’s a remarkable drop in 3 weeks, I hope the readings are accurate!

Everything seemed to be improving until a few days ago when I’ve had another gout attack. Not even close to being as bad as the first one, but still red, swollen and quite painful. I’m taking Naproxen to calm the attack, whilst staying on the Allopurinol. The Naproxen seems to be working and this morning, whilst the swelling is still there, there’s less redness and ‘heat’.

I *think* this is normal and that this is simply the Allopurinol working and dissolving the crystals and whilst this happens, you can have further mini-attacks.

Do you have any suggestions? I’ve been really strict with my diet since my diagnosis: no alcohol, very little meat, no seafood and lots of fruit/vegetables. And about 3-4 litres of water per day!

Many thanks,

Dave.

---

Is 200 mg allopurinol OK?

[Keith Taylor]

Dave, thank you so much for digging out those test results.

Now, though you say you were first diagnosed with gout 6 weeks ago, uric acid crystals have been building up for years before that. It’s impossible to know exactly when. There are now advanced imaging techniques that paint a better picture of your uric acid burden. But, we can manage without those.

We just need to know what to manage. There are 2 things:

1. Uric acid burden
2. Gout Pain until uric acid burden has mostly dissolved

Your test results show your uric acid is well under control. You could go lower if you wanted to as a temporary measure for a few months. Most doctors will only agree to this if you have visible signs of tophi. I’m guessing this is not the case for you. So, all that’s left to do is to maintain regular tests. I recommend monthly tests, at first. As your results stabilize, you can extend the interval. Always test at least once per year. Uric acid tests should be accompanied by kidney function and liver function tests. That is usual for most doctors, but always best to check.

You might find fluctuations in uric acid test results. This is normal, especially if your appointments are at different times of day. However, you should soon see a natural average. Ideally, this will fall below 300μmol/L, but 309 is very close. If it does start to rise as you get older, you might have to increase allopurinol dose. This is fine, as you are well within the maximum dose.

For a few months, you are absolutely right when you say “I *think* this is normal and that this is simply the Allopurinol working and dissolving the crystals and whilst this happens, you can have further mini-attacks.”

For this reason, good gout doctors usually prescribe pain control for a few months. There are several different approaches to this. Some doctor prescribe daily colchicine for a few months as a preventative. Personally, I think if you are managing OK without that, then best to stick to naproxen.

All I would say, if you are incapacitated, is to speak to your doctor about paracetamol, or similar compatible painkiller, to take alongside naproxen. I think it’s important to stay mobile when you have a gout attack. That, at least for me, stopped gout attacks sticking around for many days.

All in all, Dave, I’d say you are well on the road to recovery. Your diet seems healthy, which will be good for other potential health problems that often run alongside gout. Of course, if I need to clarify anything, or you get other questions, just ask.

I’m sure your gout attacks will become fewer, and less intense, as you continue to bring uric acid under control. It amazed me how little gout hurt when I knew my uric acid was safe, and occasional flares were just a sign of old crystals dissolving. 🙂

[Gout Patient]

Hi Keith,

Many thanks for the detailed reply. I’ve scheduled another blood test for a week’s time and will post the results here. I guess there will be some natural variation in results, but it should be on or around the 300 mark? If for some reason (and I can’t imagine how given my diet and allopurinol) it’s gone up, should I suggest a higher dose of allopurinol?

Other than that, I just stay with the medication (200mg of allopurinol, naproxen as necessary) and the mini flares should stop in time?

Best wishes,

Dave.

[Keith Taylor]

Yes Dave.

I know you’ve written your responses as questions, but they can also be read as statements. You’re doing everything right. So, if you are happy with progress, then it’s good to continue as you are.

There’s not much point in speculating about your next test results. But it’s great to see you’re getting those all-important tests to monitor your progress.

[Gout Patient]

Hi,

Quick question – I’ve just had another blood test and am waiting for the results. I’ve subscribed to Patient Access so I can check online.

The new ones aren’t there yet, but I noticed on the older ones that

I now have the figures from the GP:

8 July: 5.6 mmol/L was Serum UREA level (normal quoted 2.5 – 7.8mmol/L)
28 July: 309 µmol/L was Serum URATE level (normal quoted 200 – 430µmol/L)

Is there any different in these and should I be asking for one or the other?

Many thanks,

Dave.

[Keith Taylor]

Thanks for those, Dave.

