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I assume there are several effects at work and that one of them is as you mention that the blood can hold more UA when the temperature is higher, resulting in a effect similar to mild ULT. For what it’s worth, my longest attacks have started in the spring.
Temperature might affect UA excretion outside of dehydration. But I’ve noted weight loss before some summer attacks. So dehydratation might well play a role.I’ve had attacks after being out in the cold too.
I guess if you mostly stay inside and dress warmly in the winter, you’ll exeprience less temperature variations than you do in the summer.My rheuma did call colchicine an anti-inflammatory. And it’s not a steroid so…
I guess NSAID is a bit of a misnomer and that what’s really meant is peripherally-acting COX-1 or COX-2 inhibitor.I had told you about my little “combination” trial in another thread.
Briefly, it seemed to work. I didn’t notice any drug interaction. But n=1…I’ve tried different febuxostat doses and went on and off the drug. Sorry but I’m not going to sift through old notes to provide useless details. Suffice it to say that after decades of hyperuricemia, my SUA has consistently tested in the safe zone for the better part of the year. I went into some of the details in other threads when they were relevant.
I mean I’m not used to having so many attacks of this type. They had become quite rare and now I’m basically getting one every other week more or less at the same location.
I was saying that’s not a big surprise on account of my ongoing ULT.My hemo tests didn’t seem to be affected by febuxostat dosage but n=2. Meaning that the lack of change in observed hemo values could easily be a coincidence. Either way, I don’t have enough data to conclude anything other than what I’ve already told you.
I’m not currently taking NSAIDs. But it takes a while for the liver to recover. I guess taking something like febuxostat every day doesn’t help.
Like I told you, I tried mild “combination therapy” for one of these recent attacks, in part because you had asked about it and I had never tried that on top of febuxostat. Normally I would only use colchicine.
I don’t know if colchicine is technically an NSAID but I don’t call it that though we use it as an anti-inflammatory. I think paracetamol is technically an NSAID but we generally don’t call it that, do we? I used the phrase “and stuff” in case there was any doubt regarding the semantics, hoping that it would make clear that all drugs used in the face of gout symptoms were included. But since I’m only playing an English speaker on the Internet, I guess my shorthands must sometimes be opaque. And jokes about how words sound will be lost on me.In case you’re wondering why I’m not getting yet another joke, I don’t know this Bourne fellow. No matter.
The main reasons for getting frequent blood tests early on are:
-the allopurinol starting dose is low so as to minimize the damage in case you don’t tolerate it well but in case your system does handle it well, you’ll want to increase that dose quicker than every 6 weeks in order to minimize the length and severity of the numerous gout attacks people often get after starting allopurinol
-if on the other hand it turns out you do not tolerate allopurinol well, you will want to try an alternative before the side effects turn your system into a mess
It often doesn’t take many weeks for clear clues to show in blood tests.As to spinach in the purine list you found, it sounds about right. Spinach is only high in purines relative to the amount of protein and energy it contains.
Such lists shouldn’t be used a list of “good” or “bad” foods but as a guide to how much of any food you can eat before it might become a problem in terms of purines. And the amount of purine in the most nutritive foods shouldn’t be compared without adjustment to the amount in the least nutritive foods. Else there would be a way to make anything into a low-purine food: simply add water.
That said, there are issues with the purine list you linked to. There are several types of purines which have a different effect on the body. Most plants do not have the worst purine type. For instance your list might lead you to conclude that soy beans are slightly worse than chicken in terms of purines while they are actually much better.
Unfortunately, I don’t know any comprehensive list of foods which breaks down the purines by type.Yes, my two hemo test results since starting febuxostat were basically identical. In the last few years, all my other hemo test results have been a bit higher.
I haven’t had a very long attacks since I started using colchicine. Of course that attack is gone. But I got three other attacks on the same foot since then. This is very unusual for me but not a huge surprise considering my ULT. And these attacks seem to be getting milder.
The main problem is that my liver is struggling, probably more because of the anti-inflammatories and stuff than because of febuxostat. But of course it contributes to the problem. And it’s most likely the reason I’ve been taking so much colchicine and stuff in the first place.
