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Hey everyone,
I typically run between 3.5- 4.5 SUA, however yesterday I tested before bed and was at 5.5. Retested this morning at 6am after fasting and was still at 5.4. No lifestyle changes or anything. Ive only been on 300mg of AP for about a month and a half. The only thing I can think of is that my knees are slightly sore so maybe urate is dissolving into the bloodstream temporarily elevated my numbers? When crystals dissolve does UA go up?
Yes.
Another reason why people on insufficient allopurinol get into that terrible place where they are in almost constant pain due to crystals partially dissolving and reforming.
Nasty, sadistic thing, that allopurinol underdose.
In your case, the 3.5 to 4.5 gives you good margin. It might not stop the occasional soreness, but it will prevent the partial treatment hell.
So would it be safe to say that the 5.5 is temporary and the 3.5-4.5 will most likely be the actual almost all the time “once there are no more crystals to dissolve?”
As GoutPal said…Yes the numbers can go up as crystals dissolve. You will even feel some twinges as your body reacts.
Crystals come in two forms. The first type are free flowing in your entire bloodstream until they eventually collect loosely in joints or capilairies, but have constant access to regular bloodflow. The secondkind are the compacted ones that make up tophi and/or otherwise dont have regular access to bloodflow.
The first kind will be the first to dissolve. Once your UA numbers start to drop, these will begin rapidly dissolving back into liquid acid and get expelled. Once these are mostly gone, you will see your numbers start to drop again. It takes a long time to dissolve the compacted crystals – frequently years.
I suggest drinking more water for the next few weeks/months to help eliminate the liquid acid. If your numbers dont go back down, then you are producing new crystals as fast as the old ones dissolve. Eventually you want to stabalize at a lower number.
Thanks Tavery. That makes perfect sense I just don't know if my increase in UA is due to crystals forming or dissolving (I'm assuming dissolving). So the first type of crystals should dissolve rather quickly. I'm assuming within a matter of weeks so mine are probably gone. I'm wondering about the 2nd type and how long it will take for my numbers to stabalize. So a couple questions:
How long do I wait for levels to stabalize?…until another attack? until I exceed UA of 6, 1 yr, etc?
If I've seen my numbers between 3 and 4 75%+ of the time. Would that indicate that's the range I would stabalize at once urate is cleared out? And should I be concerned with this 5+ level I'm currently at?
In regards to the last sentence you said “producing new crystals as fast as the old ones dissolve,” how can new ones be forming if I'm never above 6?
How are you feeling? How's your treatment going? Did you move up to 300mg?
I think that once you have gout you will NEVER get to the point where every crystal has dissolved, NEVER! Once gout develops you have LOTS of urate deposits, probably OUNCES rather than milligrams, many of which are so firmly enshrouded in encapsulating scar tissue and god-knows-what-other-detritus that it is with you forever. And there will always be that certain deposit that is close to breaking out.
Secret, as I see it, is to make surre that when the breakout occurs to make sure it doesn't tip the nearby body parts into a saturated condition.
A Gout attack is a localized condition and thus when a deposit erupts you don't want it to erupt into an area that is either too close to saturation, too acidic, or too cold.
An awful thought that we must all digest: ONCE WE HAVE GOUT WE WILL ALWAYS HAVE GOUT.
Corollaries are :
1. The faster we lower our serum uric acid the less urate we will deposit, i.e., treat uric acid EARLY before we have too may attacks and lay downn too much UA.
2. THe lower we keep our SUA the less likely a migrating deposit will redeposit
3. The lower we keep SUA the more likely we will NEVER suffer an acute attack, damage our kidneys or develop heart disease.
By this logic, once gout develops, running a 6.0 MAY be okay but running a 4.0 is a LOT better
To the precise question: Yes, when crystals dissolve UA goes up…when they deposit UA goes down!
I undertand that I always will have gout. I didn't necessarily mean “all urate would be cleared out.” Just meant enough to where it is not dissolving as much because most of what can be cleared has been liquified already. So if UA goes down when crystals deposit, does that mean my 3.5-4.5 was lower due to that? I'm confused now
What is confusing, to me at least, about UA- is where it is.
Joints, tissues, blood or being/been excreted.
The focus usually is on the joints- but the bigger picture is very fundamental to understanding UA management.
I suppose a test kit tells more- but not enough.
A wild card , for sure!
trev,
Remember those wonderful pictures that GP posted showing those urate deposits almost EVERYWHERE. All we can be REASONABLY sure of is how much is in serum becasue that's all we measure. How much is in the intracellular fluid, the lymph system, the organs, the ligament, within the bones, inside arterial plaque…these are things we'll NEVER know. I presume they havee taken the occasional cadaver and boileed it down to get the total urate load but it can;t be a common practice.
