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I fully support GP in his call for regular UA tests for Gout sufferers.
If in the initial treatment, Allopurinol, the UA reduces to allow the crystals to leave the joints and then another attack or flare occurs on an on going basis. This can be over a long term.
It is also recommended that you wait 7/10 days after an attack before having a UA blood test. This may not be possible due to the ongoing attacks.
As false readings may/ will occur in the initial treatment stages is there any value in having regular UA tests?
Over to you Keith.
I'll go back in my cave again.
How come Allopurinol and other medicines, don't come up in the spell check??
David
The only way to manage gout, is to manage uric acid.
This is true however you choose to try to fix your gout.
Many people, including, unfortunately, some qualified people, see pain management as being most important, but it is not. Untreated high uric acid has many perils. The most obvious risk is slow build-up of urate deposits in joints, under the skin, and in the kidneys. These deposits are known to be capable of causing permanent physical damage, irrespective of gout flares. There might also be increased risks of heart disease with high uric acid, though current science can only see that there is a link, with an unknown cause.
Though pain management is important, it is absolutely no measure of how well you are managing gout in the long term. When I first heard about the processes that can cause gout attacks from old crystals dissolving, I suddenly realized that a huge portion of what I had previously learned about gout was worthless. The obsession with avoiding gout triggers is pointless if you cannot distinguish between an attack from new crystals forming, and an attack from old crystals dissolving.
If you measure uric acid at reasonable intervals, you at least have some factual information that you can use to track what is happening. In most instances, the figures reveal all, and you can use that feedback to decide if you need to change your management procedures. Sometimes the figures can be difficult to interpret, but at least you have that fixed data for comparison in future tests.
What is a “reasonable interval” will vary from person to person, and through time depending on what stage your treatment is at. When stable, once a year might be enough, but whilst trying to get to a stable state, with changes in medication or lifestyle, then more frequent feedback is needed to see if the changes are appropriate or enough. Every two weeks might be appropriate when trying to reach a new target level. Definitely no longer than a month.
Personally, I believe that the test interval should be determined as part of a gout management plan, and then stuck to. As part of the recording of test results, it is appropriate to note the incidence of gout flares, and anything else deemed appropriate (weight change, the weather etc). In this regard, results are not really false, they just need to be interpreted in the light of individual history. Without the tests, you have no history, and cannot manage gout other than by luck.
My ideal approach to gout management planning is very much in my head at the moment, but I will publish something soon. My suggestion is that everyone should develop an agreed gout management plan with their doctor, or in a friendly forum for self-managers. It might be pie in the sky, but I think it is a crucial development to get everyone involved “singing from the same sheet”. (aargh
cliches and mixed metaphors – anyway, I hope you understand what I'm suggesting)For me, the key is to be comprehensive, but not over-complicated. That is not always an easy balance to achieve, but my starting point will be a plan for “uncomplicated gout” first. Then some way to recognize the complications of treatment resistance and co-morbidities.
Uncomplicated gout is actually quite easy to manage if the basics are covered:
- Clear diagnosis
- Uric acid target to get rid of old crystals
- Urate deposit reducing medication an/or lifestyle strategies, including pain relief, at a maximum to remove old uric acid crystals
- Adjustment period to stabilize uric acid level around 6mg/dL
- Maintenance period for rest of life, continuing 6monthly, or even annual, uric acid monitoring.
Sounds easy doesn't it?
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