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Hello Keith
I am 73 years old and am busy trying to rid my system of excess Uric acid.
I was first diagnosed with gout at 36 years old. At that time, I had played tennis barefoot which precipitated an attack in my feet (middle). The GP at the time cured it with Indocid I think. But on thinking back at that time I realised that I had had a previous attack in my feet. Also, that lasted a few days when I was 23 following a long barefoot trek across soft sand carrying a heavy pack.
From then I progressively became a qualified gout sufferer with attacks in feet, ankles, big toe and wrist. At the time I controlled the pain effectively with NSAID pills. Initially Voltaren and later Celebrex and Cataflam D. I would use Citro-Soda to control the uric acid. Attacks were extremely severe. But they were usually short-lived because of the pills.
When I became about 50 my doctor advised me to really control the Uric acid. So the doctor put me onto Allopurinol. Initially at 100 mg progressively increasing until 300mg. But this treatment was not too effective. So, following a 24-hour Urine assay, I was found to be an under excreter rather than an over producer. Then I switched to 100mg Probenecid daily.
Probenecid seemed to work and the occasional attack could be tamed with NSAIDs and later I was introduced to Colchicine to cure an attack and which I thought was controlling the Uric acid levels.
For some reason, I felt the Probenecid was disagreeing with my system and therefore switched to 0.5 mg of Colchicine daily instead. This seemed to work quite well for some years. Because?0.5mg Colchicine every 2 hours until diarrhea controlled any serious attacks. Also, I supported that routine from time to time with NSAIDs and Citro-Soda.
A few years ago I noticed that the middle joint of my left index finger was quite swollen on each side and becoming stiff but with no pain. As I needed an operation on the same hand two years ago I had the swelling cut out and it proved to be a gouty tophus.
The finger remained stiff and I noticed other fingers becoming stiff so 12 months ago I visited a Rheumatologist for the first time. Blood tests showed Urate at 5.6 mmol/l so she explained to me that the Colchicine had only an anti-inflammatory effect. She was sure that Allopurinol would work and prescribed 300mg Allopurinol and 0.5 mg Colchicine morning and evening. She said that if I should have an attack only one extra 0.5mg in between.
But then she immediately emigrated.
This regimen brought the Urate down to 0.3mmol/l so it was working but I was suffering a few flares in new places like a left shoulder, inside the ankle etc. But the fingers remained stiff and I noticed some visible gouty tophi on both sides of my feet at the base of the toes as well as my left elbow. So I started to look for solutions and found GoutPal.
I put myself back onto 100mg Probenecid morning and evening in addition to Allopurinol and my Urate level last week was 0.2 mmol/l but the fingers are still stiff and I do not see any improvement in the size of the tophi.
I also still get flares that seem to last a long time. So I control the pain partly with the additional 0.5mg Colchicine. As the Rheumatologist advised me. But I am now taking Warfarin daily which is contraindicated with the use of NSAIDs. So I now treat severe gout pain with Prednisolone injections.
I understand that the flares are the result of greater mobility in the Urate in my system. But I am getting despondent at the ongoing nature of the flares. Also the continuing evidence of the tophi and finger stiffness.
What do you suggest I do next?
Citro-Soda for Gout
This is an admin summary about Citro-Soda for gout. Because most readers of this topic are gout sufferers who are concerned about using Citro-Soda. However, the topic is really about the difficulties of controlling gout properly if you do not manage uric acid levels. Then you will see that, even when Roger got uric acid under control, it still takes months or years before gout recovery is complete. Also, gout can be painful until recovery is complete.
It is unlikely that Citro-Soda can help. Because it is a chemical mixture for alkalizing urine. Comprising of sodium bicarbonate 1,716 mg; tartaric acid 858 mg; citric acid 702 mg; sodium citrate 613 mg. I took that from the 4g dose described on the manufacturer’s website in December 2017. Although alkalizing urine can help lower uric acid, the main component of Citro-Soda is dangerous sodium bicarbonate (baking soda). Therefore, the correct way to alkalize urine is to learn healthy diet habits.
Never use Citro-Soda for Gout! Finally, you should know that this is especially true for citrus fruits. Because citrus fruits have been shown to lower uric acid. At the moment, I am updating my gout facts about citrus fruits. But, you can find the latest information using the GoutPal Search box near the top of every page. Try searching for
oranges for goutorlemons for gout. Then, if you cannot find what you are looking for, ask in the new gout forum.Firstly: do you mean 1000 mg. probenecid?100 mg. is not a sensible dose.