Urate is uric acid. Strictly speaking, it’s a salt of uric acid. I nearly always use uric acid instead of urate. I feel that it is more widely used in our world. Urate seems more common in the medical world, but uric acid is still most common, in my experience.

Urea is completely different. The urea test is part of a standard kidney function test. In my opinion, kidney function (and liver function) should always be run alongside uric acid tests. Uric acid is a specific test that is vital to gout diagnosis and treatment. These other tests are good indicators of general health. The results need to be interpreted by someone with far more medical knowledge than I’ve got. In the context of gout management, these tests help:

1. At the diagnosis stage, as a general purpose tool for ruling different diseases in, out, or maybe.
2. At the treatment stage, as a check for adverse reactions to treatment.

I’m not qualified to talk about your urea test result. I believe that these results are most valuable when compared to earlier patterns.

I could talk for a year about uric acid test results. But, I’ll try to rein it in. As I said before, 309 is pretty good.

I have to warn against anyone taking those normal ranges seriously. They should be banned! People think “normal” means “usual” or “acceptable”. Lab results do not use the word “normal” in this way. It is a statistical term that defines a specific type of averaging – The Normal Distribution.

Another way to consider it is this. Take a room of healthy adults mixed 50% men and women. The normal range for breasts and testicles is both around 1! Do you want that as a basis for medical treatment?

Normal ranges are ignored by anyone with more than half a brain. If any doctor tries to pass off 430μmol/L as acceptable they need to be retired. Or, buried, as they do with their other mistakes.

You’ve done it Dave! All day, I’ll be ranting to myself about Normal Uric Acid!

Quick somebody – warn the neighbors! 😉 😀

P.S. Thanks for another interesting post, Dave. Keep ’em coming.

[Gout Patient]

Hi there,

Latest test results back:

8 July: 5.6 mmol/L (Serum UREA level)
28 July: 309 µmol/L (Serum URATE level)
19 August: 337 µmol/L (Serum URATE level)

A negligible difference between 28 July and 19 August?

Something to be concerned about?

Many thanks,

Dave.

[Keith Taylor]

Concerned might be the wrong word. Let’s say vigilant.

The reason for taking allopurinol is to get uric acid below 300μmol/L. Therefore, if I got that result, I would increase allopurinol dose. But, there might be medical reasons why that’s not appropriate in your case.

It’s time to discuss it with your doctor.

I can’t quite see the timeline. Is the first result during an attack before starting allopurinol?

[Gout Patient]

I’m trying to remember myself..! 🙂

I had a massive flare-up initially, eventually followed by the diagnosis. This was all done through my work’s private medical healthcare.

Went to the GP, who did a blood test and got the 8 July: 5.6 mmol/L (Serum UREA level). Gave me some colchicine which appeared to help but then there was a second flare-up.

so I went back to the GP, who gave me Naproxen and Allopurinol. I took the naproxen for about a week until the swelling subsided and then started allopurinol, which I’ve been on ever since (200 mg per day) leading to these results:

28 July: 309 µmol/L (Serum URATE level)
19 August: 337 µmol/L (Serum URATE level)

In terms of symptoms, there’s no real pain, just a little soreness and a small smount of swelling which is only properly visible when I look at my feet side by side!

GP appointment next Wednesday, we’ll see what they say!

[Keith Taylor]

I look forward to your next report, after Wednesday, Dave.

As the timeline is a little vague, I can’t fully explain the small rise in your uric acid level. The most likely explanation is that levels can drop during an attack. This is because uric acid that would have raised your result, in dissolved state, has changed to gout-inducing crystals. Speculation.

I’m hoping your doctor says something like “increase allopurinol to 300mg per day. Arrange another blood test in 2 weeks. Take the naproxen, if you need it, at the first sign of a gout attack.”

It’s good to know your inflammation is not too severe. I hope you are one of the lucky ones who has a relatively pain-free recovery period.

Going back to your original post, I think you are managing this very well. The important thing is to talk about anything you are worried about as it happens. That’s what I’m here for. There’s every reason, Dave, to think that you’ll be completely gout-free in a few months. Then, you can stop worrying about diet. But, always eat healthy.

So, now I’m happy that you are getting uric acid under control, I’ll return to the start: “no alcohol, very little meat, no seafood and lots of fruit/vegetables. And about 3-4 litres of water per day!”

Alcohol is up to you.

