Immediate gout attack/twinge after crystals dissolve?

[cjeezy]

I'm wondering to what extent crystals can be dissolved.  I've read that nearly all crystals can be dissolved if gout is managed correctly, but I'm starting to think that's not the case.  For example, if one took Allopurinol for many years without any attacks (UA levels below 6), how could one string of events, long weekend, discontinued use of a UA drug, etc trigger another “immediate” gout attack so fast? Wouldn't there have to be a period of unhealthy lifestyle to build up crystals again? Just wondering

[zip2play]

THe way I see it, the immune system “walls off” the urate laid down during an acute attack. Until it is walled off, it is exposed to the bloodstream and the immune system visiously attacks it wcausing much pain and inflammation. Once it is walled off, it is hard for the newly UA diminshed (from allopurinol) to reach the urate to dissolve it. But there are little leaks in the walling so you can VERY slowly leach out the tophus over years if you have some luck and a low enough UA.

Apparently a newly HIGH uric acid level that would otherwise be supersaturated can find either this wall breech or else find some tiny crystals somewhere else that were laind down without causing pain. And then BOOM the crystals come out of supersaturation rapidly and cause another acute attack.

I maintain that ANYONE who has had a previous gout attack can never again sustain a supersaturated serum like a non-gout person. So a non-gouty might run around with a UA of 9 without an attack but a 7 is murderous for a goutie.

[cjeezy]

lol.  I had a feeling you'd respond to this one Zip! 🙂 So in your case, since you've been on Allop for 20+ years, if you had a full blown attack in the near future, do you think you think it would be debilitating or less severe since your UA levels have been controlled  for decades (and I'm asssuming you've dissolved quite a bit of crystals in this time)?

Also, how have you been since your twinges the other day?

[zip2play]

First and foremost, I would never ALLOW an attack to go fuull blown since I can recognize it early and have the guns in the arsenal at a moments notice. It takes DAYS for an attack to get to its “lethal” potential.

If I stopped taking my allopurinol and started taking thiazide again, I think I could bring on an attack as furious as the worst I've had. THis presumes I would leave the colchicine untouched. It might take a few weeks or a few months, but I am certain the attack would come.

Last week's gout mutated to extreme malaise and then a sore throat with a low grade fever. So right now I'm in the differential diagnosis stage, aka, I don't know what the Hell is going on, probably just an annoying Summer cold. (But no pain in my feet…maybe it was from that long bike ride in the hot dehydrating sun with no potable water to be found.)

I'll check today to see if Friday's blood results are done yet, and if so I'll make an appointment with the doctor…I have several issues going on and I haven;t had my uric acid measured in 2 years (nor my cholesterol or Lp(a))

[cjeezy]

Hope you get to feeling well zip

[Author]

Posts