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Wow! I just got my latest labs today and my SUA (serum uric acid) went from 6.5 to 4.3 while taking 300mg of Allopurinol daily. The lower the number, the better for gout sufferers since the uric acid crystals forming around the joints (big toe and shoulder, in my case) cause excruciating pain and deformed joints. My liver enzymes were a little higher then I would like them to be, but nothing like they were before I started my semi-vegetarian, no alcohol or high fructose corn syrup diet.
I still get minor pains and twinges in my toes and shoulder and I take 220mg of Aleve (OTC) for that, but not very often.
Overall I'm very happy with the results of the labs and I attribute the lower SUA to the 300mg daily dose of Allopurinol.
Atta boy, Art.
The allopurinol is doing exactly what it is supposed to and you should be looking at a pain free, or at least GOUT pain free life ahead.
Don;t expect too much with the shoulder though. I have mangled rotator cuffs and they hurt periodically no matter what. I just have to spend several/many weeks staying off bench presses.
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When was your last acute?attack?
Zip2play,
?? Thank you! My last attack was July of 2010, and it lasted for two weeks or so. I was in pain for the 1st two months after starting the 300mg of allopurinol. I can still feel twinges in my toes and shoulder, especially after physical trauma (banging my toe on something, etc…). I can live with minor pain and twinges, just not another acute attack! Thanks again.
I'm having another attack right now, although it's not nearly as severe as my previous attacks. My SUA is at 4.3, so I am extremely frustrated. I have a call into my liver specialist so I can ask him to put me on Colchicine. I'm taking 300MG of Allopurinol a day and I thought i was beating this, but apparently not!
azasadny said:
?I thought i was beating this, but apparently not!
Yeah you are. Allo can cause flare ups at the beginning; some people get them, some don't. 4.3 is pretty low, so your urate deposits may be shifting quickly enough to cause minor flares. Stick with it; you will benefit in the long run.
The Dr wants me to start on Colchicine, so I'll be taking it this weekend when I get home. Months after starting Allopurinol and with my SUA at 4.3, I'm having pain in my toes. Very frustrating!
I tried the Colchicine regimen last Friday and I started with 2 x .6mg at 2pm, followed by 1 x .6 each hour until midnight. No relief from pain and no side effects until early the next AM. The Colchicine kicked my butt (literally) and I had severe nausea, abdonimal cramps, fever and diarrhea for 24 hours and still no relief from gout pain in my toe!
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A Dr that I know suggested that I take 1 x .6 Colchicine daily with my Allopurinol instead of the way I tried to take it last Saturday, so I've just taken my 1st daily dose.
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I spoke to my brother on Sunday and he also has gout and he tried Colchicine and had the same experience I had. His gout is getting worse and he'll be asking his Dr about Allopurinol. I asked him what his SUA is but he didn't remember what it was, mine is 4.3, down from 6.5 when I staerted on the 300mg of Allopurinol.
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I'm taking 220mg of Aleve (naproxen) for the near-constant pain in my toe, but this is getting old!!!
If the anti-inflammatories are having no effect, it might be unrelated to your gout. Think about getting an x-ray to see if there is some other problem.
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Also, if the 4.3 is the same reading as when you started this thread in February, it's time for retesting.
Azasadny,? sorry to hear about your flareups. You must have a lot of uric acid deposited in your body.? I've read it can be in the bones in addition to soft tissues. ? When I was decrystalizing, I drank a lot of water and tried to exercise as much as possible.? Also drank coffee, which I figured would help as a diuretic.?
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You mentioned that your liver enzymes were elevated.? I'm dealing with that right now and was wondering if you could speak a little more to it.? What were your levels?? What did the docs say about it??? Mine are elevated at 62 AST / 83 ALT, or 2x the ideal level.? Doc says I need to try the other drug options and rule out liver cancer, hepatitis, etc. It would be great to hear about this part of your experience if you're willing to share.
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Thanks.
Art,
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So sorry you flared up again.
