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I have a question regarding what is considered the “normal” range of uric acid level.? Specifically, why a uric acid level between 6.0 and 7.0 might fall within the “normal” range, according to the lab, yet, still be considered “dangerous” for someone who has gout.
Please let me know if I'm understanding this correctly…
The “normal” uric acid level range according to the lab is based on a
sampling of uric acid levels from a wide range of people – people with,
and people without gout.? Because not everyone with high uric acid levels develops gout, the “normal” range (according to the lab) can go higher than 6.0.However, for people who do have gout, urate crystals will start to form above 6.0.
(Sorry if this is a dumb question, but my last blood test came back at 6.8 – technically, in the “normal” range, according to the lab – and I want to be sure I understand why this isn't good enough, so I can explain to the doctor why we should adjust my allopurinol dosage.)
As far as I am concerned…6.8 is not good enough for us who suffer gout.
everyone has opinions though, I think the goal for us sufferers is below 6.0
I was still have frequent gout attacks at 6.5
At 5.3 GONE!
Ravenwood,
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That's a good but complicated question. Outside the body, the solubility of gout is complicated and even in water solution it is dependent on many factors,?like temperature, pH, sodium concentration, ligament condition, and a host more, the most bizarre seeming to be TIME. Inside the body the complications multiply more.
We have out plasma urate measured but it is very likely that almost NO urate depositis directly from plasma but rather from interstitial fluids outside the vascular stream and measurement is nigh unto impossible.
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And to complicate matters further, it seems some people are able to tolerat a supersaturated plasma without crystallizing urate into the joints. BUT once anyone DOES have a gout attack that supersaturation is no longer possible, either in a beaker or a foot. This is normal for supersaturation: once a crystal has formed and created a focus, more will quickly join it.
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I doubt if anyone on Earth understands the complications very well but all we need know is the finale and that is ONCE YOU HAVE GOUT, you are not normal and never will be. You will always have crystal focus points and MUST keep your uric acid below 6.0 and since urate concentrations vary a lot with time, below 5.0 is far safer.
No, your 6.8 is not good enough.
So in layman's terms, I would be accurate in telling the doctor, “6.8 might be fine for someone who does not already have gout, but since I do, it's still high enough a concentration for me to be developing urate crystals.? Therefore, write me the bloody script, damn yer eyes.? Please and thank you.” ??
Ravenwood said:
So in layman's terms, I would be accurate in telling the doctor, “6.8 might be fine for someone who does not already have gout, but since I do, it's still high enough a concentration for me to be developing urate crystals.? Therefore, write me the bloody script, damn yer eyes.? Please and thank you.” ??
Ravenwood, you have basically two options:
?1) You accept your doctor as your MASTER and GOD and say:YES MASTER, YES GOD, I am your obedient, dumb, ignorant slave and do as YOU say and even pay you for that privilege. ? ?Or
2) You can say: Dr. So-and-so, I am here not to argue with you but to request a prescription for Such and such medication of such and such strength. (Remember: S/HE is there to help/serve you, NOT YOU to serve HER/HIM. Even, though that is the attitude many doctors take today.)
You'll encounter three possibilities:
1) S/he is an arrogant asshole and won't give in. Ask for an immediate bill and leave. Don't waste your time arguing, pleading, begging. You can't win if s/he is a real asshole, unless you are a bigger one.
2) S/he gives you a logical, sound reason for not wanting to give you what you want.
3) S/he will give you what you want, but will also make you aware of the possibilities you may encounter. That puts the ball in your courtyard and it is YOUR responsibility to accept the future consequences. Remember, it is YOU, not HIM/HER who suffers the negative or enjoys the positive results.