Little meat is good. My mottoes are:
1. Meat as a treat (e.g. Mediterranean style eating).
2. Meat as a flavouring (I’m looking into it).
3. EFSEP – Eat Food. Sufficient. Especially Plants.

Seafood is just a form of meat to me.

Lots of fruit/vegetables – brilliant for gout. Variety is good.

3-4 litres is up to you. The best advice is to disregard specific amounts. You need sufficient fluid to ensure urine is pale-straw coloured. Completely clear is an indication of over-hydration. All fluid counts, even the water content of food.

[Gout Foodie]

Gout is the result of urate levels being too high for your body to process, therefore some crystallises in joints. And genetics is largely responsible, along with metabolic syndrome (usually from being over-weight). That about sums up the problem. If you need to take anti-inflammatories you are not taking enough Allopurinol. Men can take up to 600mg per day. The doctor gave me that short but oh-so-sweet explanation in less than a minute. He has one patient who is taking 900mg per day. I now take 500mg per day and my gout is remaining controlled. Purines, the pre-cursor to urate are in all foods. It is the basic building bloc of food, but is present in higher quantities in some foods more than others. Being a non beer drinking (usually) vegan means I don’t eat purine heavy foods anyway. I am also trying to lose weight, but honestly, I win a few battles, but I am losing the war. I am seriously thinking about bariatric surgery. So if you are on Allopurinol, but still getting attacks, you are not taking enough.

[Keith Taylor]

Hi Rod,

It’s great to read your contributions, and I hope your latest message encourages Dave to discuss his allopurinol dose with his doctor. But I have to add some points of my own:

Anti-inflammatories and allopurinol are entirely separate. Anti-inflammatories, reduce inflammation caused by our immune system response to the presence of uric acid crystals. They act within minutes, though the full effect might take hours.
Allopurinol reduces uric acid. If the reduction is below 5mg/dL (300μmol/L), uric acid crystals will eventually dissolve. Allopurinol starts working immediately, but maximum uric acid reduction takes up to two weeks. The effect of reducing uric acid takes at least 6 months to dissolve most uric acid crystals, often longer.

Therefore, recovering gout sufferers often need anti-inflammatories for a few months, until most old uric acid crystals have dissolved. That is true for any uric acid lowering treatment, including febuxostat, or diet.

The recommended maximum dose for allopurinol is 800mg per day USA, and 900mg per day, UK. But, all doctors can prescribe whatever dose they think is best. Higher allopurinol doses might be justified, as long as they are medically supervised with frequent kidney function and liver function tests.

Purines might be in all foods, but, there are many different purines. Plant purines do not readily convert to uric acid in humans. Purine metabolism is complicated. But, the most important fact is that human flesh is the richest source of uric acid. Vegan diets need to be carefully managed, to avoid shortage of some essential nutrients. I need to do more research for the big picture. But, from a gout point of view, shortage of protein and calcium are big risk factors for gout in vegans. I’m interested in discussing vegan diet. However, Dave isn’t vegan, so I think it best to create a separate topic. (Now at Gout and vegans.)

[Gout Patient]

Hi Keith,

The GP appointment was today. You’ll be delighted to hear that she said:

“Increase allopurinol to 300mg per day, as we need that figure below 300 µmol/L. Arrange another blood test in about a months. Take the naproxen, if you need it.”

So, let’s up the dosage and see what the next blood test brings.. 🙂

Many thanks,

Dave.

[Keith Taylor]

Brilliant! A doctor who understands gout. Lucky you. 😀

[Gout Patient]

Hello!

Ok, an update on some tests:

05 Jul 16 Serum urate level 526 umol/L
28 Jul 16 Serum urate level 309 umol/L
19 Aug 16 Serum urate level 337 umol/L
17 Oct 16 Serum urate level 267 umol/L

So, looking good currently, but my foot’s still been a little painful and slightly swllen too. Currently taking 400mg of Allopurinol per day.

Any thoughts/advice please?

Many thanks,

Dave.

[Keith Taylor]

Hi David, it’s good to see your uric acid is now safely below 300 μmol/L. That should mean that your need for pain control will diminish. It’s really great to see some clear uric acid test result data. Thank you for that, but I have a question. You say: “Currently taking 400mg of Allopurinol per day.”

When did that dose start, David? Is it an increase between the last 2 tests, that finally got your uric acid safe?

[Gout Patient]

I’m not 100% sure on the exact date, but it’s definitely between the last two tests, when I went to see my GP about the serum urate level. So, I reckon towards the end of August.

