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Yikes! I am rather shocked he would give you a steriod injection. I admit none of us are doctors, but the treatment for gout has been fairly standard for decades now.
Steroids are great treatment for a million different problems….but gout isn't one of them.
All forms of strenuous exercise increase uric acid levels in the body.
In my experience, the best thing to do is to take apple cider vinegar (ACV) soon after you finish and then take further doses every 3-4 hours later until the 'gouty' feeling diminishes.
Definitely keep taking allopurinol and combine with ACV, baking soda etc when allopurinol isn't enough and additional support is needed.
zip2play said:
If you have a pair of gloves, take them into his office, smack him in the face and tell him he’s fired.
Gloves!:eek: Have you gone soft:wink:
Interesting stuff. As long ago as last year, I reported how benzbromarone seems much more effective than probenecid, and is often successful where allopurinol fails.
There has since been other reports supporting the efficacy of benzbromarone, including an Australian report (“A benefit-risk assessment of benzbromarone in the treatment of gout. Was its withdrawal from the market in the best interest of patients?”) that questions the withdrawal in some countries. In particular, they question the link between benzbromarone and liver problems. They conclude that, even if there is a link, the risks are so slight as to be far outweighed by the benefits.
I feel sure that if it’s use in those countries that allow it continue to show safe use, then it can only be a matter of time before it is re-launched in the USA and other countries.
Curiously, when looking at recent research, I noticed a study (“Mechanisms of antihyperuricemic effect of Phyllanthus niruri and its lignan constituents”) that compares extract of a member of the euphorbia family (Phyllanthus niruri Linn) favorably with benzbromarone. Apparently this plant, common in traditional South American medicine, exhibits both uricosuric, and xanthine oxidase reduction properties.
South American folk medicine, eh? Well, they still have to Peru-ve it to me. (bet that gets a Chile reception)
@gouty – sorry I missed your post earlier. If you had gout for a long time before you got it treated, then permanent joint damage from uric acid crystals is a possibility, but I would have thought that you would see this in other joints also – especially if you play football. Your second option is more likely, though to assess this properly, you should review your last 6 months uric acid tests results (if you do not have them, it’s a good idea to make a note of them every time your doctor tests you – be sure to get the exact numbers, not just a worthless low/normal/high assessment).
@Ryan – I agree that allopurinol is your best option – you really do not want to risk the aforementioned permanent joint damage.
I have noticed that I get flare ups sometimes after playing football, colchicine usually helps but it seems to take longer and longer now. I am in the middle of my longest attack so far at 7 days and im taking colchicine every 4 hours, the diareah is getting harsh. I think I may have to start taking the allopurinol.
Get to another doctor or a rheumatologist ASAP.
Any doctor who cannot explain how your falling uric acid levels might trigger gout attacks ( and prescribe appropriate pain relief) simply isn’t doing his job. If he is also failing to monitor your uric acid levels, with dose adjustments as necessary, then we are moving into the realms of clinical negligence.
Before you discuss pain relief with the doctor, ask him about uric acid lowering. This is the most important treatment to stop future attacks.
During the first few months, you will also need pain relief. As zip2play says, colchicine is probably the best. NSAIDs are not good for long term use, but if you take ibuprofen to cover a few days gout attack, be sure to discuss the right dose with your doctor. For severe gout attacks (and I wouldn’t take anything for less than severe attacks) the standard over-the-counter dose may not be sufficient.
Don’t forget your free gout pain relief guide.
I’ll start with the cholesterol. As far as I know, there is no link with uric acid or gout. Unless anyone knows different, I ‘ll leave it at that.
Your uric acid at 0.47 (mmol/L = 7.9 mg/dL) is in the high risk range, and too high to dissolve existing crystals. Generally, I would agree with your doctors advice. However, I do not know what your gout history is – i.e. severity of attacks, when did they start, which joints affected, any tophi or skin abnormalities.
My best guess is that at the moment you are in a “steady state” where old crystals are not dissolving, and new crystals are not forming quickly enough to promote a gout flare. They may however be increasing slowly to cause problems in future.
If I am right, increasing allopurinol as your doctor suggests, may cause a few twinges as old crystals dissolve – but this will not last long, and your joints will end up much healthier.
My opinion (which, as usual is totally unqualified, and based only on what you have told us so far in this thread), is to keep the allopurinol at 100mg.
I say this for two reasons.
First, you have achieved the uric acid level goal. One test is too soon to be certain, and I would only consider changing if two or three consecutive tests point towards a need to increase.
