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hello everybody,
im a young guy (25 yrs), suffering from gout since i was 19, and i really need some advise from some more experienced folks
for the last years i didint put much attention to the gout attacks i had in my foot, but in the last years the attacks became much more severe, and a month ago i went to the reomathologist.
since the reomathologist gave me the direction that it might be gout, i started researching a lot about it, and i have some questions that i hope you can advise me.
1. my UA level is 11.6 mg/Dl, and i know that i must bring the UA level to the safe ranges (<6.8) to manage the gout, avoid tophies, and all the additional trouble the UA can cause, my doc want to give me Allopurinol, and after some days of research about this drug, i got really scared from it side affects (specially about steven johnson syndrome
it may cause, and the skin rash). my question is, how rare are the side affects? maybe im just terrifying my self too much with all this researching? is there anyway to know if im alergic to Allopurinol before i start taking it?2. i searched for some natural cures, and i found out that extracted cherry juice, works really good for me, and i can really mannage the pain using it, but of course it helps only the pain and it dont lower the UA levels,
i found another product called GoutCare, and from their site, and users feedback on yahoo, it seems like a really good natural option. anybody here have tried it?
is there any other available natural subsentence, beside low purine diet that can help reducing the UA level?
3. my blood UA level as i mentiond before is high (11.6 mg/Dl) i made a 24/hr urine test, and the UA level was in the normal range 760mg, can it maybe indicate some kidney problems on flushing the UA away?
Many thanks in advance..
-Daniel
Hello Daniel I'm a newby here myself and just found out the first week in May that I have Gout. I've been on Allopurinol for a little over a month. I'm still having attacks but hoping they will soon be a thing of the past. I've had no side effects from Allopurinol. And my blood tests are all good. I think a lot of the negetive things said about this drug are from people that are trying to sell a cure that doesn't exist. I've read some post on different sites where some people have been on this for 20 to 30 years with no problems. That being said if you do go on it make sure you keep your doctor appointmemts. Good luck. LIMPY
Hi Daniel !
I've tried Gout cure herbal remedy and got good initial figures with using it and the diet. However,I'm at the lower end of the SUA 'over- limit' so have some leeway in trial and error on this.
With your figure of 11+ I would say bite the bullet of using meds. They can always be stopped , if a problem – but high SUA is the bigger threat, as you know.
I worked out empirically, that the most I could hope for with the natural method was about 3 points on the scale [on a good day] and you need double that to get into a good region on SUA. The diet is quite hard to work, tbh- even for a non meat eater like me.
Further, if the herbal approach has any effect- then using it with other meds [like for BP] can be unknown territiory too.
From your tests it seems like you could be a poor excretor of urate, which AlloP covers- but alternatives could be used if this doesn't suit you, on use.
The one thing to watch is getting on a too low dose and going through extended periods of flares- but fear of the unknown is always somwething to beat down when facing up to gout. What is known, is it needs working on -at your readings. Good luck..
Daniel,
Welcome to the club nobody wants to join (I LOVE that phrase.)
Serious side effects of allopurinol are very rare …if you can take it for a week you can probably take it doe a decade. I'm on my second decade.
You have SERIOUS gout if you have already had several attacks AND you have a serum urate of 11.6…that's horrific. You will NOT be able to manage the condition without allopurinol or $$$Uloric$$$. (I don't mention uricosurics becasue your kidneys are excreting enough, you are just MAKING too much uric acid. Your kidneys sound fine.)
Forget about the “natural” “cures.” They are as effective in curing gout as they are for curing cancer.
You'll be tossing your money away. You are just a kid and you cannot afford to be laying down any more urate deposits at age 25…by the time you are 60 you'll look like Lot's wife (turned to a pillar of salt.)
Start right in with 300 mg. allopurinol…don't let your doctor talk you into 100 or 200 mg. doses because low doses are likely to cause more attacks than they prevent.
zip2play said:
Post edited 1:17 pm – June 30, 2010 by zip2play
Start right in with 300 mg. allopurinol…don't let your doctor talk you into 100 or 200 mg. doses because low doses are likely to cause more attacks than they prevent.
Zip, I know you've gone into this concept in detail somewhere before, but can you just run through the science again of why low doses can cause more attacks. Is it just because of the greater risk of straying above 6.7 if you're at, say, 5.5, rather than 4.5? I don't understand why if the attacks are due to old urate deposits gradually being exposed, a higher dose makes any difference, as long as you stay below the threshold.