I hope the attack abates soon.
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I would normally say consider upping the allopurinol to 400 mg, but with readings of 4.3 mg./dL that shouldn't be necessary. Are you testing yourself frequently or is the 4.3 a doctor's reading from some time ago. Perhaps hourly, daily, or weekly swings have you far higher at time?
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If it were I, I would up the allopurinol to 400 mg. for several months and see if that stopped the attacks. If it did I would retry 300 mg. again and watch. You are loooking for a lifetime dosage so you have all the time in the world to get it exactly right.
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Have you tried Alleve or indomethacin for the attack?
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(Like GP, I'm amazed the colchicine had no effect and thus tempted to consider other causes of this attack.)
Gentlemen,
?? Thank you for the posts and good info.
I'm also having an acute gout attack right now and my SUA is at 4.3 ?My Dr is as confused as I am. I've been talking 300mg of Allopurinol for about 9 months now and I'm in almost constant pain from gout in my great toe on each foot, mostly my left foot. Because of a liver condition (NASH), I'm not able to take most meds, but the Dr gave me a shot of Tramolol yesterday and 1pm and I felt sleepy until 9pm. I'm trying to just take 220mg of Aleve every 12 hours to hold off the pain.?
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I tried Colchicine last month and it almost killed me! My brother also has gout and he can't take Colchicine either. The Dr doesn't want to increase my allopurinol, she's sending me to a rheumatologist for further evaluation.
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My increased liver enzymes are related to my diagnosis of NASH (non-alcoholic steatohepatitis). The way I got my liver enzymes (AST & ALT) down from 400's to low 30's was to drop about 20lbs (from 200lb to 180lbs and I'm 6'1″ tall), remove all red meat and alcohol from my diet, remove all HFCS (high fructose corn syrup), REALLY watch what I eat and increase my intake of green veggies and fruit, only eat chicken or fish once a week.?
I've been living this lifestyle for about 4 years and right now I'm at 190lbs, so i need to drop 10lbs, which is fairly common for me after the winter, since my activity level is reduced during the winter and increase in the spring/summer.
I also take vitamin C, D and E supplements per my Dr's recommendation and I drink tart cherry juice concentrate very regularly. The Dr (liver specialist) is adamant that I check with him before doing anything different than this regimen because it has successfully lowered my liver enzymes. The only other signs that my liver enzymes are up is chronic insomnia and a “feeling of dread” that I had when the enzymes were elevated. We think the liver condition and gout may be related but we really can't run the liver panel whil I'm in the throes of a gout atack because the inflammatory process throws the lab results off.
?Why would our gout be flaring up even when our SUA is low? I understand that you can have pain when you start Allopurinol, but I've been taking it for quite awhile now and it seems to be working to lower the SUA. My SUA was 6.5 prior to the Allopurinol and is now 4.3
If you sense that I'm a bit upset, disappointed and confused, it's because I truly am. I'm doing everything I possibly can, but the gout will not let go of me. My family Dr thinks the gout may be related to my liver condition because she has never had a patient with gout respond like I have…
Thanks for letting me rant…
azasadny said:
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If you sense that I'm a bit upset, disappointed and confused, it's because I truly am. I'm doing everything I possibly can, but the gout will not let go of me. My family Dr thinks the gout may be related to my liver condition because she has never had a patient with gout respond like I have…
Thanks for letting me rant…
Art, your story is almost entirely the opposite of mine. I am quoting one other comment of yours from another post: “Let's keep learning from each other and trying to offer assistance where we can.” I am trying not to be judgemental or critical of your comment, rather raising a caution flag: While we can and do learn from others' experiences we should NOT offer assistance (tell what to do or not to do), simply what works for one gouty may not, most often, will NOT work for the other. That's why I am posting my story here which is, as I said, 180 degrees from yours.
