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I have been a joint pain sufferer for many years now. Started when I was around 39 and have had it till nowadays (57 years old).
Over the years most doctors have told me I suffer from hyperuricemia and that all my pains are gout related. When I first suffered from a swollen knee and had to stay in bed for several days. My uric acid level has always been high (7 to 9). Tests for other types of arthritis have always been negative (even though that does not mean you are free from them). I have only had once the famous toe pain and my other attacks have been limited to my knees (one at a time).
I once followed the doctor's recommendation and started taking Allopurinol, but I guess I only took it for a month or so.
My main problem is that if I do have problems with gout and high uric acid in blood, it is not the common type where you have attacks, the toe swollens and then it goes for a long period. No my real problem lies on the fact that I have constant pain on most of my body joints at all times being the most obvious the hands, starting from the distal finger ends, can't rest myself on the hand because my wrists hurt a lot, I also suffer from shoulder, elbow, groin tendon pain doesn't allow me to lift my legs properly when dressing-up, can't neal down on my knees or flex my knees all the way; it feels as if the knee was going to explode.
I need to excercise, but the numb pain gets worse and it takes all the fun of trying to be fit. I am overweight (108 kg for a 1.74 mt tall guy). I used to weigh 80 kg when I was perfectly fit and sufered no pains.
So, can it be that the multi joint pains I suffer constantly are gout related? and if so, should I start medicating myself for gout? What I do lately is take indometacin when pain worsens; Some x-rays show I already have my two index fingers by the nail or first distal joint totally damaged and slightly bent so as one small toe.
It is badly affecting my work, my life, since I have lost all the happiness due to this costant pain. (If I don't move I feel no pain and my joints are not swollen, I don't know what a Tophi is (apart from pics I've seen in the Net…).
To end this story, I was told by two different doctors the following: One said YOU MUST START TAKING ALLOPURINOL FOR LIFE IF YOU DON'T WANT TO END UP CRIPPLED!! and the other said: ARE YOU CRAZY? BY NO MEANS START WITH GOUT TREATMENT, WHAT YOU HAVE IS SOMETHING ELSE, GOUT IS NOT MULTI JOINT SICKNESS AND JUST THE THOUGHT OF TAKING SUCH STRONG MEDICINE IS ONLY RECOMMENDED FOR CLEAR GOUT SUFFERERS; APART FROM THAT, THE DAMAGE TO YOUR FINGERS SHOWN IN THE X-RAYS IS TYPICAL OF ARTHRITIS, NOT GOUT.
So what to do? one thing is clear, I cannot continue this way; my wife tells me, Do whatever, as long as your bad temper goes!!
Best Regards,
SF
Whoever told you that gout is not multi joint is a fraud. Please do what you can to report that person to the appropriate authorities. It is dangerous nonsense, and you just might be able to prevent the lies affecting other patients lives.
If you do have gout (and this is easily confirmed by a rheumatologist), one month's allopurinol is simply not enough. You must take this seriously, and have frequent uric acid tests whilst taking allopurinol to make sure the dose is enough to bring your uric acid level below 6mg/dL. Anything less is a complete waste of time effort and money.
As you can see from your experience, gout sufferers often have to take control of their own treatment. Do not let buffoons ruin another 20 years of your life.
Thanks a lot GoutPal,
Reading your comments, I understand that gout can be a multi joint issue and be there on a continuous basis, meaning that it affects you at all times, not only during gout attacks…. some kind of chronical gouty condition.
If that is so, knowing that I do have Hyperuricemia, after a visit to a proper rheumathologist, I might have to face a long term anti gout treatment with Allopurinol and Colchicine (to prevent gout crisis)… on the other hand, if I take Allopurinol and I DO have an attack, that would prove that my problems are hyperurimic/gouty and not from other possibly nastier sources (which don't have a real cure).
I'd be the happiest guy if what it takes to live without these pains is only to treat it with Allopurinol; even if it is for life…..
Will keep you posted.
Best Regards,
SF
I had my first gout attack on New Years Eve day. Big toe of right foot. Lasted two or three weeks. Very painful. I didn't pay close attention. Took Indomethacin for swelling and inflammation. I don't like to take drugs so I stopped taking that as soon as the pain had subsided. When I was back to normal I continued on as I had before in terms of diet. Probably went overboard with eating chicken and carnitas. Not intentionally but it just worked out that way over about a 14 day period. Big mistake. I got another attack only this time in big toe of both feet. Even more painful than the first attack. Tried Black Cherry Juice, ACV (Apple Cider Vinegar), and black bean broth. Didn't seem to help much. Started using what I had left of the Indomethacin. That helped and fortunately the pain was mostly gone when I ran out. Since then I have been watching my diet closely. I never was much of a red meat eater. Mostly chicken, some fish (Salmon) and occasional pork. I ate a lot of beans which I rarely eat now.
