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Hi Zero,
Welcome, and let’s hope we can get this sorted fairly soon.
Firstly, I second everything nobody has written.
My first thought when I read your message was a feeling of concern about your uric acid test results. Because without reliable results, you will never get a straight answer. Anyway I hope some of my experiences are relevant to you.
- Home uric acid test kits. The real problem here is accurate blood sampling. Because a finger prick is drawing blood from capillaries. And that’s notoriously unreliable. I believe they have a place if you are very meticulous. So please don’t take this the wrong way. But “I take my UA levels daily at home, I’m usually in the 3.5-6 area.” is a sure sign to me that you are not meticulous enough. If you’ve kept a daily log, please post it. More importantly, do you have any lab tests to corroborate home test data?
- Gout recovery starts when you have gone six months without a gout flare with uric acid never higher than your safe target. Safe targets are controversial among gout doctors. Some aim for below 5 mg/dL. Others aim for below 6 mg/dL. But most primary care physicians don’t know what a safe uric acid target is – or what to do with it.
From your description, I can’t tell if you have started gout recovery and relapsed for some reason. Or if you are still in the early stages of dose adjustment to reach target.
As far as what to do next is concerned, I can’t really offer an opinion at this stage. Because analyzing data on your uric acid levels matched with allopurinol dose changes would be my first step. Generally speaking, it’s a bad thing to stress joints that are weakened by uric acid crystals. So I would consult a professional trainer in your situation. Then when your recovery starts (as per my point 2 above) you can gradually increase exercise intensity. The good news on that point is that studies I have seen indicated that joints damaged by uric acid crystals tend to recover once uric acid is made safe. Sorry that’s a bit vague – I’ll research deeper if you wish.
On reviewing my article about honey and gout, I see that I missed the study mentioned above.
Another recent study complicates matters. Because it refers to a controversial component of honey known as 5-hydroxymethylfurfural (HMF). Now this compound is limited to processed or aged honey, not fresh. But it does have the capacity to lower uric acid, as a Xanthine Oxidase Inhibitor.
Shapla, Ummay Mahfuza, Md Solayman, Nadia Alam, Md Ibrahim Khalil, and Siew Hua Gan. “5-Hydroxymethylfurfural (HMF) levels in honey and other food products: effects on bees and human health.” Chemistry Central Journal 12, no. 1 (2018): 35.So there are mixed reports on the benefits or drawbacks of honey for gout. That might be due to different types of honey. Or due to mismatches between its effects on animals and people with different starting levels of uric acid.
Until there are studies of honey for gout sufferers, I guess we will never know.
When my gout spread from my ankle to my knee, I knew it was gout. Because I’d already started researching gout symptoms. Mainly due to my first gout doctor who subjected me to a four-day hospital diagnosis. When he doubted I had gout because it started in my ankle not my toe.
Subsequently, I learned that gout is a progressive disease. Which can affect all joints and spread into all organs except the brain. Left untreated, gout is a serious joint-destroying, life-threatening disease. However, it’s really easy to cure with uric acid lowering medicines – if they’re managed properly.
Interestingly, Ancient Greeks had different names for gout depending on the joint affected. So foot gout was podagra and knee gout was gonagra. See Another Name For Gout for more gout names.
Untreated gout spreads from joint to joint getting worse every year.
Hi Irma,
I hope you got my help desk message. If not, please check your spam and also whitelist [email protected]. Or maybe this is your answer to my question about stopping allopurinol. If it was just a temporary stop, then that’s OK. But I will remain worried if you’ve been advised to stop allopurinol permanently without good reason.
Anyway, apologies to other readers for that private exchange. I’ll get back to the issue.
Doctors often stop treatments before blood tests if they are reviewing how the case is being managed. The idea is to get a fresh start by removing any complications caused by existing treatments before creating a new management plan. When I’ve spoken to people about this before, they’ve mentioned one or two weeks treatment-free before retesting blood. But that might depend on the drugs involved.
Allopurinol is soon eliminated from our bodies. But before elimination most of it changes to oxypurinol. Now oxypurinol lasts longer. But any remaining effects should be gone after three days. Since half of it is eliminated in 30 hours.
Allopurinol has relatively short half-life in plasma (2–3 h), whereas the half-life of oxypurinol is much longer (14–30 h) due to renal reabsorption (Pea,. 2005).
As nobody says, this is something that your doctor needs to explain. Because we are all in the dark about any potential change in your treatment. Also, I agree with his remarks about regular testing while taking allopurinol as normal. Otherwise, you cannot tell if your allopurinol dose is right.