Thanks everyone for your input.
its really great to have a such support community…
i`ll update here with the progress on my battle against UA
odo,
Here's how I look at it. Allopurinol will cause less urate production and cause some of the old urate deposits to dissolve as serum uric acid drops. This newly dissolved uric acid will migrate throughout the body until it is slowly disposed of by the kidneys. During that time, depending on local conditions, it might find a locale that is hospitable to recrystallization…perhaps some cold acidic joint. The larger the dose of allopurinol the lower the circulating concentration of urate and the less likelihood of having areas that are receptive to locallized precipitation. As we know it is the NEW precipitation that causes the immune system to bo bananas and cause a raging attack. The old settled deposits are troublesome but not acute.
Thus a 4.0 serum uric acid probably has no areas of the body with locallized 7.0, but a 6.0 uric acid probably DOES.
So somebody with all of the easily soluble urate deposits long gone from years of treatment migh be able to lower his allopurinol but someone just starting with lots of freshly laid down miscible pools of urate would likely get into trouble with low dose allopurinol.
If I were a doctor, I would prescribe 300 mg. immediately and tell new patients to watch carefully for any signs of hypersensitivity…never 100 mg.
Think of a hornet's nest. To get rid of it would you douse the nest with as much poison as you can get in as quickly as possible or would you squirt in just a little…and RUN?
@ Zips' “Forget about the “natural” “cures.” They are as effective in curing gout as they are for curing cancer.”
That is your opinion Zip- but my experience shows readings as low is 4+ attained on diet and herbals versus a normal 7+ .
I'm not inventing this , so your approach to Meds the only way is not supported by my figures. I've not persisted at this regime due to still being attack free.*** NB
I will agree that a sure 'cure' via this method is unlikely, and certainly difficult to prove , as the old urate coming out of solution is not easy to attain or even monitor using diet only. Meds are not a 'cure' either- purely palliative to urate layup causing ongoing symptoms.
Many people reading this will want to hear of alternative methods -as we already know that the medical establishment can be a blunt instrument at least- and too often gets gout quite wrong in management approach.
So, though meds may be an obvious solution to those so minded, the options on other methods need to be kept open- or we just hand over to Pharma for good.
I do not intend this route for myself and many will agree, without having the in depth arguments to refute your approach.
zip2play said:
Post edited 12:15 pm – July 1, 2010 by zip2play
odo,
Here's how I look at it. Allopurinol will cause less urate production and cause some of the old urate deposits to dissolve as serum uric acid drops. This newly dissolved uric acid will migrate throughout the body until it is slowly disposed of by the kidneys. During that time, depending on local conditions, it might find a locale that is hospitable to recrystallization…perhaps some cold acidic joint. The larger the dose of allopurinol the lower the circulating concentration of urate and the less likelihood of having areas that are receptive to locallized precipitation. As we know it is the NEW precipitation that causes the immune system to bo bananas and cause a raging attack. The old settled deposits are troublesome but not acute.
Thanks Zip, but how do we know it is only new deposits of urate which cause serious flares; I thought old deposits do as well, as they become exposed prior to disolving back into the blood? (I'm assuming that urate becomes uric acid again in the soluble state?)
Thus a 4.0 serum uric acid probably has no areas of the body with locallized 7.0, but a 6.0 uric acid probably DOES.
Surely there is no discernable local difference in SUA once it has rejoined the systemic flow? I assume you mean that newly disolved old urate may be more likely to raise SUA is above 6.7 and settle elsewhere? So I guess the question is: how much can alloP raise SUA by disolving old urate deposits? Which begs the question that maybe lower doses would dissolve urate more slowly and run less risk of causing flares?? Confusing ( but fun to chew over
)
I've wondered about that exact point you make, Odo. That is, are we better having our blood tests showing in the 5s or lower than that. I take 200 mg allop a day and, touch wood, have had no flares since starting the drug. I get plenty of minor sensations, some worse than others which I assume is urate dissolving, but no actual flares. My home tester shows SUA of between 5 and 5.5 mg/dl.
Obviously if I move to 300mg allop per day I will get a lower blood score. Which will, one assumes, dissolve urate faster. That may be a good thing, I'm not sure; but I remain cautious. I've had no flares, why risk it ? What we cannot know for sure is whether we ever go above that 6.8mg figure…and, if we do, whether it causes us any damage if we are only above that figure for a relatively short time.