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To illustrate with one of my own experiences with my doctor (a rheumatologist, a woman from India):
1) In July 2010, when I saw her the first time, she prescribed 40mg Uloric, since I was allergic to Allopurinol. (She would not even consider trying Allo again since 15 years had gone by.) My SUA level was 6.5/5.8 (Home kit vs. SED lab test. I have explained in earlier posts the difference between home and lab test results.) ?I told her that there is no way I could pay $5 a pill/day. She gave me referral to one of the doctors who has a contract with the health organization who provides me with a 0$ health plan. This doctor gave me 40mg Uloric for ~12 weeks, (till next appointment with my rheumatologist.)
2) In mid-September, after 10 weeks on 40 mg, my SUA was 7.5/5.8mg/dl. Since no real change in y SUA had taken place, I requested an 80mg Uloric prescription. And here my #2 possibility from above occurred: She said that I should stay at least another two months on 40 and have another lab test to confirm that my liver and kidney vitals were all in the normal range. That made sense, since we do know that, particularly, healthy kidneys are important for combating gout. In the meantime, I had been accepted by Takeda for their free medication program and had received the first 3-month supply of 40mg Uloric.
?3) In late-November, after, now, 4+ months on 40 mg, my SUA was still at 7.0/5.2mg/dl. This showed that 40mg Uloric did not have the expected results of lowering my SUA to 4-5, as Takeda had predicted/promised. She, consequently, wrote a prescription for 80mg Uloric and faxed that to Takeda. So, now, I have been on 80 mg Uloric since mid-December.
4) Unfortunately, my SUA level has not significantly dropped, yet. Last home/lab test (mid-February) was: 6.1/4.2mg/dl. The home test trend line is even going up slightly, approaching 6.8mg/dl. HOWEVER, I have not had any gout attacks (worth its salt) since last September. Oh, I had a few twinges, here and there; on a pain level from 0-10, not more than 1-3, and that is in my book acceptable. Let's not forget, I have been nibbling on the wine bottle (3-4x a week, and once or twice a month on the gin bottle since Oct/Nov. However, I have not yet opened one of my home brews. That has to wait till I am constantly under 4-5mg/dl. And, what is more important, all, and I mean all, my COMPREHENSIVE METABOLIC PANEL TESTS RESULTS ARE NORMAL.
(Keith, why can't I insert an image/table???)?
Ravenwood, I hope this lengthy, detailed explanation is of help to you.?
hansinnm said:
Ravenwood, I hope this lengthy, detailed explanation is of help to you.?
Thank you hans.? It does, somewhat.? I'm expecting either 2 or 3 in terms of a reaction.? He'll either agree to increase the dose (#3), or he'll express some reservations (#2).? If the latter, I'm just trying to be certain I can produce an intelligent explanation for why my 6.8 should not be considered 'normal', even though the lab is saying that it is.
Ravenwood said:
#2).? If the latter, I'm just trying to be certain I can produce an intelligent explanation for why my 6.8 should not be considered 'normal', even though the lab is saying that it is.
Quite simple: 6.8 is the border/critical line. If you look at all the GP forum comments, you'd come up with hundreds of documented, actual gout-inflicted people, from all over the world, who'll confirm that with a 6.8 level they were experiencing attacks of several degrees intensities. Any doctor, really experienced in/with gout will agree.
Raven- as OP you should know better 😉 Read Zips treatise above again and see that 6.8 is NOT acceptable for an established gouty and inform your Doc with confidence.
Print it out if necessary- he'll never forget the lesson 🙂
You will have to get used to this 'training mode'when dealing with Drs.henceforth – they are not likely to know UNLESS they are gout sufferers,and as most are under 45 on average {qualifying at? age 25 and retiring at 65] they are unlikely to qualify on this vital factor. [more commom after 50]
Hans is also right to point out that you must insist on a supportive attitude from your Doc [God]- I argue a lot -and still they?persist?with?unsuitable meds, with a weary professional smile. Another Doc will agree with me readily.
Be firm, it's for life
Ravenwood,
Just history should be enough for your doctor. Ask him what level was taught as desirable? for treating gout when he went to medical school. If he doesn't remember ask him if “BELOW 6.0 mg./dl rings a bell.”