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Secondly, FINGERS!!!! ?As a long term sufferer let me throw in a unique but?very personal ?thought: even with sufficient control, good enough to prevent acute atacks and foot pain, after years and years the finger joints take a hit.
I can only presume that the fingers are clearly the coldest joints of the body and thus most susceptible.
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I HATE the whole concept but I am seeing a subtle??breakdown of my poor little fingers, and a couple metatasrsals of the hand, i.e, trigger fingers.
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Roger,
If I were you I would consider 300 mg. allopurinol + 1000 mg. probenecid. I am going to ask my doctor for the same when I next see him.
Welcome, Roger.
It is very frustrating when you do everything right, and you still get gout flares. The 0.3mmol/L (5mg/dL) is the minimum safe level. Like you, I've managed to get down to 0.2mmol/L and I'm pretty certain that my visible tophi are shrinking – slowly.
But yesterday I got hit with noticable knee swelling and today the pain is almost keeping me away from the pub. (calm down, I said almost). Only positive mental attitude can help here, though I did see a report in the news yesterday claiming that swearing helps lower pain. I'll spare you the details, as I don't think typing it helps, but if you live anywhere near the Yorkshire area of England, best keep your ears covered.
I feel positive because I know things will get better, but I'm prepared for the long haul. I am not expecting my 16 years of gout to go in anything less than six months, and if it takes 16 months to match the years, I'll be happy. If it takes longer, I'll be less positive, but if necessary, I'll get another boost by trying the allopurinol/probenecid combo.
I have seen a number of studies that measure urate removal in months, if not years, though nothing comprehensive to give a firm timescale. All you can ever do is get your uric acid as low as possible, as it is clear that uric acid crystals dissolve quicker when uric acid levels are lower.
On completely unrelated health issues, the good thoughts and kind contributions from people here have helped me enormously. My day is devoted to continuous positive thoughts for Roger and Zip2play. Together we can make it better.
I guess you are saying keep on keeping on. As it is now 12 months under Allopurinol treatment,?somewhere I think you said it could take as long as 20 months I will watch with hope but the flares seem to become more frequent.
Meantime the pub should be good for you!!
Yeah, keep on keepin' on.
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The length of time to dissolve urate deposits is variable. But, they will go if you keep that uric acid level low.
I must confess to being only partially computer literate. I have posted questions on the blog in the past but have not been able to get back to the same point to read the responses. I am 75 years old, have suffered gout attacks since early 20’s which in the main were controlled by anti-inflammatories like Indocid and uricosurics like Probenecid and sometimes colchicine as I was diagnosed as an under excreter. . 25 months ago I was concerned about certain gouty tophi and so visited a rheumatologist who prescribed 300mg of Pr 300 mg Allopurinol as a change. Since then I have had my Uric acid tested regularly and have been maintaining about 0.21mmol/l and was hoping to get rid of the tophi but I still have them even if sometimes I think they have reduced slightly. So following GoutPal I have increased the Allopurinol to 900 mG/day and my Uric acid is sitting at 0.15 mmol/l. I have frequent Gout Flares which respond only partly to Colchicine or Medrol.
My first question is what else can I do to get rid of Tophi and attacks.
My second question is that I currently have an extremely painful point of insertion of the Achilles tendon into the heel which is not really a joint and so should not technically be a uric acid crystal attack. But it is responding to a course of colchicine.. Could this be a gout flare? I do not recall an injury which should have caused tendinitis.
Roger, I’m sorry about the difficulties you have experienced with asking your questions. I will not waste your time with excuses, but I will work my hardest over the next few weeks and months to make posting as easy as it can be.
I think your best course of action is to consult a rheumatologist who has experience with long-term gout.
I cannot assess the state of your urate load from a distance. Though you seem to have uric acid in your blood under control, it can take months, if not years, to dissolve uric acid crystals. Indeed, there are some wise people on this forum who doubt that you can ever dissolve them completely. I simply do not have the experience to know if this is true or not. I’ll be back in 15 years to explain my own experience of uric acid control.
My biggest worry is long term damage caused by uric acid crystals.
Whilst gout flares start in the joints, uric acid deposits grow slowly throughout the body. This means that cells, that should be repairing growing tissues, get caught up in the gout war, with two very serious effects.