I knew going into this than my liver was likely to be the limiting factor in addressing gout. You’ll probably be fine.Indomethacin is a dangerous drug which is know to affect some people’s stomach. That side effect causes many doctor and ER visits and can be deadly.
I don’t know if that’s the side effect you got but if so, there are drugs called PPIs you can take with indomethacin to keep that in check. Unfortunately, these drug have side effects too…
I would recommend discussing these side effects with your GP. As you noticed, the class of drug called NSAIDs which includes indomethacin helps a lot with gout symptoms. So even if you barely tolerate these drugs, it can be worth taking a pill or two during serious attacks. Maybe you could try another NSAID. Just be very careful not to damage your stomach and oesophagus.
I would never take indomethacin daily but some people do tolerate it, at least initially (the side effects can get worse over time).6 weeks is a long time. I would recommend getting an extra blood test or two during your first months on allopurinol (and colchicine if you end up taking that regularly).
Most people tolerate these drugs well but some people do not. You might not notice immediately if your liver takes them badly but a blood test would show abnormal liver function values. Kidney function is also something which should be tested often when starting these drugs.Thanks for the explanation but as you might have guessed, I don’t understand what’s going on with your thyroid. I don’t know what drug you take for that and how that might affect your gout or interact with gouty drugs or dietary changes.
There is store-brand plain yoghurt with no added sugar in every chain store here. It’s the big brands which tend add sugar into everything. So I would recommend you look around.
I don’t know what your serving size is but yoghurt can have 4-7% sugars when no sweetener is added. The naturally-occuring sugars in dairy are OK. So it’s fine if the dietary information shows a small value in the “sugars” category but you should avoid products which have “sugar” in the ingredient list (often times, you’ll find some maize product such as HFCS instead of “sugar” which is no better).
You could eat other dairy products but some studies suggest you’d do better picking products which contain little fat such as yoghurt made from skimmed milk as opposed to the the ones containing lots of fat such as cheese. Many dairy products are in between these two as far as fat content is concerned. See what’s available in your area.If you have gout, you need the same amount of protein as someone who doesn’t have gout.
For what it’s worth, I disagree with Keith about protein from plants.
Still, “legumes and beans, NO” is way too strong. Likewise, “yes you can” is simplistic. Of course you can eat legumes and beans. Better eat that than meat. But they’re not necessarily harmless. There are differences between various legumes and larger differences between various plants. Then there is the matter of processed foods made from plants.
Since you mentionned spinach and chicken, I’ll use these as an illustration. Both foods are about as bad for gout if you’re using them as protein sources or energy sources. But of course most people would not use spinach that way because it would require eating very large amounts. Chicken is much more nutritous. If you were to put equal amounts of spinach and chicken on your plate, the chicken would be way worse (like 7 times, possibly more depending on how the spinach was cooked). So spinach is basically harmless the way most people eat it.
Bottom line: you can eat pretty much anything in small amounts and most plants in larger amounts. You should eat lots of vegetables but, ideally, you should get much of your protein from dairy. Grains and legumes are the next best thing. And if you don’t eat dairy, you need legumes to balance the protein mix of grain.
Yes, the above is simplistic (I would not recommend eating large amounts of broccoli for instance) but I dare say my kind of simplistic is better than telling people not to eat legumes or that plant protein is good for gout.Hi!
Have you discussed alternatives to hydrochlorathiazide with your doctor? If not, I recommend doing so without delay as that drug is known to increase the amount of uric acid in people’s blood. There are gout-friendly alternatives.
If the amount of uric acid in your blood was ever tested before you started taking this drug, it would be helpful to know the results.Now, as to your question about allopurinol and colchicine…
You shouldn’t wait very long before taking allopurinol. Yes, it would be best if you could start it when you are well but waiting for the ideal time to start is often counter-productive.
That said, I would recommend testing other unfamiliar drugs first (it’s not clear if you’ve already tried indomethacin) in order to get a feel for how they work and the side effects they cause. That’s not a reason to delay taking allopurinol for long however, only a few days to a week. Inasmuch as possible, I would recommend trying any unfamiliar drug without mixing it with other drugs. And since allopurinol will affect your system 24/7 once you start taking it, I would recommend trying that last.Allopurinol should be taken every day.
