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Thanks for this great question, Alan. It’s very interesting to me for a few reasons.
Most importantly, your question highlights the problem of getting new gout research known to frontline medical professionals. Because, we now know that, for most gout patients, there is no need to wait for gout flares to resolve before starting allopurinol. So, that’s the quick answer to your question – start now.
Then, you ask, what will happen if you don’t start allopurinol now. So, again, the quick answer is, you will needlessly delay your admirable goal of wanting “to get to the root of the problem”
Now, I’ll indulge myself with a bit more explanation. Please feel free to ignore this if you wish. Because, most of it relates to the importance of your question to how I manage GoutPal.
Firstly, I searched for “should i start allopurinol now or wait until all pain is gone”. But, as you can see, there are no results that are relevant to your question. Because, it’s a fine example of the paradox of asking good gout questions. That is: you don’t know the best way to ask the question until you know the answer.
Incidentally, I get round that paradox in 2 ways:
– Either, you do exactly what you did, and post your question here. That’s the best way for most gout patients.
– Or, you start a structured help project. Which, requires time each week, but results in a more personal answer.Next, I changed my search to “when should i start allopurinol”. So, I was delighted to see my complete explanation at the top of those results: Start Allopurinol Quickly, But Carefully. But, in reality, it’s not the complete explanation about when to start allopurinol. Because, I need to improve that page to reflect:
1. More recent science confirms the findings of the report I reviewed.
2. The message needs to be clear: this only works where the gout patient is confident of gout pain control during uric acid lowering. So, I believe this to be true in your case, Alan, as you refer to indomethacin with confidence. However, I’m slightly concerned that you don’t make any reference to uric acid blood test results.
3. I need to widen the scope of this key information to ensure it gets picked up by searches similar to “should i start allopurinol now or wait until all pain is gone”.I hope that answers your question adequately, Alan. If not, please ask for clarification. Also, please feel free to ask more questions about managing your gout recovery. Because, I want to be sure that 2017 is the year you finally kill the root of your gout problem.
Wow! Thanks, d_q ๐
Your kind thoughts are exactly the reward I crave for running GoutPal. That’s not to say that I constantly crave praise. But, it’s very satisfying to know that I’m helping gout sufferers.
However, I must return the compliment, and praise your bravery on behalf of thousands of gout sufferers that you help every day. Because, your questions help in two ways:
1. You step up and ask questions that thousands of gout sufferers want to know the answer to. But, most people are scared of asking questions in forums. Also, quite rightly, they want to keep their medical situation private. Then, they see you’ve braved the barriers, and got the information they also need.2. Your questions often make me think about ways I can make my information better. Sometimes, this is new gout information that I need to publish. Often, it is improvements to current information. Either way, you prompt me to improve GoutPal.
Ultimately, I think it would get tedious if we all spent every day praising and congratulating each other. But an occasional ‘thank you’ reminds us all we are doing something worthwhile.
So thanks again d_q, and thanks to everyone who makes time to post to the gout forums.
Generally speaking, uric acid meters are effective. But, a lot depends on your personal reasons for wanting to monitor uric acid. Especially, what you want to achieve from the results. Significantly, I’ve never seen anything to suggest that uric acid meters can predict gout flares. Just like a speedometer won’t accurately predict a road traffic accident.
Most uric acid meters are manufactured in China and Taiwan. The important thing is to find a supplier with good pre-sales and after-sales support. So, I recommend UASure from Arctic Medical. Because they offer good service throughout the world.
In conclusion, there are some situations where uric acid meters are very effective and useful for gout management. But, they depend on your gout history, and how you want to manage your gout in future. So, I recommend you start a new topic. Then, you can explain more about what you hope to achieve.
nobody, I think it’s great that we bring different points of view to this forum. After all, gout management has to be tailored to each individual. Therefore different gout sufferers will, and should, make different choices.
Also, there are often several different ways to reach a solution. So, the only wrong way is that which is taken without considering patient needs. I realize this is a generalization. But, pain control is a good example. Personally, I think steroids are to be avoided at all costs. Yet, I vaguely recall an article by a rheumatologist. Where he explained that sometimes they can be the right choice. So, my approach generally is to look at what a gout sufferer is trying to achieve. Then, work from that, gathering relevant personal facts, to find acceptable, appropriate, gout therapies.
Unfortunately, I’ve completely lost the point of this topic. Also, it’s very long for finding any outstanding questions. So, d_q, can I ask you to start a new topic for any unresolved questions. In fact, unless they are closely related, I prefer one question per topic. I’m not trying to be awkward here. I just want it to be clear to other gout patients who are looking for information about general gout attack severity and gout duration.
That’s great news, Steve.
I’ve no data about what happens during the first few months of allopurinol use. But, logic tells me that it might fall further. Because, you will have fewer old uric acid crystals to dissolve.
However, we’ve seen elsewhere that a single test is not the full picture. Because, there are natural variations in uric acid. But, the main objective is for old crystals to dissolve, and gout attacks to reduce to zero. And that is likely to take months rather than weeks. So, you should see gout symptoms reducing in intensity and frequency. Then, the magic day comes when you can’t remember when you last had an attack.
