Forum Replies Created
-
Posts
-
Thanks Keith. The information here and subsequent discussion with you then about lowering uric acid to 5 mg/dl for eliminating gout and reducing tophi per the British guidelines (vs. 6 mg/dl per the American guidelines) were key in informing my decision to go on allopurinol and actually convincing my doctor to go with the British guidelines. I was actually only at 6.8 mg/dl during my “never-ending gout attack,” so I may be highly susceptible to gout. I have only been tested twice since everything started working and the first time I was at 4.8 and the second time 4.7, but both times were closer to when I started on allopurinol and fairly close together, so I have scheduled blood work again. Perhaps I am not under 5 mg/dl right now and that’s why the one lingering tophus is not completely reduced. If I am under 5 mg/dl though, I am not sure what else I can do to eliminate that tophus completely. Although it’s really fairly small and you might not notice it if you were looking at it and didn’t know I had gout, I am wondering why I can’t get rid of it completely since I have been able to reduce and eliminate the three tophi for the most part.
I will add that I had no problems during an extended three-week vacation overseas when I had to make some dietary and routine compromises, and when I’ve done some physical volunteer work where I put a lot of stress on my feet (where the gout has primarily flared in the past, and where it first occurred after a skiing vacation when I had ill-fitting ski boots). I really believe allopurinol, weight-loss, proper hydration, a low-purine diet, drinking wine mostly vs. other alcoholic beverages, regular exercise, and avoiding concentrated sugars, salts, and yeasts (especially brewer’s yeast) dramatically reduce your chances of getting gout.
Finally, I will also say that if you go on allopurinol, it is worth it do it properly and stick with it. I started with 200 mg daily when I was pain-free and followed all my doctors guidelines, and then increased to 300 mg and had no gout attacks as a result of going on the allopurinol.
Likewise, I also have to say allopurinol is the way to go if your gout begins recurring too frequently. I had been managing gout very effectively for about 8 years (4-5 attacks over the period with a few additional instances killed with an early dose of colchicine) when my attacks inexplicably began happening often, and for longer periods of time. Though I had been reluctant to go on medication, the growth of tophi and development of a never-ending attack were the final straws. Although I can’t say allopurinol has been 100% responsible for my success in eliminating gout, it has definitely been key. I would guess taking off about 25 pounds of weight has been equally effective, and a combination of a number of other efforts has helped with my outcome as well. I’m sure there are differences in what will work for everyone, but here’s what’s worked for me:
* 300 mg allopurinol daily (100 mg in the morning, 200 mg at night)
* Taking off the 25 lbs I needed to
* 4 pints of water daily (helps the system flush out uric acid and other toxins)
* 30 minutes of cardio 4-5 days a week* Largely vegetarian diet focusing on balance and diversity of fruits and vegetables
– No red meat
– Chicken, turkey, salmon, or other non-shellfish a few times a month (sushi and shellfish only occasionally)
– 6 oz 100% cherry juice almost every morning
– More yogurt
– 2-4 cups of coffee most days
– Seeking out more “anti-inflammatory” fruits, vegetables, spices (tumeric), and herbs
– Reduced sugar, salt, empty carbs (breads), and concentrated sugars, salts, and yeasts
– Mixed berry, banana, soy milk, cacao, hemp, flax, pecan, coconut oil, spirulina smoothie 5 days a week* Wine no more than a few days a week
– Spirits only occasionally
– Avoid brewers yeast and funky microbrews for the most part, going with a pilsner or lager when I do drink beer (Trumer, Sapporo… )I feel like my gout, which was diagnosed in my early 40s, had gotten way too severe for my age at 48. So I am very pleased that at 50 the combination of allopurinol, weight-loss, and other adjustments has resulted in not even a hint of gout since my “never-ending episode” that went on for months, which seems pretty unbelievable now, considering what I was going through then. My one issue is that while I’ve also eliminated or reduced the 3 tophi I had developed on or around my toes, the one larger tophi at the site of my original outbreak (big toe) is not completely gone, but about 20% of what it had been at its height. Compared with others, this tells me my gout would be pretty severe if only minimally treated. Thus, I am considering upping my dosage from 300 mg to 400 mg allopurinol daily. But after almost two years, I’m wondering if it is even possible to eliminate the one tophus entirely, and if that’s even worth risking monkeying with my dosage given my results?
I am surprised. My doctor actually thanked me for the link to the British Society of Rheumatology gout guidelines and agreed to the 5.0 target. I was going to start on allopurinol this week, but since my acute attack(s) are finally subsiding, I will start next Monday (as the BSR advises). I will also be continuing all the lifestyle changes I made, e.g., going completely vegetarian, drinking more water than I used to… I will report on how tolerable the allopurinol is, if I continue to get attacks, and what my uric acid level is every couple of months.
It looks like there is a difference in approaches in various regions. I notice the American College of Rheumatology (ACR) lists <6mg/dL as the minimum number to target, and that 5mg/dL “may be needed to improve gout signs and symptoms.” Whereas the British Society for Rheumatology (BSR) clearly says 5mg/dL. I will bring the following passage from the BSR to the attention of my doctor and see what she says:
“A number of investigators have examined both threshold and target concentrations of plasma urate in the treatment of gout [129?131]. One rather strict goal has been to reduce plasma urate concentrations to, or below, the median concentration for men [32]. In the UK today this is <300 umol/l (using a specific uricase assay; non-specific colorimetric methods give higher values). The goal of this is to prevent acute gout, tophus formation and tissue damage. Reduction in plasma urate to this degree, has been shown to be associated with reduction or elimination of intra-articular microcrystals of monosodium urate that otherwise persist even in symptomless patients; suggesting some reduction of the total body burden of accumulated urate. Cohort studies [130, 131] have demonstrated a reduced frequency of subsequent attacks in those that achieved lower plasma uric acid concentrations (<360 umol/l). However some patients, even with such low levels, suffer further attacks. Conversely, attacks may remit without reduction in uric acid concentration [132], and in some of those withoutattacks, uric acid crystals are still present within the joint [133].”
Unfortunately, I do not see a specific number from the Mayo Clinic, whose overall gout treatment and diet guidelines I follow, or from the University of Maryland Medical Center, which also makes good recommendations on treatment, diet…
Well, I thought I had been fairly effective in treating the gout with diet, exercise, and lifestyle considerations the past 8 years considering I only had 2 major attacks over this period. Clearly though, the duration of this recent attack, movement of gout through a number of joints during the attack, multiple acute episodes over this period, and persistent swelling indicate that the gout has progressed. Symptoms finally seem to be letting up, but I am reluctant to return to the same treatment plan if crystals are just building up and doing damage while I am symptom-less. So, I am definitely starting on the allopurinol this week. I just want to make sure the target SUA level is correct.
Thanks for the studies. I’m good with coffee and tomatoes and treat soy as protein. But like other gout sufferers, I’m always looking for things that will make a substantial difference.