Colchicine is most effective when it is taken every day to prevent attacks. So people often take it every day when starting allpurinol. It is less effective when taken after an attack has started but can also be used that way.
Indomethacin is sometimes taken every day to prevent attacks but is usually taken to stop swelling and pain after an attack has started.
If you plan to take a drug when an attack starts, don’t wait 12 hours. That’s way too long. Take a few pills with you when you’re away from home just in case.It’s important to get frequent blood tests to monitor some of the side effects of these drugs. Once you get used to them and stop adjusting the doses, blood tests need not be so frequent.
Finally, diet: if you are indeed not getting enough protein, that would be a serious problem and could potentially contribute to your gout. Fortunately, it’s easy to get enough protein without eating any animal flesh.
If you can safely (I have no idea what’s going on with your thyroid for instance) drink lots of skimmed milk or eat lots of yoghurt made from skimmed milk, that would be ideal for gout and help remediate any protein deficiency.
Also be aware that consuming sugars contributes to gout. So I’m not recommending sweetened foods such as most flavored dairy products.If the study was published in a decent journal, it almost certainly isn’t meaningless.
But note “hyperuricemia is not expected to be adequately or successfully improved by traditional urate lowering measures”. So it seems it would be relevant to people who keep getting abnormally high blood tests after taking drugs such as allopurinol. There should also be other signs pointing to “excess accumulation of fluids and salts”.
If I recall correctly, your tests were never really high in the first place.I knew you’d appreciate it so I got it tested again: no change, still a touch lower than it used to be but not weird. Could be a random variation… not the most likely explanation perhaps but at least my hemo didn’t keep dropping. That would have been more significant. As it stands, it’s nowhere near my one clearly anomalous hemo test result (that was after a surgery).
Yes, you are finally getting adequate testing. But I was commenting on your infrequent tests before we even knew about the hemo issue. That leisurely testing pace didn’t just make it harder than necessary to detect and pin down your hemo problem but also led to a slow dose increase. As a result, you had already spent too long with an above-target SUA before you stopped allo. And then your break between drugs kept getting extended… all in all, not the best way to prevent or stop chronic inflammation, I’d say. If the reason for such a long break was a course of colchicine, presdnisone or something, OK. But simply waiting?
The reason I’m being a bit of an asshole right now isn’t that I want to dwell on the past but that I think you could benefit for expediting the next steps, especially in case it turns out febuxostat doesn’t work for you either.Your main problem I think has been not getting enough blood tests and being too slow to adjust your medications. This hemoglobin thing should have been detected much quicker and you’ve spent way too much time with above-target SUA since starting your ULT.
Based near a border in Europe, I am. Sometimes we have to shop for health care for the other side of the border so as not to be limited by the regulations of any single country.
I have no useful advice to give you on this matter. Febuxostat is just another way to do ULT. We can talk side effects, pill-cutting and stuff but it should have the same effect as allopurinol on your inflammation.
What I was trying to say is that if you’re confident ULT is what you need to do, what’s the point in trying to determine ahead of time what ULT would and wouldn’t solve? You’ll find out anyway.
I also assume you’d get a clearer pricture of the damage done by uric acid once it’s (mostly) gone than in the middle of the process (even if there was a point in having pre-ULT imaging, it’s too late for that now that you’ve spent quite a while under 400 umol/l).
Maybe I’m missing something.About predicting damage, it seems we know one thing: the longer you’ve had untreated gout, the more damage there will be and the harder it will be to stop the damage from getting worse even with ULT. The relationship is going to hold regardless of exercise. Perhaps weight-bearing exercise could increase the amount of damage but I think that’s a separate issue from the matter of how you should behave during attacks.
About your assumption, the first times I got really serious attack, weight-bearing exercise involving the affected joint had disastrous effects. I very much doubt the problem was bone erosion or anything of the sort since no doctor noticed anything out of the ordinary, even on the MRI I had done back in the day. Granted, I saw a bunch of clueless doctors but that kind of damage can’t be easy to miss, right?I don’t understand enough about your high schools or debates to get a good joke, sorry.