Now I'm a firm believer in monitoring the PRAL levels of what I eat. I have some computer programming skills so I downloaded the US FDA nutrient database and wrote a program that computed the PRAL value for all the foods where the required nutrients were listed. Then I enhanced it so I can enter what I eat during the day and compute the PRAL level. My goal is always to keep it as far on the negative side as possible for the day. I still occasionally eat small quantities of chicken and I had Salmon twice this week. But I balance it with lots of food with negative PRAL values. I also drink Black Cherry Juice with 1 Tbs of ACV at least once a day, usually twice or sometimes V8 juice in place of the cherry juice. And whenever I start to feel a twinge of pain in my toes I drink a batch of black bean broth. After having two attacks pretty much back to back this regimen has kept me pretty much pain free. While I suspect there was some permanent damage done to my joints in the big toes I can live with it.
So what does my story mean for you? Become a vegetarian. If that’s two big a change of lifestyle for you as it would be for me then start by building your daily diet around negative value PRAL foods using the tables elsewhere on this website. Try and keep your total PRAL value for the day as much to the negative side as possible. Try a Black Cherry Juice regimen with optional ACV. Drink black bean broth at least once a week. Do this for at least a couple of months and see if it helps.
Hi Gary,
Before any of the measures you have mentioned, the most important thing is to know your uric acid levels. There are hundreds of ways of reducing inflammation and minimizing pain, but none of that matters if uric acid levels are high. You risk more long term damage from uric acid crystals by focusing on pain relief – the crystals can still build up slowly even when pain is minimized.
Whilst using PRAL values to controlling diet may well promote a healthier body, success depends on balancing nutrients, not just aiming for the lowest PRAL value. 25-30% of food intake should be positive PRAL, and variety ensures the best mix of all nutrients. PRAL values have absolutely nothing to do with uric acid. There is a chance that higher pH values can make uric acid more soluble, but any effect is likely to be minimal. There are many vegetarians with gout.
All gout therapies must start with measuring uric acid. You can then use whatever methods you choose (medication, diet, alternative) to try and control it, but only your uric acid value can tell you if those methods are working.
GoutPal said:
Hi Gary,
Before any of the measures you have mentioned, the most important thing is to know your uric acid levels. There are hundreds of ways of reducing inflammation and minimizing pain, but none of that matters if uric acid levels are high. You risk more long term damage from uric acid crystals by focusing on pain relief – the crystals can still build up slowly even when pain is minimized.
Whilst using PRAL values to controlling diet may well promote a healthier body, success depends on balancing nutrients, not just aiming for the lowest PRAL value. 25-30% of food intake should be positive PRAL, and variety ensures the best mix of all nutrients. PRAL values have absolutely nothing to do with uric acid. There is a chance that higher pH values can make uric acid more soluble, but any effect is likely to be minimal. There are many vegetarians with gout.
All gout therapies must start with measuring uric acid. You can then use whatever methods you choose (medication, diet, alternative) to try and control it, but only your uric acid value can tell you if those methods are working.
Good point. I still have a lot to learn. I have noticed that for me if I eat a lot of protein I start to get twinges in my toes. I can pretty much make them go away by avoiding protein and doing the cherry juice, acv, and black bean broth thing. I'll see how well my theory holds because I've eaten a lot of protein the last few days and I'm getting twinges in my toes. Tomorrow it's black bean broth, and more cherry juice and acv plus no protein. I should get my uric acid level tested again and probably get a UA test kit and monitor it. To be honest I don't relish the thought of sticking myself with a needle. Is there any correlation between uric acid in the blood and the PH of urine? It's a lot easier to pee on a strip of paper. The upside is I'm loosing weight which I have needed to do for a long time.
The uric acid test kit comes with a device for pricking the finger which is adjustable. At the right setting, it just breaks the skin surface and is panless. Start with a low setting and increase until you get a large enough blood droplet – it only needs to cover the small hole in the test strip. In any event, you should be getting uric acid tests from your doctor.
There is no correlation between uric acid and pH, except that uric acid is more soluble at higher pH. Alkalyzing will help prevent the formation of kidney stones.
Losing weight is good – I wish I could find it easier.
I am the starter of this thread (Gout Addict), but forgot my details and re-registered as “goutorarthritis”.
Thanks for the comments and help.
Since May and following the good advice from GoutPal I started taking Allopurinol 300 mg and Colchicine to avoid any gout attacks.
Today I still take both plus some Indomethacin when pain on my knees starts to worsen.