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EVERY medical text for the last 50 years has said the same thing. If he says otherwise he is?a?fool never having read ANYTHING about gout?and should be immediately fired by his emnployer, YOU.
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Honest, I don't mean to sound glib or flip but if your doctor doesn't know even THIS about gout, he can be of no further use to you unleess he accepts his proper position of writing you a script for whatever and whenever you wish. I have had two doctors like this and their cooperation has been better for me than someone arrogant who wants to countermand everything I tell him to do because HE'S the doctor.
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Hans,
Do you think your immense tophi deposits make it difficult to lower your serum urate no matter what you try? It seems?possible that the outpouring of urate into the bloodstream might easily counteract your best efforts at getting a low SUA.
Does that sound plausible?
zip2play said:
…
Hans,
Do you think your immense tophi deposits make it difficult to lower your serum urate no matter what you try? It seems?possible that the outpouring of irate into the bloodstream might easily counteract your best effeorts at getting a low SUA.
Does that sound plausible?
Zip, that has been my thoughts, too. However, since I can only check the UA in my blood stream and don't have any means of checking how much UA leaves my body every day, there is NO way of knowing for sure. One thing I am sure of is that I still have plenty of tophi. Only need to look at my big toes and some of my fingers.
HOWEVER, as I said before, I haven't had any real attacks for almost 6 months and I am taking any relief Mother Nature is giving me without questioning Her. And when I say Mother Nature, you know what I mean: Millions, billions believe in the existance of a GOD who NOBODY has ever seen (except as a figment of imagination). I believe in MOTHER NATURE=NATURE which every living being on this planet can perceive every instant of its existence.
And here's a good parallel analogy Hans.
A glass filled with half ice cubes and half water will remain at 32F no matter HOW much heat you apply until such time as the very last ice cube dissolves completely. Only then can the water temperature rise.
Perhaps a sizeable amount of tophi acts the same way.
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I guess controlling your urate to the point of no attacks can be considered good enough.
Hans,
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How long has Uloric been around; and what are the performance reviews?? Both my nephrologist and rheumatologist are suggesting I try it.? I am on daily colchicine and allopurinol; but my SUA level doesn't go below 6.8.?
Kidney issues are?the significant factor in any treatment for me.? The effect of any medication on?my damaged?kidneys has to be the primary concern.?
GoutyGal said:
Hans,
?
How long has Uloric been around; and what are the performance reviews?? Both my nephrologist and rheumatologist are suggesting I try it.? I am on daily colchicine and allopurinol; but my SUA level doesn't go below 6.8.?
Kidney issues are?the significant factor in any treatment for me.? The effect of any medication on?my damaged?kidneys has to be the primary concern.
GoutyGal, Uloric has been sold for public use since (I think) February 2009. Performance reviews, in my book, are questionable, at best. Reason: Depending who performed them , for what reason, they are done to support whatever the interested party wants. (Sell, money, avoid law suits , you name it.) The only thing I look at is what true, honest gouties report. HOWEVER, ?and that is a big HOWEVER, all these reports from gouties are ALL individual cases and it would be dangerous to deduct that what works/ed for one will work for someone else. I know, I am not much help here, however, it would be irresponsible on my part if I'd recommend anything, particularly since you have serious kidney problems. I do suggest that you google Uloric and read all that is published on the medication.
?By the way, why are you taking Colchicine daily? Are you suffering from any inflammations? That's really where it helps gouties. It does not work on pain (directly) nor does it affect your SUA, as far as I am aware.
I would think that your nephrologist would be the most qualified person to advise you regarding Uloric and your kidney problems.
GoutyGal, it is YOUR responsiblity to decide what medication and how to take. As I have said in other comments: No doctor, no pharmacist, NOBODY, is going to SUFFER the consequencies of meds YOU are taking, only YOU.
Please see Normal Uric Acid Levels guidelines for latest information regarding normal levels of uric acid.
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