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The second pillar of my better gout treatment campaign is urate lowering therapy. If you are subscribed to my gout newsletter, you probably know this – if you are not, subscribe today!
Without good procedures for frequent testing of uric acid levels, and treatment to lower them below 6mg/dL, you will continue to be plagued with gout.
Yet many patients do not get tested, or treated. Of those that do, many do not complete their treatment, and others do not get the correct dose to lower uric acid enough to get rid of gout.
This topic is strictly for telling us about good uric acid testing and lowering procedures.
How often was your uric acid tested? How confident were you with the results of urate lowering therapy? What explanations about uric acid did you receive?
Please share your good uric acid lowering experiences here.
Urate lowering therapy can be very effective for reducing flares of gout, thereby preventing ongoing joint damage and deformity. Despite this efficacy, most gout patients are undertreated, leading to undue painful flares and joint damage. Non-adherence to therapy is a strong contributor to undertreatment. Here, Solomon et al (Ann Rheum Dis 2008; 67: 609) explore adherence to and barriers to urate lowering therapy in a cohort of patients receiving urate lowering therapy through a state supported pharmacy benefit program.
Abstract
Background: Uric acid lowering therapy (UALT) is considered a chronic treatment for gout. Relatively little is known about adherence to UALT.
Methods: We assessed adherence with UALT over a 1-year study period among 9823 older adults enrolled in a pharmacy benefit program. Two adherence measures were calculated, the percentage of days covered (PDC) and the time until an extended break (at least 60 days) in treatment. A PDC <80% was considered poor adherence and its predictors were examined in multivariable logistic models.
Results: The mean (SD) PDC was 54% (36%) with 64% of patients considered poorly compliant over the study period. A total of 56% had experienced an extended break in UALT. Predictors of poor adherence included younger age (odds ratio (OR) 1.50, 95% CI 1.33?1.69 for ages 65?74 compared with 85 and above) and African?American race (OR 1.86, 95% CI 1.52?2.27 compared with Caucasian race). Most patients (93%) received their initial UALT prescription from a non-specialist and this also predicted poor adherence (OR 1.15, 95% CI 0.96?1.38 compared with rheumatologists or nephrologists).
Conclusion Adherence with UALT is poor. While uric acid levels were not measured in this study, poor adherence with UALT is likely to reduce attainment of goal uric acid levels.
I got a new GP several years ago and despite my having taken 300 mg. allopurinol for YEARS and getting consisten readings of 5.0- 6.0 mg./dL uric acid he keeps yammering about my going to 200 or 100 mg. allopurinol becasue they are finding “all kinds of problems with long term allopurinol use.”
He bases his recommendation for the lowered allopurinol on the fact that my gout is well controlled. I many have actually said “Well, DUH!” to him after he said this. Against my better judgement, I went to 200 mg. for a month and saw my uric acid go to 6.5 (which his lab CHART says is in the “normal” range….”DUH” again)
THEN I began to get those certain ankle pains in the morning and the tophus on my pinky began to ache when it got cold.
I put myself back on 300 mg./day.
Yes, doctors can be VERY detrimental to gout! What I need my doctor for is to draw my blood, order the tests I want, and write me the Rx that I ask for. Once he realizes this our relationship will be perfect.
(After I trained my OLD doctor to do precisely what I want we were fine…and then the bastard retired!)
Just reviewing some of my uric acid notes when I spotted that you don't seem to have had a long enough period of time with low enough uric acid.
Latest recommendations are that uric acid should be maintained below 5mg/dL:
Initial long-term treatment of recurrent uncomplicated gout normally should be with allopurinol starting in a dose of 50–100 mg/day and increasing by 50–100 mg increments every few weeks, adjusted if necessary for renal function, until the therapeutic target (SUA <300 µmol/l) is reached (maximum dose 900 mg)
These are British Rheumatologist Society recommendations, but I believe American rheumatologists follow similar guidelines.
Once you've had a 6 month period with no gout flares, and no visible signs of tophi, it is possible that all existing uric acid crystals have dissolved. In such a case, it might be possible (under advisement of your doctor) to relax dosage slightly to maintain levels in the 5 – 6 mg/dL (300 – 350 µmol/L).
Get the new bastard trained 😉
I have stockpiled enough allopurinol that I can take 400mg./day for the foreseeable future and this my my current (1 month so far) self-prescribed dosage. I hope that the little extra allopurinol will give me the <5.0 that I desire but I haven't had it confirmed with a recent serum uric acid asssay…I'll go as soon as I can decide who I want as primary provider with my new insurance.
Adjunctive to my treatment is the use of 50 mg. losartan (for hypertension but uricosuric as a bonus…the ONLY BP drug that is) and mildly uricosuric atoorvastatin for cholesterol.
I have heart disease and REALLY would love my uric acid below 4.0…and I may arrange for proper agents to get that.