I understand a little more about what people in the US call high school or debates… very perplexing things. Kind of like “country and western”.The injection wouldn’t have been only for the pain, right? I mean, you wouldn’t need to bother with this type of injection if that was the point. Pain management is routine.
What I suspect your rheuma had in mind was an injection that targets the inflammation. Not a permanent fix obviously but probably still worth trying since clearing crystals with febuxostat is going to take a while (assuming you tolerate the drug).My rheuma figures a well-done ultrasound is more informative than an MRI. Or maybe that depends on what you want to see. Based on SUA, physical exam and X-rays, serious permanent damage wasn’t expected in my case.
The advantage of MRIs is apparently that any qualified fool can do them. For the ultrasound though, I was to see a specific fellow.
In the end, if you’re 99% confident that the right course of action is going to be simple ULT whether or not a scan is done… well, in that case the cost/benefit of a scan is questionable.I see I forgot a “not” in my post above which I just edited: you do NOT have very high uric acid. That means that you probably would not require medication for life.
Yes, allopurinol can lead to attacks but that’s not specific to allopurinol. You noticed yourself that your symptoms were worse when your uric acid was lower. However you reduce uric acid, the result is the same: attacks often increase during the next several months. But if uric acid stays low, the attacks eventually stop (if the cause was indeed gout). If your uric acid goes up and down during that phase however, it may take a very long time for the attacks to stop depending on how high is “up” (7.5 mg/dl is too much).
It’s also true that you can get attacks even with very low uric acid levels.
Lowering uric acid helps in the long run, not only by preventing attacks in the following years but also by protecting your body against further damage. Some of the damage done by uric acid is permanent.Allopurinol is not the only drug you can take to lower uric acid. And as you know there are plants which seem to lower uric acid.
Keith here has had a good experience with allopurinol.
Allopurinol and its main alternative (which is called febuxostat) are both more effective and reliable than most other solutions. But like most effective drugs, they are also dangerous and should only be used with serious medical supervision. Some people should not take these drugs.On a “now and then” basis, Quorn products are probably harmless (barring rare allergies and whatnot).
Purines add up when you eat a type of food frequently. If you eat something often enough that the fat content, protein mix and so forth are an issue, purines may be an issue as well. If not, enjoy…The thing is, your cites are about what I’d call habitual exercise, not about what you should do during brief acute episodes.
Obviously, it’s not somehow your fault or an argument against your experience that there seems to be little scientific reasearch into how best to deal with such episodes. Nevertheless, Pinto’s recommendations are as far as I can tell irrelevant to acute episodes.
Habitual mobility may prevent gout-related inflammation (or merely reduce it, which is good enough). It simply doesn’t follow that mobility would do much for acute episodes once they’ve started. If someone breaks a bone because of severe obesity, exercise may help address the cause in the long run but it obviously wouldn’t heal the bone. Likewise, it may be advisable to keep moving in the face of RA but it doesn’t follow that the same goes for acute gouty episodes.More to the point considering DQ’s questions, how do you know that crystals cause no damage outside of inflammation or other things the immune system does or fails to do?
I’m not talking about crystals being “pointy” or anything like that. But if you have a sizable foreign growth in a weight-bearing joint, how could that not create a mechanical problem? Maybe I simply don’t understand where large amounts of uric acid are typically deposited.The recommendations you linked to aren’t for vegans. They recommend dairy over legumes. And indeed I eat a lot more cheese than lentils.
But since dairy isn’t an option for you, you have to settle for the next best thing. And in order to do that, you need more specific information than what these recommendations provide because as it is, the foods vegans should eat for protein are basically all in the “eat in moderation” category.Based on the limited information I have about meat substitutes, the ones based on plants contain a good bit less purines. Yes, Quorn products contain less purines than the really dangerous stuff like yeast or anchovies. But that doesn’t mean you should disregard the difference between Quorn and plant-based products.
In my opinion, the only rule you have to follow in order to be safe purine-wise is to stick to plants. There’s probably no need to make it more complicated even though there are a few dangerous things unreasonable people could in principle do with plants. At first I didn’t think you’d have to follow any rules because I figured that as a vegan you’d only want to eat plants anyway. Goes to show how little I know…