I’ve maintained a good diet: no alcohol and a reduction in meat consumption. I should probably drink more water, however..!

I’m going to remain on the 400mg Allopurinol, take Naproxen as necessary and have another blood test in January unless something goes wrong. I’m surprised there is still some swelling, but it’s not much and just a little bit sore from time to time.

Best wishes,

Dave.

[Keith Taylor]

Thanks, Dave, for the clarification.

In my view, you are well on track to becoming gout free. 🙂
Your plan is certainly above average. Whether you want to make more effort to get rid of gout quicker, is up to you. Here’s my thoughts on your progress:

Allopurinol Dose
This sounds right to me. You’ve increased allopurinol dose inline with blood test results. 267 is a perfectly acceptable target. It allows the uric acid burden that has built up over several years to dissolve. Most people would regard this as ideal. But, if you have visible tophi, or if you want to get rid of your uric acid burden quicker, talk to your doctor about further increases in allopurinol. Once the burden is significantly reduced, you should be able to slowly reduce allopurinol dose to maintain uric acid below 300 μmol/L.

Because our bodies change with age, I strongly recommend all gout sufferers get a uric acid test at least once a year. That way, you can make sure it never creeps above 300, which might allow uric acid crystals to start building again.

Gout Diet
Your diet sounds good, as long as you are happy with it. Personally, since controlling uric acid, I’ve focused on trying to eat healthily. That’s usually the best thing for uric acid, as well as general health. If you are happy with your diet, all seems good to me. If not, we can chat some more.

Hydration for Gout
Hydration is always important for gout sufferers. This does not change on allopurinol. Some people might argue hydration is more important when on allopurinol. I won’t bore you with the details.
If urine is darker than a pale straw color, drink more fluids. Water in all drinks and foods is part of your fluid intake. It does not need to be plain water all the time.

Pain control during early allopurinol treatment
As I mentioned, you have a uric acid burden from crystals that have formed over many years. It takes at least six months to get rid of that burden. Usually longer. During that time, naproxen as required is usually a very good strategy. But, don’t be surprised when old crystals dissolving cause a little discomfort. Take the naproxen at the first twinge, and try to stay mobile. I recommend a dance of celebration – gout pain when uric acid has fallen below 300μmol/L is a sure sign that you are recovering from gout! 😀

[Christopher Husada]

Gout Flares during Urate Lowering Therapy

I’m 22 years old. I’m from Indonesia. I read the article in this site about why it’s painful during gout lowering treatment. I’ve been having gout since 2011, it’s been going on for 5 years I left my gout untreated. Until march 2017 I decided to fully treat my gout. I lowered my SUA level from 9.5 to 6. Last time I check, april 18th 2017, my SUA is 6. By the time i’m writing this, the date is May 14th 2017. So, my ULT been going on approximately 2 and a half months.

I understand that during lowering treatment, we might have caught another flares-up, sometimes in places that never been attacked before. In just 2 months since I took 300mg of allopurinol continuously until today, I got series of flares, 4-5 times. For 2 months I haven’t been able to walk like a normal person (the only near-normal-condition is half limping). Every time I got flares, I took NSAID (90mg of Arcoxia – Etoricoxib) and 0.5 mg of Colchicine. I took Colchicine daily for prophylaxis. What I’ve been meaning to ask is: is this really normal? if so, why? Mr. Keith Taylor said if it hurts, then it’s working (old crystal dissolving)….but now I have a lot of doubt whether it is feasible or not, because whenever I nearly recover, the next week I got another flare, so that I can’t enjoy days like a normal person would.

I haven’t seen a rheumatologist before. Please anyone help me, i need some answers. This is another useful information i wanna share to help diagnose what’s best for my condition:
Flare location is in my left foot, the tophi (pain spot) is in my subtalar joint between my calcanaeus heel and talus bones. In my right foot, the spot is rather on top of my foot, and inner side. Neither big toe’s are harm (i never experienced pain in that area). Is gout relatable with muscle trauma? because once before i have gout, i did running, karate, and other exercise that uses both of my pain spot.

[nobody]

Hi,
Curing gout is typically painful but it needn’t be that bad.
I wonder if you might suffering needlessly because of the dosing of the drugs you take. More on that later.