Here's a WONDERFUL but HUGE read on the tie-in between uric acid and heart disease…you'll find it interesting:
medscape.com/viewarticle/472684_1 [login required]
Ok here goes. I find that ALL pharmacuticals have serious problems. Not to mention the price! Here however is what works for me, eat 2 bannanas, drink cherry juice (even with my diabeties the jucy juce which says its no added sugar but tastes like marashino cherries works just fine) take ibuprofin and drink tons of water. I have effect in 24hours! For those like me who believe that there are actually several types of gout but find doctors unwilling to consider the FACT apple cider vinegar actually made it worse,much worse!
Heres my stats I think are important to this
Im Diabetic. Have both plaque pshoriasis and Standard everyday Arthritis in several joints, add to this profile I have had Gout attacks for 8 years. Aluprinol worked wonders, but of course now we find lots of associated risks. I have managed to control the diabeties with diet, I watch it very closely. Oh yeah almost forgot the yogurt. As soon as I feel an attack comming on I get yogurt.
I happen to like yourt, so it goes down very easilly. So heres my Rx
2 Bannanas,At least 32oz of non fat yogurt,A bottle of Chery Juice, and Ibuprofin
While I realize this probably wont work for everyone, we all are at this point willing to try anything and this combination has very little risk and my own personal seal of approval.
Try extract of black cherries, found at holland and Barrett taken as a drink throughout the day works and I find Apple cider vinegar mixed with raw honey as a hot drink at night works wonders. But just a tea spoon of the vinegar.
I refuse to go down the tablet route.
James Humphreys said:
Try extract of black cherries, found at holland and Barrett taken as a drink throughout the day works and I find Apple cider vinegar mixed with raw honey as a hot drink at night works wonders. But just a tea spoon of the vinegar.
I refuse to go down the tablet route.
Just edited it to get rid of a problem smiley.
Please note that this is a thread about lowering uric acid. There is absolutely no evidence to show that cherry drinks or ACV and vinegar can lower uric acid. If they make you feel better, then that is fine, but only if you are also keeping uric acid below 6mg/dL. If not, you are storing up some serious medical issues that will cripple you at a time in your life when you are probably unable to deal with it.
My research has shown one antihypertensive regimen that lowers uric acid. I will repeat it here.
It involves the use of two antihypertensive drugs, furosemide and losartan, (Lasix and Cozaar) but they must be taken in a particular way: first take the Lasix (which causes brisk diuresis) and then several hours later, take the Cozaar which causes uric acid elimination. Dosage of both drugs is titrated to get reasonable blood pressure control. Needless to say, people with NORMAL BP should not use this regimen.
The study confirming this regimen is small but rather convincing, but studies showing the uricosuric effect of losartan are all over the net. It;s the ONLY antihypertensive with this capability but used alone its effect is not large.
Lasix, as a diuretic will always lead to higher SUA if all the literature is to be believed over diuretics. (They are not good over long term, I gather, anyway)
This happened to me with a standard Thiazide drug and on cessation my gout receded till recently
Used with Losartan this effect may be mitigated- but why would the benefits not cancel to some degree- OVER TIME?
In other words , this combination that works so well may end up as a double edged sword again.
I'm on a Renin blocker now (Rasilex-[Aliskiren]) and this supervenes the job of both ARB's and ACEIs- whether it's that good will take time to evaluate- but it aint magic , as yet!
I still slipped the old ACEI back into in the equation,as it seemed to help still.
Maybe after 8 years on it- I'm hooked?
http://www.life-enhancement.com/article_template.asp?ID=2089
Interesting article shows how diuretics, though an easy fix initially, eventually can lead to loss of potassium (K) and hence then contribute to more heart problems in old age.
Acidification of the body is no help to a gout cure either!
By way of explanation of my attitude to diuretics (apart from it precursing gout imo) is the remarks of a nurse customer, a few years back, who said “No one should be on Diuretics for as long as 7 years!”
This article supports Zips' contention that K is low in Western diets and illustrates that less than half of PotBi Carb is elemental K in the process.
Luckily,I've been Fishertarian for many years- or I would really be in the s**te- no messing!
Diet is so important in keeping healthy and gout free. Drugs are not the same and our forebears didn't have to fight for their health like we have to now.
I know it's an oldish post but I would be a fisetarian if I could afford it…cod is $14 a pound here. Fresh flounder maybe $5 higher.
Frozen inedibles are less…a lot less, but TASTELELESS is the operative.
For salt sensitive, low renin hypertensives there is only one class of drugs that work…diuretics.
They cause gout but loop diuretics, Lasix/furosemide, much less uric acid saving than thiazide.
I can take ACE inhibitors, ARBS and calcium channel bockers til I turn blue but my BP stays high…unless I have a diuretiic. I share this trait with my black brothers but I am WHITE as the driven snow????? Go figger!
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