The first is that bone, cartilage, and other tissue starts to crumble and die. This is the damage you can see on X-rays in prolonged untreated gout cases. (Please note that indomethacin and colchicine are not gout treatments in this context – they are forms of pain control that are commonly prescribed to gout patients.)
The second serious effect is the development of tophi – visible lumps of uric acid crystals mixed with dead white blood cells. I say visible, but these are often not visible to the naked eye, and only rare advanced technologies can spot them before the damage. As they grow, they cause physical disruption to organs. Kidney stones lead to kidney disease; cardiovascular deposits lead to stroke and heart disease; skin deposits lead to lesions and the risk of infection. In the past, I’ve shown pictures of tophi growing in the eye, and I have many other references to organ damage throughout the body. What qualifies as our most considered organ, for most men, is not safe, as startling pictures will reveal when I get round to posting them.
Roger, I’m not writing this to scare you, but as an explanation that gout affects much more than our joints, so a visit to a rheumatologist should be a priority for damage assessment and a treatment review.
To other gout patients who have a chance to control uric acid, but want to leave it for another day – you have been warned.
Roger,
I get flares in my right ankle. ?They occur in the joint, and then work their way around to my foot and to my Achilles. ?Sometimes they just start in the Achilles.
I have been on 3-400 mg Allopurinol for 10 months. ?Flares are reducing in intensity and duration, although they have remained fairly frequent. ?I am hoping that frequency reduction is next.
So, I’ve had gout for about two-three years. I’m 28 years old. In the past the attacks used to be weeks and months apart. So much that I would even forget to take the medicine prescribed for it. Lately, I have improved drastically in that regard. I do have prescriptions for 100mg of Allpurinol and 50mg of Indomethcin. I have been taking the Allpurinol daily and the Indomethicin during flare ups, as directed.
But, lately (the past three months) it has just gotten out of hand.
In August I decided that I had enough of being overweight. I was 336 pounds and feeling like crap most days. So, I started dieting and exercising with conviction. I started off with the Atkins diet. I was eating a lot of protein and fat. I cut sugar out completely. No soda. I drank two liters of water each day.
By October my gout was hitting me hard. It faded in and out, some days worst than others. On days where I wasn’t feeling the flare ups I would walk 2-3 miles for exercise. I still try to do this. I enjoy the exercise greatly.
About mid-October I had already suffered two gout attacks. I went to the urgent care. They told me that the low carb diet was causing it, because of high protein intake. They gave me some presnidone and sent me home.
I switched to a low-calorie diet instead. I eat roughly 1,600 calories a day, eating whole grains, chicken, fruit and vegetables. I still do not drink soda. I don’t drink alcohol either. I am trying to be healthy as possible.
After about five days I was back to normal. I started exercising again, amping myself up to 3-4 miles a day. As of today, the gout is back again in force.
The medicine prescribed to me isn’t working. I’ve lost 45 pounds since the end of August. So a lighter body, exercise, and healthy diets don’t seem to be helping. I’ve tried ingesting cherry juice, apple cider vinegar, and baking soda in the past. Those “natural” remedies did nothing.
I plan on visiting my doctor this week. But, honestly… she basically gives me the same packet of things not to eat and sends me home every time. It’s frustrating. This time I plan to be more assertive in trying to get help.
I just don’t know if I’m doing anything wrong. I’m trying my best here to be a healthy person and improve myself.
Any tips or suggestions?
Brian, I know it’s tough, but you have to believe you can beat this. From what you’ve written, I think you’ve been given some pretty poor medical advice regarding your gout. Let me try and explain and encourage, but first a serious warning.
You haven’t said anything about ibuprofen in this post, but I notice it’s in your profile along with indomethacin. Please assure me that you take one or the other. You must not take both together. There might be an exception under strict medical supervision. But that’s beyond the scope of a gout forum. The correct indomethacin dosage for gout, for most people, is 50 mg three times per day.
When you were prescribed allopurinol, you should also have agreed target uric acid levels, and monthly monitoring with dose adjustment. At the same time, it should have been explained to you, that you are at risk of gout flares until most of your old uric acid crystals have dissolved. It’s impossible to say how long this will take, but the scale is months, not weeks or days. With more information, I might hazard a guess. But for now, you have to be patient.
