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I have been on Probencid for 9 months now and I'm slowly getting better, i.e. pain is reducing, joint mobility is getting better, etc. I keep thinking about the process, I take drugs to lower blood levels of uric acid and then the deposits can randomly start dissolving in my body, causing pain and attacks and I drink tons of water and pee out a small amount of uric acid. Their must be a better way to do this, why can't someone come up with a treatment where by an injection is given into the area or the joint and the “treatment” chemical/drug would combine with the uric acid and render it neutral so it could then be dissolved and passed from the body with little to no crazy pain. What is non-toxic to the body and will combine with uric acid and render it inert? Does anyone know of such a thing, or was/has this been tried before? Could this same substance be put in a cream that could be applied to the joint?
Though the pain of a gout attack is often localized in one or two joints, uric acid affects all joints, and other body tissues. It is only when you get an immune system reaction to these urate deposits that uric acid causes gout pain. All gout sufferers have an abundance of uric acid crystals all over the body, but not all are causing pain (yet).
Uric acid is carried all around the body, and will crystallize where it can. Hence tophi in the ears are common. New technology shows us how crystals, though concentrated in joints, are spread throughout the body (use the search box above to find DECT images here, or “dect gout images” in the blue Internet search box at the foot of each page).
So to stop new crystals forming and dissolve old ones, the only answer is to lower blood uric acid levels and treat the whole body via the bloodstream. Allopurinol is one drug that can be administered by injection. The new genetically engineered uricase treatments must be delivered by injection. However, none of these are site specific, because they do not need to be. They also involve trips to medical facilities that pills do not.
As for neutralizing uric acid, the chemistry is somewhat beyond me. My basic knowledge suggests to me that even if a specific agent could be found to react with uric acid alone, this would inevitably produce deposits of the resulting salts. I can only assume that such a reaction would be fatal. Maybe someone with a better grasp of chemistry will be along soon to comment.
Finally, if you are only peeing a small amount of uric acid, is probenecid the right treatment? It is not a good choice for under excreters. Have you had a 24 hour urine test? Are your uric acid levels measured regularly?
Urate lowering therapies are currently the best they have ever been, with recent new drugs, and more under development. However, they are only any use if uric acid levels are properly monitored and managed. Not much point in looking for new treatments, if the existing ones are not applied correctly.
Thanks for the response. I have problems with many joints, I was mis-diagnosed for not having gout for about 15 years; It got to the point I could not use my right arm and was developing lumps of uric acid on my arm before a doctor would believe I even had gout. I tried Allopurinol for two months and saw no improvement in my arm, actually it got worse. I then tried probenecid and in two weeks I felt and saw an improvement. I'm on a gram a day, 500mg twice daily; everytime I try and bump it up even by a 1/4 tab (125mg) I have problems with my knees, which would prevent me from doing my job and put me in pain for a week or two. I did colchicine for the first 7 months for the pain but stopped due to my hair falling out. I will have to go in and get my levels checked now after being on the meds for this long. Honestly, I am annoyed by doctors at this point from being in pain for this long… I actually put myself on Probencid; after doing much research on the net. Also, I replaced my colchicine with Lemon/Lime juice a few times a day. I read that this helps kick the acid out of the body and alkalizes the body, although it is acidic. It seems to be helping with the pain/burning.
My pain is not only from having immune reactions but from joint obstruction. I still cannot fully extend my arm without some crackle and then maybe a pop and then pain. My knees and one ankle are the same.
I'm still convinced that their must be a better way to clear out problem joints faster and without invasive surgeries. I will continue to look. thanks and regards.
I have a result from a 24 hr urine i took some years ago. How would i determine if I am an under excreter or over producer from the results? I can post them. I just want to get complete understanding before I start getting all the tests through the Rheumy, plus a little backgroiungd wouldn't hurt. I'm also going to get a UA blood test tomorrow, but I can't get a 24hr urine until Dec 10. It is very hard to get an appointment with a rheumatologist even close to where I live. I live in a very rural area, and must travel an hour and a half to see a doc.
Should I start a new post?
Dr Buff said:
I'm still convinced that their must be a better way to clear out problem joints faster and without invasive surgeries.
There is a well proven way, which is to lower blood uric acid. It must be below 6mg/dL, but lower is better. Get it down to 3, and the uric acid will be gone from your joints in a few months.
ok got it. I did some more research and I found an article explaining that probencid lasts like 8 hours in the body at effective dose; so I was taking 1 every 12 hours at 500mg; so it was in these 4 hour gaps where the uric acid was building up in my body or so it felt like it. I switched to 500mg every 8 hours and now I have mild pain in many joints but not the intense burning I had before. I will go in at the end of next week to check my levels to see where I am at. I hoping it is close to 3mg/dl.
Like all in this group I have seen the gnarly looking gout pics on the web; are you telling me that these guys can clear out in a couple months? I read a study online done by New England Journal of medicine that based on test studies stated it would take 3 years for all the crystals to be gone from people who suffered from chronic type gout with gout symtoms for 15 years or more. I tried to find the study again so I could link it but could not.
There are many factors that will affect how long it takes to get rid of old urate deposits.
The biggest factor is how low can you get your uric acid.
Some of the gross pictures we see are really exceptional, and will probably need extensive surgery as well as maximum urate lowering therapy. How on earth were they allowed to get to that state?