I’m looking forward to that happening for you ๐
Whenever you have gout-like symptoms, but no clear gout diagnosis, you should consult a rheumatologist. Because, as well as further blood tests, joint fluid analysis is vital to rule out other potentially dangerous diseases.
What might arthritis be if it isn’t gout?
I mentioned earlier: “I invite you to give me a brief overview that I can use as piece on my main website. Then, Iโm convinced that will attract many more answers to your 3 questions.”
Now, with 2 extra questions, we have 5 in total. So, I believe that reinforces my idea that a survey on my main gout website will bring more responses. Also, I’m planning a new survey on uric acid test costs. So, those surveys might complement each other.
Of course, it’s entirely up to you. I’m happy either way. ๐
Thanks for the info nobody.
For all the issues with NHS-type setups, they do keep costs down.
I’m a massive fan of UK’s NHS (National Health Service), where blood tests are free. Hence my interest in costs for other nations. Because, collectively, we might find ways for needy gout sufferers to get better, affordable blood tests.
This is probably a long shot, but I’m hoping others will join in and share their uric acid blood tests and experiences. Anyway, I think I’ll add a survey form to relevant pages. Because, people tend to respond more to surveys than forum messages.
Your experience of big variations is interesting. I’ve never noticed that with professional tests. But, I’ll bear it in mind when other gout sufferers report strange results that affect their diagnosis or treatment.
But, that page actually says (my bold):
The medicinal uses of alfalfa stem from anecdotal reports that the leaves cause diuresis and are useful in the treatment of kidney, bladder, and prostate disorders.
[…]
There is no evidence supporting the use of various parts of the alfalfa plant for diuretic, anti-inflammatory, antidiabetic, or anti-ulcer purposes.Also, it claims some evidence for positive use against cholesterol. So, I searched further, and found a better referenced article about alfalfa and uric acid:
Alfalfa may increase serum urate and urea levels
Unfortunately, I’m still waiting for my full copy of that article to see in more detail what the specific effects are of alfalfa on uric acid. So, if anyone has access to the report, please let me know. It’s:
Alfalfa seeds lower low density lipoprotein cholesterol and apolipoprotein B concentrations in patients with type II hyperlipoproteinemia. Atherosclerosis 65(1-2):173-9 ยท June 1987. Mรถlgaard J, von Schenck H, Olsson AG.In any case, it’s always best to test herbal gout medicines by blood test. Because herbal medicines are likely to have different effects based on stage of gout recovery, baseline uric acid levels, and combined effects of other supplements and diet. Therefore, do something like:
1. Get uric acid test, and record results.
2. Start taking, or stop taking alfalfa for at least 2 weeks.
3. Repeat steps 1 and 2 until clear results are demonstrated. Or, abandon due to lack of clear connection.Not for this thread, but I’d be interested to read about your experience with uric acid test. Because, I’m intrigued by your cost issues. But, more importantly by “results tend to be all over the place.”
Anyway, that’s up to you. Because, I’ve no wish to intrude. But, more importantly, I agree with your skepticism on point 3. Over the past few years, I’ve read lots of new revelations about our understanding of triggers for gout flares. Also, I don’t recall any research that links gout flare incidence to changing blood uric acid levels.
Now, it’s clear that flares cannot happen without a history of excess uric acid. By which I mean uric acid levels high enough for crystals to form. Also, uric acid levels in the blood might be a factor in triggering gout attacks. But, the latest research that I’m studying suggests that a bigger flare factor is related to Free Fatty Acids (FFAs).
On the bright side, boffins might confirm the FFA connection. Then, maybe, measure FFAs together with uric acid, non-invasively. So, given the if, buts, and maybes, we might have an effective solution.
But, I have to conclude with another note of skepticism. The biggest tragedy of gout management is that frontline healthcare professionals do not follow professional rheumatology guidelines. So, would better uric acid monitoring necessarily lead to better gout management?
This is exciting! Because, I love to hear about new ways to help gout sufferers. Of course, I’d love to know more about the processes you are researching. Therefore, I invite you to give me a brief overview that I can use as piece on my main website. Then, I’m convinced that will attract many more answers to your 3 questions. Pending that, here’s my answers:
1. It would interest me to the point of obsession. But, to put that in context, I’m obsessed with most practical gout research. More importantly, I feel that gout sufferers are very badly served with current uric acid test facilities and interpretation of results. So, anything that can improve that is at least as revolutionary as Uloric to gout sufferers. With more knowledge, I might even claim it’s as revolutionary as DECT for uric acid deposits monitoring. Can you imagine a world where we can get non-invasive measurement of total uric acid burden in crystal and dissolved form? I’m so excited I won’t sleep until I find out more! ๐
2. I’ve suffered excruciating pain. Worse than that, permanent uric acid damage to my joints still restricts my knee mobility despite having gained complete control over my gout.