Getting rid of gout takes time. I can help with specific things you can do to make this time shorter and less painful. I need more of your medical history to do this properly, but even without that, I can give you some general pointers. It’s up to you – just ask what you want from me.
Before I continue, you have to understand that gout is not an eating disorder. At your age, it is almost certainly genetic. That means that bad diet will make gout worse faster, but good diet might not be enough to control it. The first priority is to reduce uric acid low enough to ease the burden on your joints and other tissues. Once uric acid is under control, maintaining healthy weight with a balanced diet and regular exercise might reduce your need for allopurinol. That is not the issue now – you need sufficient allopurinol to get rid of old uric acid crystals as soon as possible. Without that, you just get frustrated, because all your healthy lifestyle improvements are never enough to fight crystals that have built up over several years.
Let me address some of the specific points you have made, then you can let me know how I can help you better.
1. “But, lately (the past three months) it has just gotten out of hand.”
Gout is progressive unless/until uric acid is reduced below 5 mg/dL. It gets worse every day irrespective of if you have a flare or not.
2. “In August I decided that I had enough of being overweight. I was 336 pounds and feeling like crap most days. So, I started dieting and exercising with conviction.”
Weight loss is good for gout. Rapid weight loss almost always causes gout attacks. 1 or 2 pounds a week is best. You should have a target weight that matches your height. As I said, I recommend allopurinol intervention, combined with weight loss. Once targets are achieved, and you are ‘all clear’ you can consider allopurinol dose reduction.
3. “About mid-October I had already suffered two gout attacks. I went to the urgent care. They told me that the low-carb diet was causing it, because of high protein intake. They gave me some prednisone and sent me home.”
They are bastards.
Your diet might not have been the best there is for gout, but high protein intake is not the reason. You were trying your best, and I think they could have given you a lot more encouragement to manage your diet more effectively.
Prednisone is very much a last resort for gout, but I don’t expect the bastards know why, or even care.4. “I switched to a low-calorie diet instead. I eat roughly 1,600 calories a day, eating whole grains, chicken, fruit and vegetables. I still do not drink soda. I don’t drink alcohol either. I am trying to be healthy as possible.”
Brilliant! The only thing better is probably 1600cal Mediterranean or Alkaline diet, but you can consider that when you’re ready.
5. “After about five days I was back to normal. I started exercising again, amping myself up to 3-4 miles a day. As of today, the gout is back again in force.”
Let’s be clear. The gout never went away. The gout flare subsided. Big difference. Gout is still destroying your joints and building up to a bigger attack, even when the flare has gone.
6. “The medicine prescribed to me isn’t working. I’ve lost 45 pounds since the end of August. So a lighter body, exercise, and healthy diets don’t seem to be helping. I’ve tried ingesting cherry juice, apple cider vinegar, and baking soda in the past. Those ‘natural’ remedies did nothing.”
Cherry juice sometimes helps a little bit with gout pain.
Apple Cider Vinegar can be an effective placebo for some people.
Baking soda can help lower uric acid, in the same way that an alkalizing diet can. One of those is healthy. The other raises blood pressure. Baking soda was thought to be safe last century. Doubtful now.7. “I plan on visiting my doctor this week. But, honestly she basically gives me the same packet of things not to eat and sends me home every time. It’s frustrating. This time I plan to be more assertive in trying to get help.”
Yep! Don’t leave there until you have a plan for uric acid control at least, and preferably some help with weight loss targets as well. Uric acid must be lower than 5 mg/dL, and I recommend 6 months as low as you can get. That minimizes the time you are at risk from another gout flare, and gives your joints the best chance of recovery. Allopurinol dose needs to be adjusted as directed by blood test results. I recommend 4 weeks between tests. 2-week intervals are the minimum to allow for dose changes to register. Anything more than 6 weeks between tests is a clear indication that gout is not being taken seriously.
8. “I just don’t know if I’m doing anything wrong. I’m trying my best here to be a healthy person and improve myself. “
Brian, you are doing everything right, and I feel you are definitely on the right track. Because you have not had the right explanations, it is very frustrating. Especially so, as you have to learn the science before you can tell your doctor what is needed.
If anything I have written here is not clear, please tell me, and I’ll try to clarify.
I’m trying my best to help you be a healthy person and improve yourself. Just keep coming back with your questions, experiences, and opinions.We’re gonna beat this!
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