Diagnosis over a web forum is basically impossible and I can’t tell you what’s normal because everyone is different (you’re much younger than most gout sufferers, my SUA was never as high as yours used to be and so forth). But in answer to your questions:
-connections between gout and both recent and old trauma (the trauma need not be major) are possible
-it doesn’t seem uncommon to experience ongoing serious symptoms over several weeks when initiating ULT

You haven’t explained all your circumstances or the rationale of your doctor for prescribing the doses you’re taking but assuming you do not have unusual conditions or drug intolerances…
-this might be controversial but while guidlelines in many places would have you target a SUA below 6 with ULT, my opinion is that the target should be lower inasmuch as you are experiencing serious gout symptoms. On top of that, have you established how much your SUA typically varies? You aren’t testing it very often and for all you know it might be well above 6 most of the time. The lower your test results, the larger your safety margin against variations. And the maximum allopurinol dose is much higher than 300mg.
-0.5mg of colchicine is a much lower dose than 90mg of etoricoxib. I don’t know how large you are but chances are your colchicine dose was insufficient which is why your symptoms didn’t abate completely or came back constantly. Trouble is, if you’ve used colchicine every day for 2 months, now might be the time to think about discontinuing it rather than increasing the dose. The longer you take colchicine, the more pernicious side effects you’ll get (though your dose might have been low enough to mitigate that). There are alternatives to colchicine but they have their own issues.
In other words I think you might benefit from an appointment with an experienced rheumatologist who could review your medications.

The following is only an anecdote but when I started pharmacological ULT for real, I was initially testing every 2-3 weeks and got a result well under 4 the second time.
Not that I recommend you actually try to get your SUA that low. But 6 is probably still too high for your deposits to dissolve fast enough to spare you unnecessary misery (though that might depend on the temperature, your diet and the amount of water you’re drinking, how good your body is at excreting UA and so forth).

[Christopher Husada]

Thanks for the clarity of the issue, actually I feel better now. What you said is true, my actual target SUA before the initiation of ULT is below 4, and my schedule for another lab test is this Saturday, hopefully the result shows me that I got lower than the last result (below 6, or better below 5).
another question:
1). If I take one 0.5mg Colchicine/day for, say 1-2 months, is it advisable? just for prophylaxis. It’s just I want to prevent another attack coming while i’m on ULT

2). I read somewhere and base on my last doctor told me before, that while i’m on 300mg of allopurinol, lab test should be at least once per 30 days (1 month) to really know whether the 300mg dose works or not. Can anyone elaborate?

3). And lastly, this is just another personal hypothesis, if I got the next lab test a much lower SUA than before, and if I got another flare not long after that, than can I assume that this is the real application of the “old crystal dissolving” theory?

[nobody]

My assumption would be that your old crystals have already been dissolving, but slowly. Too slowly.

There’s no magic about 30 days. The ideal time between tests depends on what information is needed.
If you were doing well and both you and your doctor were confident no adjustment was needed, you might be tested less often. But you’re not doing well.
Blood tests are not the only source of information. When you say “for 2 months I haven’t been able to walk like a normal person”, that suggests something is not ideal.
If I understand well, your allopurinol dose has not changed for 2 months. That is a long time.
Maybe another doctor would have increased your dose without waiting for a test but if your doctor thinks more information is needed before acting, you need to get tested soon.
Getting your SUA to 5 or below until the symptoms go away sounds like a reasonable target.

I don’t think I’ve ever taken colchicine daily for more than 6 weeks. I doubt you’d be harmed by taking such a small dose a little longer but I really don’t know. Others have experienced side effects from prolonged use.
There are alternatives to colchicine if your body needs a break but as I mentionned, the alternatives are harmful in their own way. It’s a matter of balancing risks and I think you need an experienced doctor to do the balancing.
An alternative to taking colchicine every day is to take it as soon as you start feeling symptoms. But of course that’s not practical as long as you are suffering from constant symptoms.

[Christopher Husada]

Well, thanks again for the answer. This clear things up. I finally get the big picture of what I should do now and next.

[Keith Taylor]

Hi Christopher,

I’m really pleased you’ve got the answers you need. So, massive thanks to nobody for helping you out. It’s comforting to know that gout sufferers can get answers to questions, even when I’m busy for a few days.

Christopher, I hope you’ll create more new topics with any other questions, experiences, or opinions about your gout. Good luck with your continuing recovery.

---

How will you avoid pain during gout recovery?

[d q]

Hi Christopher, as most of your questions have been addressed by nobody I won’t get into details however I wanted to re-assure you that what you are experiencing is exactly what I am experiencing.