Anyway, thank you for prompting me to write about the need to lower uric acid to remove tophi quickly.
Goutpal,
So, my uric acid tests came back at 3.05mg/dl, after bumping to 1.5g of probencid a day; plus up another 500mg. Right on the money. Uric acid measured after a meal and about 4 hours after my meds.
Dr. Buff,
Re those horrific tophaceous pix on the web (and in medical books), no they will not resolve in a couple months…maybe a couple years. Big enough tophi that are mangling the function of a joint must/should/may be removed surgically.
At a SUA of 3.05 (talk about medical personnel not knowing what significant figures mean??? maybe it was 3.05127932? ROFL) I think you are doing as well as you can and should see significant tophi reduction without too much pain in several months. Keep measuring your uric acid, and to 1 decimal point is MORE than close enough.
Yes, that is as good as medical treatment gets so try to stay there. As GP says, EXCEPTIONAL.You will not remove all your tophi with meds nor can you restore any erosion that has occurred becasue your doctors were incapable of diagnosing the oldest disease in time…I'm sure they were busy measuring your blood pressure, which is what they do best.
Remember, we remove uric acid by a few hundred milligrams and tophi weigh in at ounces or 30 grams per ounce or 30,000 mg. per ounce. Add to the fact that the deposits are walled off by fattly deposits, pus and, scar tissue so drug treatment may not reach them. That's whay it's so important to prevent their formation. So the net is that some tophi you will have to live with unless you want to resort to surgery. Caution: I doubt that many surgeons are good at this anymore…too busy with brain and heart surgery that pays better.
(I am beginning to think that more of us should be on probenecid…but I have no experience with it.)
ps…If you are getting UA levles of 3 with probenecid, do not worry about under or over excretion becasue it is obviously the right drug for you.
It was a combination of diet, hydration and the meds. Cut out red meats, beer/wine and booze, Multi-vitamins, teas and coffee and soda's; also a few vegetables. Multi-vitamins gout me up worse than beer. Drink plenty of water with lemon juice.
I was justed amazed I was shooting for the 3.00000000000 and came so close it was eary. Now, I'm on antibiotics so I'm back on the gout wagon.
one more thing, probencid does not make me feel tired and crappy like the allipourinol did. I took it for 3 months and saw more improvement on probencid in 3 weeks.
zip2play said:
Dr. Buff,
Re those horrific tophaceous pix on the web (and in medical books), no they will not resolve in a couple months?maybe a couple years. Big enough tophi that are mangling the function of a joint must/should/may be removed surgically.
And even then, they , generally, can't be removed 100%. I am living proof. (My doctor, just to cover her, you know what, told me before she got started that she could not remove every bit of tophi.)?
At a SUA of 3.05 (talk about?medical personnel?not knowing what significant?figures??mean??? maybe it was 3.05127932? ROFL) I think you are doing as well as you can and should see significant tophi reduction without too much pain in several months. Keep measuring your uric acid, and to 1 decimal point is MORE than close enough.
?Yes, that is as good as medical treatment gets so try to stay there. As GP says, EXCEPTIONAL.You will not remove all your tophi with meds nor can you restore any erosion that has occurred because your doctors were incapable of diagnosing the oldest disease in time?I'm sure they were busy measuring your blood pressure, which is what they do best.
I am not so sure about that. First, a “Nurse' or “Medical Assistant” takes the readings, and second, instead of rejoicing when you have a “low” BP, they rejoice when it is high. Because they feel justified to write you a prescription for their shitty BP meds.
Remember, we remove uric acid by a few hundred milligrams and tophi weigh in at ounces or 30 grams per ounce ?or 30,000 mg. per ounce. Add to the fact that the deposits are walled off by fatty deposits, pus and, scar tissue so drug treatment may not reach them. That's why it's so important to prevent their formation.?So the net is that some tophi you will have to live with unless you want to resort to surgery. Caution: I doubt that many surgeons are good at this anymore?too busy with brain and heart surgery that pays better.
Luckily, I found one. Even though she couldn't remove it all, she, at least, put my index finger back into operation again. And now, 10 months later, I can say that she did a fine job. (Well, if anyone is interested, I have commented in detail on that operation and ensuing consequences on this forum during the past year.)
(I am beginning to think that more of us should be on probenecid?but I have no experience with it.)
ps?If you are getting UA levels of 3 with probenecid, do not worry about under or over excretion because it is obviously the right drug for you.
Here is the reason for opening up your comment again: I had be been on Probenecid from Feb 2010 to July 2010 when I started with Uloric 40mg. After reading about some research with Allopurinol/Uloric and Probenecid combination on this forum (about 5-6 weeks ago) I decided to also do me own research and added 500mg Probenecid (5 weeks ago) to my 80 mg Uloric/day.
My SUA was 5-7 mg during the 80 mg Uloric phase and has dropped to 3-5 mg now. I'll have a COMPREHENSIVE METABOLIC PENAL TEST done in a couple of weeks, to make sure that my body approves of my “high-handed”, unapproved (I haven't asked nor told my doctor about, yet) research.
One good thing came out of “painreliefindia”'s post: It got me to read again all those comments made back in Nov/Dec of 2009. (Co-incidentally, Dec 13, 2009, the date of your post, was the day I discovered and joined GoutPal.) And, as I have said so many times, besides Keith, you generally hit bull's eye right on.
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