I always worry when doctors start talking about withdrawing allopurinol without good reason. I’m oversensitive on this issue. Because I’ve seen too many friends have their later years ruined by illogical ill-informed allopurinol cessation.
Prepare for Baseline Uric Acid Blood Test by Stopping Allopurinol.
I’m very interested in your experience and would love to update my articles to reflect the use of Celebrex for gout patients. I had hoped I would have finished that by now. But everything seems to take longer these days. Anyway, If anyone has any questions, experiences, or opinions about Celebrex please share your thoughts.
Gamebronc, I hope you will start to care for your uric acid. Because gout is a progressive disease. So the occasional attack that you can cope with in your 60s becomes joint damage that stops you enjoying your 70s and 80s. If I can do anything to help you with that, please let me know. Because I have had several friends older than you and I who have wished they started allopurinol earlier. I’m 62 and I started a few years back. But I’m feeling the damage in my knees now so I wish I hadn’t delayed.
Hi Suyash
I refer you to the reply I gave Sandeep – https://goutpal.net/forums/topic/alternate-protein-sources-and-getting-rid-of-side-effects-of-feburic/#post-3097
Because my attitude to gout diet is:
1. First establish healthy eating patterns. So there’s a link to Indian government advice in my first reply.
2. Consider improvements to a basic healthy diet for better uric acid control. Now that means reviewing the weekly list of food you eat. So there’s not much more I can say without a list of what you eat now.As for exercise, there are no specific gout exercises. Except to avoid stressing joints. Because your joints will be weakened by years of uric acid crystals.
Finally, for now, you need to get your doctor to review your febuxostat dose. Because 7.2 mg/dL is still too high – get under 5 unless there are medical reasons why you can’t.
You just need a little bit of Enhanced Google…
In less than seven days Keith’s search results…
Is your Gout Pain so Bad you Can’t Think Straight?
Surprising what you can find with a crucial search engine. Even though it filters obvious spam there’s still enough to see that the only way this will lighten the burden of your gout is to lighten your pockets.
Hi Jorge,
Thank you for joining this forum.
I would like to discuss a few points you have raised. But the main one for now is:
But today I had a terrible pain again. And again, I don’t know why.
Because I believe this is the most important issue. Then once we’ve discussed this I might ask more about some of your other points.
I wonder if you know why gout pain happens. Because I can see that you are frustrated to see gout pain returning. So I have to ask you about your understanding of what gout pain is.
I want to explain it in terms that mean something to you. So perhaps you could explain to me how you deal with other types of pain in your life? Say toothache, headache, or any other type of pain that has happened more than once.
Why does gout pain return?
I also stopped allopurinol for a few years. It took about 5 years until uric acid built up enough to start gout attacks again. Anyway I restarted allopurinol and the attacks stopped again after a few weeks. But I’m very annoyed with myself. Because I got more joint damage when I stopped allopurinol.
One things certain – I’ll never stop allopurinol again!
So if I were in your shoes Dave I’d get uric acid tested. Because if uric acid is high those tweeks will get serious.
Hi Rob (@yahoouser)
I echo everything nobody said. Also, I’d strongly recommend seeing your doctor as soon as you can get there to get uric acid tested. With lockdown, that might be delayed. But once you are able, it’s your best start.
Once you do get the test results please let us know what your uric acid level is and what your doctor advises.
Very interesting – thanks 068694
Personally, I think I found the offender at sentence 4. But that’s only based on what I’ve read in this post. I probably don’t have all the relevant information.
The reason I say this is that your first 3 sentences explain about gout and allopurinol. So I was expecting some insight into your uric acid levels. But not a number in sight!
The whole point of taking allopurinol is to reduce uric acid to safe levels. Then it takes a few months for old uric acid crystals to dissolve. But after that, there’s no need to worry about gin, lager, or any other individual drinks or food. Except you want to maintain a reasonable diet to prevent other diseases.
Thanks nobody for this and all your great contributions.
My main reason for returning to post is part of my ongoing recovery of some anxiety issues and related mental health problems that got out of hand. So it’s fantastic to get back to engaging with people. The coronavirus epidemic is hindering that engagement process in the physical world. But you’re right – it encourages me to spend more time commenting online.
The diagnosis issues drag-on despite clearer guidelines from professional rheumatology organizations around the world. But I guess that’s part of the limited time most frontline doctors get for diagnosis. Because I’ve spoken with a few doctors who complain they often have to go with their best first guess. Then rely on the patient reporting back if the problem persists. Then they can look for other diagnoses.
Unfortunately, a lot of patients lose faith. So they move on to old wives remedies.
Hi Dermot,
This sounds interesting and I hope you attract many people who want to join in.