3. I would take 2 colchicine tablets (1 to 1.2mg depending on tablet size). In the past, I would have done this at the first sign of gout symptoms. So, I would have added a dose of ibuprofen. Then, I would monitor the symptoms and take further pain relief if necessary. If I had access to your early warning system, I would still take the colchicine. But, I would monitor my symptoms, before taking anti-inflammatory or other analgesic relief if necessary.
As ever, if there is anything about my response that needs clarification, please ask.
Uric Acid chart is not necessarily relevant to the research in this topic. But, it’s the only relevant image I could find
Oops, I forgot the latest Gout Gamechanger: DECT.
It’s fascinating to see this flagged by EULAR as one of the key targets for immediate gout research. So, I’ll be updating my DECT for gout pages very soon.
Also, I’m not sure of the timeline, but another recent Gout Gamechanger is the knowledge that uric acid crystals alone do not trigger gout attacks. The related article that blaming high-purine meals for gout attacks might be a red-herring was definitely a game changer for me.
I hope you don’t mind, but I’ve changed your post to keep discussion of your research in one place. Because, this thread is about buying uric acid meters.
Now, once you have something that people can buy into, I’d welcome your input about how people can get practical value from your research. That might be specific invitations to take part in trials. Or, updates about where your process is available commercially, or medically.
It’s exciting to be involved with your research into new ways to help gout sufferers. But, I don’t want to confuse people who are reading this topic for practical advice on currently available ways to monitor uric acid.
If you agree, there’s no need to reply to this. Otherwise, I’ll be happy to read your views. In the meantime, I’ll add my comments to your main topic: Continuous uric acid monitoring
Gary, I must apologize for introducing the idea of monthly blood tests. That was in relation to my suggestion that allopurinol is the correct medical treatment for you. So, if you do not want to pursue that with your doctor, then please forget my suggestion. But, if you do want to push for proper medical treatment, I will look for some Canadian guidelines that show allopurinol is the correct medical treatment in your situation. Also, if you are getting allopurinol treatment, uric acid monitoring is definitely your doctor’s responsibility. So, in that case, buying a monitor would be pointless, in my opinion.
Now, let’s think about other alternatives for controlling your dangerous uric acid level: herbal gout medicine or lifestyle changes. In either case, a uric acid monitor can be useful. Personally, I think it’s best to have an outline plan before investing in a uric acid meter. But, I accept they are cheap enough to just buy one to see if it suits you.
Maybe you’ve seen the discussion about Where can I buy an Accurate Uric Acid Monitor?. Because, there’s been a recent post about comparing different uric acid meters. However, I’m still of the opinion that the UASure uric acid meter is the best tool for the job. Arctic Medical are global distributors of that meter. But, although they are based in the UK, they do provide global pre-sales and customer support. Anyway, only you can judge if it’s easier to deal direct or through your brother-in-law.
I’m sorry if I confused you, and I hope this clarifies your choices. Also, I hope I can continue to help you decide your best way to get rid of your gout.
There are several factors that determine when you should start allopurinol. The latest guidelines from professional rheumatologists say you should start allopurinol if any of these are true:
1. More than one flare per year.
2. Visible tophi.
3. Uric acid crystals in joint fluid.
4. Age less than 40.
5. Uric acid blood test result more than 8mg/dL (480μmol/L).
6. Also suffer from kidney disease, high blood pressure, coronary heart disease, or heart failure.I’d say, the values in point 5 are high. So, I’d recommend discussing allopurinol if uric acid blood tests show more than 7mg/dL (400μmol/L). However, at this level, gout sufferers might also consider lifestyle improvements to lower uric acid. In any case, uric acid should be tested frequently to see if it’s getting worse.
Tom, I hope that helps. But, if not, please ask for clarification. Going forward, if you want better individual help, please post uric acid test results.
Hey Gary, as you are new to GoutPal, you won’t know about the rages I get into when doctors talk about normal uric acid. But, you’ll get the idea if you search for something like normal uric acid rant.
Anyway, my point is that normal uric acid is medically meaningless. Because, it’s simply a statistical average. But, average people get gout. So 6% of men in that reference interval will have gout. And, Gary, you are one of them. and you don’t need a uric acid crystal test to prove it. Because, any uric acid level over 400μmol/L is dangerous. So, you have to get below 300 to be safe.
Now, allopurinol will make you safe. But if someone doesn’t understand uric acid test results, they won’t manage allopurinol properly. Trust me, I had to argue this out with 3 of the 4 doctors I consulted about managing my gout.
1. Allopurinol needs monthly monitoring through uric acid tests. Because, allopurinol dose must be increased until uric acid is safe. Once your uric acid levels drop below 300, you can extend period between uric acid tests. But, always test at least once per year. Also, uric acid tests should be accompanied by liver function and kidney function tests.
2. Until you have had uric acid below 300 for 6 months, you may experience gout symptoms. Because, partially dissolved uric acid crystals can trigger gout flares. So, we can adopt strategies to help you manage this. Then, it should not reduce your quality of life, as you finally get free from gout forever.
Obviously, that’s a very quick overview, Gary. But please ask for clarification wherever you need it. I’m confident that we can work together to make sure 2017 is the last year you are ever troubled by gout pain.