I have my first official blood test soon since starting 200mg. Will be interesting to see what that shows, though I confess I still debate whether to increase the dose if it shows, say, 5.5mg/dl.
I appreciate zip is a huge fan of 300mg, and I respect his views and understand completely his argument. However, I am still to see a proper study confirming that view. I'm sure that most of us would prefer not to have to take medication at all to control gout; but, in my simplistic way, I kind of feel 200mg isn't quite so bad as 300mg. 
odo,
Thanks Zip, but how do we know it is only new deposits of urate which cause serious flares; I thought old deposits do as well, as they become exposed prior to disolving back into the blood? (I'm assuming that urate becomes uric acid again in the soluble state?)
What I said was that new PRECIPITATION causes the immune system to go bananas. Old urate causes chronic pain but it is the urate that converts back to uric acid and makes its way anywhere near the bloodstream and reprecipitates new crystals that is a major acute attack of frank gout. Perhaps the new recrystallization is almost in the identical place. Thus both new (from diet and cell breakdown) and old uric acid (from urate deposits) can cause major attacks by laying down “NEW” uric acid. The body despises uric acid deposition, it seems more amenable to monosodium urate. I doubt the immune system is much concerned with settled old urate deposits unless they get acidified.
One can only conjecture here because the exquistely complicated dynamics at the interface between urate-uric acid-bloodstream-joint fluid-nerve cells cannot be precisely measured. All we have is a few ham-handed methods of lowering the blood's total load of uric acid which seems to be enough to GENERALLY prevent a life of pain and disability.
Surely there is no discernable local difference in SUA once it has rejoined the systemic flow?
Picture a pile of urate…virtually 100% concentration (like 100,000 mg./dL…for effect) Picture what happens when some dissolving in locallized acidic environment occurs. What can you see as the concentration of urate near this heap? Think of a pound of salt dropped into a bucket…wouldn't you eenvivion a HUGE gradient of salt concentration between the bottom of the bucket and the top? So yes, I can envision VERY high concentrations near the dissolving tophus. For myself I feel my twinges about 1/2 inch inwards of my bunion joint that got hammered so many years ago. Thus I envision HUGE localized differences in SUA in the vicinity of gouty joints, perhaps even leading to dissolving and recrystallizing in or near the same spot.
nokka,
I kind of feel 200mg isn't quite so bad as 300mg.
Or as GOOD. (I couldn't resist.)
Time will tell if it's the right dosage for you. I have no qualms on somebody settling on 200 mg. as a final dosage, I'd consider him lucky IF it prevented all further gout attacks. My problem is starting new patients on 100 mg. or 200 mg. I feel strongly that that is likely to result in MORE net pain.
I think the analogy with antibiotics is a good one: Would a good doctor prescribe 100 or 200 mg. tetracycline/day to treat an infection that most people find responds best to 500 mg? Would he hope it works and gradually move up to the proper doseage over several months while the patient continues suffering.
What would we call such a doctor?
Taking less than enough of a drug because it feels somehow “holier” has always struck me as kind of silly. Taking an effective dose or none at all seems wiser. I hope your dose turns out to be the effective dose nokka.
zip2play said:
Post edited 12:58 pm – July 2, 2010 by zip2play
Picture a pile of urate…virtually 100% concentration (like 100,000 mg./dL…for effect) Picture what happens when some dissolving in locallized acidic environment occurs. What can you see as the concentration of urate near this heap? Think of a pound of salt dropped into a bucket…wouldn't you eenvivion a HUGE gradient of salt concentration between the bottom of the bucket and the top? So yes, I can envision VERY high concentrations near the dissolving tophus. For myself I feel my twinges about 1/2 inch inwards of my bunion joint that got hammered so many years ago. Thus I envision HUGE localized differences in SUA in the vicinity of gouty joints, perhaps even leading to dissolving and recrystallizing in or near the same spot.
Yeah, see what you mean now, I was thinking blood flow would remove UA pretty quickly from the area, but if the urate is constantly dissolving then I guess you would have a local concentration and higher chance of an immune response in that location. Maybe this explains attacks in new areas as well? – joints that have never previously been affected because they hadn't reached critical mass, now become inflamed because of the body wide urate disolving/inflammation process??
Think I'm going to simultaneously test blood from my big toe and my finger soon
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