I’m sorry to have to delete your email link. There are a few reasons for this that I won’t go into here. But if you want to discuss it further please start a new topic here in the forum or at my help desk. If you want to get update notifications to this thread click the Subscribe link near the title above.
As far as your 2 questions:
- When is the best time to test blood for uric acid?
- Which is my recommended uric acid test reader?
I’ll prepare some notes and post my opinions soon.
It’s interesting (for me at least) to see increasing studies of gout and tendinitis (AKA tendonitis). I think some of this is down to advances in ultrasonic scanning whereby gouty tophi deposits are easier to see. So maybe symptoms that might have been diagnosed as tendinitis in the past might now be recognized as gout.
One such recent case is:
Mülkoğlu, Cevriye, Barış Nacır, and Hakan Genç. “A Rare Presentation of Gout: Achilles Tendinopathy, Ultrasonographic Assessment.” The American Journal of the Medical Sciences 359, no. 4 (2020): 245-246.Most commonly, arthritis in the first metatarsophalangeal (MTP) joint is the classical clinical presentation of gout. In chronic stages, gouty tophus deposits may cause soft tissue damage. Monosodium urate (MSU) may accumulate not only in the joints but also in the tendons and ligaments and may cause symptoms of enthesopathy [problems from uric acid crystals where tendons attach to bones] and tendinopathy [problems from uric acid crystals in and around tendons]. Herein, we report a patient with symptoms of Achilles tendinopathy, which is very rare presentation of gout.
I think some of our experiences suggest that tendon problems with gout are not as rare as suggested here. But accurate diagnosis can be very rare unless the big toe is involved.
I’m not sure if this post is the prompt. But people have been asking me help desk questions like “is CBD oil good for gout”.
There’s not much point asking me because I have no knowledge of, or interest in, CBD oil and related products. But I found a couple of studies that might be useful:
Devinsky, Orrin, Maria Roberta Cilio, Helen Cross, Javier Fernandez‐Ruiz, Jacqueline French, Charlotte Hill, Russell Katz et al. “Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders.” Epilepsia 55, no. 6 (2014): 791-802.Medicinal preparations from the flowers and resin of Cannabis sativa have been used in China since ~2700 BCE to treat menstrual disorders, gout, rheumatism, malaria, constipation, and absent-mindedness.
Ryz, Natasha R., David J. Remillard, and Ethan B. Russo. “Cannabis roots: a traditional therapy with future potential for treating inflammation and pain.” Cannabis and cannabinoid research 2, no. 1 (2017): 210-216.
This review cites 8 previous studies claiming benefits of cannabis for gout. Not specifically CBD oil:In general, the historical records indicate that cannabis root is most often extracted with boiling water and applied topically to treat gout
But all the gout references are hundreds of years old. However, if there are modern applications the authors note:
It is clear there are many different chemotypes of cannabis, including THC predominant, CBD predominant, and mixed types.60 Future research should compare the phytochemistry of hemp roots with those from various drug chemovars to determine if there are differences in active compounds.
As I said, I can’t be much help on this topic. But I’m happy to keep checking for relevant studies as long as the interest continues.
People have been asking about Epsom Salts for gout recently. Among other things we found:
- There was a variety of experiences ranging from “Epsom salt soaks make my gout flares less painful” to “never works for me so I stick with pain meds”.
- One person contributed a quote from an arthritis study:
The results of the study concluded that foot bath with Epsom salt procedure was effective in reduction of joint pain, stiffness and improving the … disease such as osteoarthritis, gout, rheumatoid arthritis and juvenile rheumatoid arthritis
Sabitha, M. “Evaluate the effectiveness of hot foot bath with Epsom salt on joint pain, stiffness, and physical function among patients with osteoarthritis in selected hospitals at Ottanchathiram.” PhD diss., Bishop’s College of Nursing, Dharapuram, 2018.
But if anyone else wants to discuss Epsom Salts for gout, it’s probably better to start a new topic.
[This is from a LinkedIn discussion. Shared here to help other gout sufferers avoiding uric treatment due to side effect fears]
Currently, I’m chatting with a guy at my help desk with similar allopurinol fears. So at some point I’ll gather some resources to address this issue.
For me, it came down to balancing potential allopurinol side effects with very real uric acid main effects. Because I had a broken knee and a gouty ankle at the same time. And I couldn’t distinguish between them pain-wise.
In fact, I dismissed the broken knee as a rare simultaneous joint flare. Until x-rays showed otherwise. So as soon as I got out of hospital I arranged with my doctor to start allopurinol.
By the way, I never discussed Uloric/febuxostat with him. But I’m more fearful of febuxostat side effects than allopurinol.