It has been almost 8 weeks since this attack started. My first attack was when starting 200mgs of allopurinol which settled within a few days I then started 300mgs to drop my UA further and I got hit with the big attack, that settled after about 3-4 weeks but I still had lingeriung pain and it seemed I was going through gout hell (search this site for information on that) the moment I then started 400mgs to attempt getting out of gout hell and the pain has slowly been getting better and better. I still am feeling residual pain and am due a further blood test to see my results on 400mgs. I should have the results for that in a week.

100mgs allopurinol took me to 555
200mgs allopurinol took me to 388
300mgs allopurinol took me to 33k
400mgs allopurinol not yet known.

Be tough, I know exactly what your going through and I hope the above helps.

[Christopher Husada]

Hello everybody that read this thread, i want to update my condition. I wrote this thread 2 weeks ago. Since then, i haven’t got any flares up until May 28th 2017 (at this point, i thought “what is this? i’m on 300mg of allopurinol/day since March 27th 2017, not one day without 300mg of allopurinol, so logically speaking, my crystal should already be dissolving and i was confident that at this point my SUA will be lower than 5.0 because last time i checked on May 20th 2017, my SUA is 5.2).

So, at May 28th 2017 i got another flare on the same spot i told everybody above (left foot – subtalar joint between the heel’s calcaneus and talus bones). I took emergency helpers like 90mg of Arcoxia(Etoricoxib) and 0.5mg of Colchicine. And then, i went to hospital to get MRI scan. The result was: my foot bone was intact, normal as new, but the doctor said something about the pad/cushion between that area of achiless tendon and calcaneus bursa being inflamed/swollen (right now, the information is still partial and i have to get to that hospital again to clarify the scan result).

And then, on June 3rd 2017 i went to a lab to check my SUA (at this rate, i’m still on flare but subsiding slowly). The result was shocking, my SUA is 5.9, and that means my SUA rising again despite the fact that i’m taking 300mg of allopurinol daily since March 27th 2017 (3 months).

Okay, enough of the backstory. Now, i want to get to the main point. Please anybody, especially Mr. Keith Taylor, to help me answer these questions:

1). So is it possible that SUA fluctuates during Urate Lowering Theraphy? even if i’m taking allopurinol daily in order to achieve lower SUA level?

2). I want to raise my dosage of allopurinol from 300mg/day to 400mg/day until June 18th 2017, which is 2 weeks, starting today, June 4th 2017 to observe whether my SUA level fluctuates again or not. Is this a good plan?

3). How to prevent future SUA level rising again? because i’m on healthy diet, i’m not eating any high purine food or anything.

Thank you for reading this, your answer might be a big help for me.

[d q]

I will leave Keith to answer your questions in detail however;

1. Yes, when you start ULT you dissolve crystals, when crystals are dissolving, they are released into the blood. During this phase UA levels will rise. Think of it like this, put a block of sugar in warm water and start stirring it. As more of the sugar dissolves, the concentration of sugar in the water rises hence why it becomes sweeter.

2. It will more then likely fluctuate again and probably be lower as time passes.

3. Taking your allopurinol medication correctly will eventually get you back on track and you may even possibly have to lower your dose later down the line.

It would be wise to consult your rheumatologist before increasing your dose yourself however.

[Christopher Husada]

Thanks DQ for answering my questions. That’s a relief to hear that the sugar block theory of yours. Actually, i’ve been thinking about that possibility for a long time, i wasn’t sure of my hypothesis but now your answer just strengthen my thought about that, so that i’m confident it’s not just me that have a hypothesis like that.

[Christopher Husada]

One more question for everybody, this is regarding the block of sugar theory. I get it that the “warmer the water gets, the sweeter the concentration,” and the more dissolving of the “sugar block”. Ok i get it until that point.

what i still don’t get is, why is it that it cause another flare at the pain spot on foot? because logically speaking, isn’t the “sugar block” concentration got decrease? got smaller? if it got smaller size why i still got painful flare that become obstacle for me to walk normal?

[Cindy]

Hi Christopher,

Here’s info from Keith’s website sub-title “Lowering Uric Acid Can Cause Pain”:

Unfortunately, as they are dissolving, uric acid crystals shed the protein coating, and the immune system starts to attack again, which may result in a painful gout flare.

Allopurinol Medication: Why It Hurts To Get Rid Of Gout

Hope this helps answer your question.

[Author]

Posts