I have also started a diet to lose as much weight as possible (already lost 9 kgr); the diet basically consists on no red meat, mostly grilled or boiled chicken, no fat, no alcohol in any form, low carbohidrates, minimum bread and some Allbran with my no fat yogurts. 5 meals a day ( 9:00 am, 11:00 am, 13:00, 18:00 and 21:00). No real limit on amount per serving (chicken, fish or salad), more like take as much as you feel like it….
Had a blood test done a week ago and EVERYTHING is great; my uric acid in blood is down to 5.3 (from 8.6), 170 Cholesterol and all the rest are well below limits.
Problem is I still suffer from multijoint pain and to tell the truth it is worse than ever; can't use my hands, my knees don't allow me to try any healthy daily walk and my stomach is starting to complain from what I think is the colchicine intake.
The doctor told me he NOW believes it is some kind of arthrosis, not Gout related, so I'm a bit at a loss here, could it be I have both Gout and and Rheumatism of some kind? Blood analysis gives negative on rheumatism, but the doctor says that doesn't mean I don't suffer such illness.
I will continue with the mild diet, but need to know if it is normal with such low uric acid in blood figures can bring about such painful joinst, mainly hands, knees, anckles and feet; when I stop moving, the pain tends to be less, but still I must move in bed constantly while I try sleep, to adopt different postures so some joints get their needed relief.
Any clues or ideas?
Thanks anyway,
Charles (57 years old, 20Kg overweight, but decreasing…)
Nice to see you are making progress, Charles.
Unfortunately, as you had high uric acid and gout attacks for many years, it is going to take a few months for the uric acid crystals to dissolve. Until they do, you are going to suffer joint pain, but this should get less with each passing month.
It sounds to me that you are doing everything right. Please don’t give up yet.
The only practical advice that I can add to what you are already doing is to drink plenty of water – 2 to 3 liters per day, and you can include tea, coffee and other soft drinks as part of the total.
Charles,
I'm glad to read Part 2 of your story.
Arthrosis by the way is DAMAGE from past inflammation, like arthritis, gout (which IS arthritis) or injury. After 20 years of gout attacks brought on by hyperuricemia, you undoubtedly have PLENTY of joint damage and bony overgrowth and damaged cartilege and ligaments. Some the body can heal in the absence of further insults but some will never heal properly. It took me 10 years after alllopurinol for my thumb tophus to resolve by migrating uunder my nail and forcing it's way out…and I still have a small sometimes achey tophius on the distal joint of my little finger.
Assuming you still have a lot of tophi, consider either upping your allopurijnol a bit or adding probenecid to dump more uric acid. For chronic gouties sometimes a level even lower than 5 is a good placee to be. I think things will get better for you but it will be slow. THe lower you can get your uric aciid the faster the old deposits will be removed.
Probably you can loosen up on your diet a bit…it makes life more pleasant and that's what the drugs are for.
Never mitigate gouty arthritis compared to the others…it is the only KILLER among the arthritises. If NONE of your pain is attributable to gout, just treating hyperuricemia will save your heart and your kidneys.
Thanks again for all your advice and your moral support to my endeavour to reduce my uric acid levels and at the same time reduce my overweight.
Both are hard tasks and very much related to each other and most importantly, to my health.
I do have many questions and few answers, but as GoutPal says I’m going in the right direction.
With regards to daily water intake (I even drink a lot during the night); I can state that no less than 3 liters go through my body. I am a heavy beer drinker (not at this stage of course), so it’s easy for me to gulp big amounts of fluid in one go and even though it was tough at first, being water the most unpleasant fluid to take when not thirsty, as most of the things in life, it takes time but you get accustomed to almost anything…..
The thing about drinking a lot of water though is that when trying to keep smaller food quantity intakes, water tends to enlarge your stomach as beer used to, so it is seldom you feel satisfied or full after meals; small and constant sips would be perfect I guess, but an impossible task when you have other important tasks in life such as working to bring money home.
I thought about that Japanese health method when you are supposed to drink 1 liter of water as you get up in the morning, all in one go and every morning, but I doubt that being the answer to all our health problems and I actually think it can even be harmful for you.
I didn’t know what PRAL meant till Gary S mentioned it; did a short search and found this page: http://www.bitterpoison.com/ar…..l-formula/
So now I know and as GoutPal mentioned and the author of the document says, “Of course, acid/alkaline balance is only one small way to look at health. I do not think it is useful to micromanage your diet to get the lowest PRAL values”. Still it must be wise to keep the total figure your daily food intake close to zero or on the negative side, so thanks for that Gary!
My PRAL balance now must be well into the (-) zone, since I eat so much fruit, mainly about ½ to 1Kgr of raw cherries per day; out of the box and in to my mouth….. Not that I was aware of this PRAL thing, but more because I read in this and other forums that it was one of the best ways to lower your uric acid.