So if UA goes down when crystals deposit, does that mean my 3.5-4.5 was lower due to that?
CJ,
There's no way of knowing for sure unless you tested immediately before crystallization and you found some way to quantify the AMOUNT that crystallized…too many variables. The question is like asking an oncologist “Yes doctor I know I have cancer, but how many CELLS?”
Some excellent points here, and I'll try to avoid clouding the issue.
As zip2play says, you can only easily measure uric acid circulating in your blood stream. At this moment in time, you cannot easily measure, or even estimate the amount of uric acid that is crystallized in joint fluid and other tissues.
Fortunately, you do not need to.
You know from a series of tests that allopurinol is doing it's job. Your body cannot raise uric acid levels by producing more uric acid, so increases are either a bad reading, or old crystals melting.
It doen't really matter which for now, because the main thing is that you are in a good place.
As Tavery suggests, increased water will help flush the free uric acid, and medical authorities also recommend alkalizing the urine to prevent kidney stones.
On a slightly related note, I have just read about some uric acid researchers who found their urine samples had gone cloudy (you wouldn't believe the stuff I read sometimes). They ascertained that the cloudiness was uric acid crystals, and the sample temperature was, from memory, 24 degrees (centigrade). When heated up to body temperature, the crystals dissolved.
Northern hemisphere readers should remember to keep kidney/bladder area warm this winter, as well as the extremities.
Interesting comment GP-
@” the sample temperature was, from memory, 24 degrees (centigrade)”.
Any idea at which point the crystal process started on the way down?
[and also ended on the way back up, too].
Very pertinent area of investigation.
Gout aint rocket science- it just feels like it sometimes…
No idea, but it is not relevant without the other part of the equation – uric acid concentration.
In practical terms, there is absolutely no way to measure all the variables that affect saturation point.
What we can do is avoid the cold.
On a slightly related note, I have just read about some uric acid researchers who found their urine samples had gone cloudy (you wouldn't believe the stuff I read sometimes). They ascertained that the cloudiness was uric acid crystals, and the sample temperature was, from memory, 24 degrees (centigrade). When heated up to body temperature, the crystals dissolved.
I've often read about the phenomenon, and of course, being me, I tried it. It's absolutely true. I guess if I wanted to get really nuts I'd have tried passing a large parcel of cold urine through some filter paper, keeping it cold, and tried to scrape off some crystals and toss them under the microscope.
But that seemed a but TOO “water-sportsy” for me.
I'm keen on this idea ,Zip-
You could charge admmission to make it worth while- or even put it on Utube!
NY 's a wunnerful place
Joking apart, there's no doubt that escaping the effects of high UA ,with or without gout , means keeping consolidation sites warm. mainly the feet. hands and knees can be dealt for, too.
The similarity with Deep Vein Thrombosis (DVT) comes to mind -where relatively young people have suffered bad effects and even died ( if memory serves) after long, immobilising plane flights.
Warnings about this are common now- but seemed strange in the early days to me, anyway- for other than the elderly.
Gout is increasing, but still not so common. Hopefully sites like this will not only highlight the risks of high SUA and how to treat & manage gout – but also bring this simple fact to the fore.
I shall definitely be watching my foot warmth this winter and ensuring daily exercise for my feet.
Interesting topic.
I am now on 300 mg of Allopurinol for last 5 weeks. I have monitored my SUA levels at home and labs regularly. In last 4 weeks, I have tested it about 26 times. The value range is 3.0 to 4.4 including 3 lab tests, with 80% of values ranging 3.5 to 3.9.
The mean average is 3.7.
The values are very consistent – afternoon around 2 pm, it is 3..8 to 4.1 and evening around 6 pm, it is 3.4 to 3.7.
Does it mean that I am not dissolving the Uric Acid crystals, or may be they have turned into hard stones that Allop can't dissolve anymore
I used to get many twinges in the early days but now they have reduced a lot, very few that also last for couple of minutes at the most.
The uneasiness in the big toe joint is still there, though reduced a lot, but that I guess is most likely residual of the toe injury. It is very subjective to the shoe I wear on that day.
Snoring is history now.
Excellent, Utubelite.
What a beacon for other gout patients who are starting, or considering, uric acid lowering therapy.
I believe the uric acid lowering phase needs to run for 6 months, below 6mg/dL, without a gout attack, before you can be satisfied that all uric acid crystals that can dissole will actually do so.
Though 6 months is a lot longer than your 5 weeks, it is very encouraging to see how quickly you are seeing benefits. I put this down to getting uric acid low enough to avoid problems with partially dissolved or reforming uric acid crystals.
When the big toe is down to “uneasiness” rather than screaming pain, life must be good indeed.
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