I was on Uloric 40mg from July thru Dec. 2010 and now on Uloric 80mg from Dec. 2010 till present. B/4 Uloric, my SUA was around 8-9mg/dl. During 40mg U. it dropped to 5.8-~7. during 80mg it dropped to 5.2 and raised again to 6.9 (above the critical line!) I had a couple of mild attacks/twinges on 40, and just one (about 3 weeks ago) on 80mg. Reason: I walked ~2 miles (too much after very little walking for almost a year.) 2 Colchicines for 4 days took care of the inflammation (left knee) with pain level of 1-3 (on a scale of 0-10) Never had to call on the emergency doc: Naproxen. ( That's only for levels 5/6-10)
To point out the differences: I take Uloric because I CAN'T take Allopurinol, you can. I CAN tolerate Colchicine, you can't. My SUA is around 7, yours is 4.3. Both, my liver and kidneys are completely normal, your liver is not. (What about YOUR kidneys?) Your diet is about as healthy as it can be, mine leaves something to be desired: I eat red meat, pork, chicken, fish, spinach, mushrooms.cauliflower, (all those “good” vegies which are no good (supposedly) for gouties), drink 1-2 glasses of wine 3-5 times a week (no beer,though) YOU have quite a few gout attacks, I rarely do. (Have had gout for 27 years.) I am sure, you are getting the drift. You have NOT elaborated on one important item: KIDNEYS. In my opinion, kidneys play a far more important role than liver in dealing and getting rid of uric acid and/or MSU (the tophi). My hunch is that MY high SUA readings are responsible for tophi being redissolved and getting into my blood stream. Fortunately, my kidneys are doing their job in getting rid of it. Have you and your doc considered that your kidneys may not be 100% functioning? Just a thought!!!
hansinnm,
?? Thank you, you have made some very good points! I don't ever want my comments to be misconstrued as “medical advice”, just simply trying to explain my gout experience and read about others and what they have experienced. My liver Dr did check my kidney function and all is normal there, but the rheumatologist may want to check kidney function again when I get to see him.
??What may make my experience with gout “atypical” is my liver condition and I always keep that in mind. My brother's gout experience is different than mine also. He had one attack, then several years passed before subsequent attacks. His Dr had him try Colchicine and he didn't tolerate it well at all, just like me. His Dr didn't want to try Allopurinol and didn't get my brother's SUA drawn.
??I'm just frustrated that I'm suffering with this even after modifying my diet, weight and drug regimen. I'm doing everything that I know how to do and it doesn't seem to be working.
??Thanks again for hearing me out and sharing your experience. I wish you good health!!
BTW, I forgot to mention that my SUA results are from the lab, I do not test it myself. My last readings were from February of this year. My Dr doesn't want me to take more than 300mg of Allopurinol a day, I asked yesterday. Thanks!
azasadny said:
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??Thanks again for hearing me out and sharing your experience. I wish you good health!!
Thank you, Art. I ?do understand your frustration, particularly in view of the fact that you have done just about everything possible to “manage/control” your gout. You probably are at the mercy of your own metabolism and there is not much more left to change/coerce that to cooperate. Maybe, hopefully, the rheumatologist has some thoughts which no body else has considered.
Good Luck, that's all I can say, and it sure as hell isn't much.
My wife and I were just talking and we made some observations. I have checked my “gout history” notes and have noticed that although my weight ranges from 185lbs -200lbs, the gout attacks seem to occur more often at the heavier weight (during the cold MI winters) than at my lighter “summer” weight when I'm also getting more physical exercise. So, I'm making an effort to get back to 185 (or 180) and I'm at 190 right now. My long-term goal is to stay at this weight and stop the fluctuation and see if this helps. It also seems that my gout may have started ?when I was 40 (ten years ago), so that the damage done may be more significant that I thought.
At 40, I had several issues that I simply attributed to age that may in fact have been the early onset of gout, I'll never know for sure, but it sure seems likely.
How frustrating?
you have my sympathies. Although Allo & SUA of 4.3 should make diet irrelevant, only thing I can think of is maybe just stick to fish. Before I went on Allo, Chicken & tofu were significant triggers for me.
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