And Zip2play, I really suffer in sympathy with your pain as I read about your gouty toe; it must be terrible, but at least you have no doubt of what your illness is. In my case and even after suffering from joint pains for more than 33 years, I don’t know what Tophi are, at least in my body; have seen pictures from gout related websites, but never on me.
I actually wish all my problems were gout related because I would then know I had a solution, even if it was a lifetime drug one. But if it is an autoimmune disease, not Gout related, then I know there is no cure, just anti-inflammatory pain relief drugs that can kill you or at least make your crippled life more miserable if that is possible.
So trying to end this “brick” so you don’t suffer additional psychological pain, I’ll end-up saying that as for me, I DO have high Uric Acid level in blood so I will continue with the Allopurinol as long as it takes, in the hope that my pains go one day; I will also aim to reaching my appropriate body weight (around 80 Kg), since that in itself will be terrific for my general health status.
Thank you all once again and keep in touch.
And GoutPal what can I say about your website, but to thank you once more, for the great job done……
Best regards,
Charles
One big element (no pun intended) in the gout equation is the matter of being over weight. I have been so for years and years, though I carry it well.
I have lost a stone since I was weighed in the heart clinic 3 months ago [100Kg] without diet,as such.
I simply stopped frying except rarely,very little salt( thus stopping excess fluid retention) & carbohydrates -and then paced meals according to the Leptin Diet, which is not a diet as such but means moderate self disciplne in meal types and timings. No food is banned!
[To precis: 3 main, moderate size !! meals. Reduce carbs
11+ hours overnight break (no snacks ever) with a high protein breakfast].
Mmmmm…but smallish !!
This protocol relies on the fact that fat is a master hormone controller and this loop needs to be reset over time.
This 'diet' is free- and will work unless you have other underlying problems.
It can't do harm like modern diets can ,anyway.
This is just one piece in the jigsaw, but a vital one in the fight against Big G !
I'm sorry to say ,as a beer lover myself, that not only is alcohol bad for gout it also puts weight on brilliantly- so this is excluded -as it is not a 'food' anyway but a Gov't licenced drug.[Be honest !]
If you are serious about good health in general then you will need to watch your vitamin and mineral balance whilst consuming large amounts of fluid, as you stated.
This is not a medical site, as stated many times elsewhere – but self help is top of any good life management list and GoutPal is full of tips for just this very thing!
I intend to expand a bit on this 'Leptin thing' in its'own thread
– I think it has mileage for gout repair- but was prompted by your exposition on weight factor in this thread.This is the easiest protocol ever- sio give it a serious try.
“With regards to daily water intake (I even drink a lot during the night); I can state that no less than 3 liters go through my body. I am a heavy beer drinker (not at this stage of course), so it’s easy for me to gulp big amounts of fluid in one go and even though it was tough at first, being water the most unpleasant fluid to take when not thirsty, as most of the things in life, it takes time but you get accustomed to almost anything…..”
Drinking a lot of water during the night tends to affect our sleep because we will need to wake up often to go the toilet. That would interupt our sleep. So, it would be better if we drink lots of water in the day.
“I thought about that Japanese health method when you are supposed to drink 1 liter of water as you get up in the morning, all in one go and every morning, but I doubt that being the answer to all our health problems and I actually think it can even be harmful for you.”
The Japs do that to flush out as much of the debris and waste (food taken the day before) in their system, as it aids bowel movement.
I do that first thing every morning – gulp down 1/2 liter of water, followed by my regular cup of coffee. Then I would go about doing other things like brushing my teeth and reading the newspapers, etc. Half an hour later, I would need to go to the toilet to clear my bowel. It's good for our general health.
goutorarthritis said:
I didn?t know what PRAL meant till Gary S mentioned it; did a short search and found this page: bitterpoison.com/archive/calculate-acid-alkaline-with-pral-formula/
Of course, there is an even better one at http://www.goutpal.com/potenti…..-load.html with a link to a full set of tables. 😉
Overall, I think you are on the right track, and now it is just a matter of hanging in there and let the allopurinol do it’s work. Good fluid intake is important, but you do not need to worry too much about it. Unless you have a very controlled work environment, 2 to 3 liters a day should not be a problem. Remember, this includes all soft drinks.
Fluid aside, your focus needs to be on uric acid level. Maintain it below 6mg/dL, and you are on the right track for fewer and less painful gout flares. Below 5mg/dL and you will get there faster.
Diet is something most of us can improve, but I always feel that you should consider this as a secondary goal for fear of overwhelming yourself and going off track on the uric acid level front.
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