Secondly, though it is quite likely that the perceived side-effects are due to something other than allopurinol, you want to keep as many things constant whilst you are under investigation. Assessing sensitivity to substances is fraught with all kinds of difficulties. The last thing an investigator wants is for the patient to make random changes to medications (or radical lifestyle changes). By all means, suggest the break from allopurinol to your doctor to see if this is the problem, but the time to do this is if he is still puzzled after you get the results of the new tests.
No other drugs – except Indomethacin when gout attacks hit.
I truly believe these are side effects – especially the spaced out/tired feeling I got/sensitive skin and gout in new locations. I have never experienced such profound symptoms and they started almost immediately after taking the drug – as I said though, most (except the sensitve skin – which feels like mild sunburn) have now gone away.
Do you really think 200mg would be sensible? I thought my levels have now reached the ideal range?
Plus will levels continue to drop, once my body rids itself of the built up urates over time?
Mark
My update:
Started daily allopurinol about five weeks ago (100mg dose). Initial side effects:
* Intestinal pain
* Spaced out
* Mild Gout in places I had never had before
* Weak forearms
* Generally feeling less sharp (mentally)
* Minor pins and needles
* slightly blurry eyes
Most of these have now lessened to the point I would not class them as a problem.
Current side effects:
* Sensitive skin around my middle and tops of legs
* Easy bruising
Just got back from doctor with my new results – expecting them to show very minor improvements. But I am v.surprised:
Some time ago: 0.52 mmol/l – 8.74 mg/dL
12/5/09 – 0.59 mmol/l – 9.91
29/6/09: 0.34 mmol/l – 5.7 mg/dL
As you can see my levels are now in the safe range – which is great because the side effects I have experienced are quite unpleasant and I really didn't want to have to raise my dosage…
Now having my blood platelet levels checked to see about the easy bruising.
Do you think my other side effects are normal and will they eventually go away do you think?
Mark
The problem with all tests is that they take a snapshot view of a complex situation, and try to evaluate that as a simple, precise number. We then try to interpret that number as if it is a pass or a fail.
It would be better if these tests reported a range of likely probabilities, say “between 8 and 10” rather than 8.8. Certainly interpretation of the average, against expectations from treatment being taken, makes more sense.
As zip2play reports, professional uric acid tests are not faultless, but they are rarely questioned. I have experienced nonsensical professional blood pressure tests. Even the “dead or alive” test has been fooled by Lazarus Syndrome. In fact many tests results are difficult to reproduce – one wonders how professionals would fare if retaking the tests that gave them their qualifications.
So where does all that testing doubt leave us?
For anyone who is getting proper uric acid control from their doctors, I cannot see the point of home testing. Each doctor will have their own specific regime, but the general approach is quite clear.
Titration phase involves gradually increasing dose of an appropriate medication with the most frequent uric acid monitoring. Once two consecutive results have hit under 6mg/dL, we move to the next phase.
Urate reduction phase involves less frequent monitoring to ensure that levels remain below 6mg/dL. It continues until there has been 6 months without a gout flare, when we start the final phase.
Maintenance phase involves the least frequent monitoring to ensure that levels remain below 6.5mg/dL. If dosage is reduced at all during this phase, it should be done gradually, accompanied with more frequent testing. In effect, a reverse titration phase.
With that level of professional medical support, any test-to-test fluctuations can be managed by dose adjustment or “wait until the next test”. The main focus is on the general trend, supported by continuous care.
Where that level of professional support is unavailable, then gout sufferers might consider home testing, but this is always likely to be less effective than good professional monitoring.
Fundamentally, there is less reliability from a pin prick blood drop (from the capillaries) compared with “an armful” (from the the vein). However, studies have shown there to be sufficient correlation to make the test meaningful. Interpretation has to reflect a wider margin of error. And correlation with symptoms is also important.
What you are really looking for is a reducing average trend. You might consider a lower target than 6mg/dL to allow for the inherent reliability issues – i.e. interpret a reading of 6mg/dL to be a range of 4.5 to 7.5. If a lowering trend is accompanied by gout flares that reduce in intensity and frequency, then you know you are on the right track. When the gout flares have gone for 6 months, then you know you have achieved your goal.
So a home test is only relevant if it ties in with your own long term plan to lower uric acid to the point that it no longer affects your enjoyment of life. Use it if you want to, but focus on trends reflected in your own condition – not absolute numbers. Also focus on a strictly repetitive testing regime to minimize procedural variances (I’ve covered this elsewhere, and will summarize all this soon).
I think the rheumatologist is a good idea. It will take a few months of therapy to keep uric acid below 6mg/dL, and get rid of all the existing uric acid crystals.
If you are susceptible to gout, rapid weight loss can certainly add to the problem. However, it will be easier to cope now that you have lost the weight – just keep positive for a few months and make sure the rheumaologist gets your uric acid under control.
Please keep us informed with your progress.
zip2play said:
…
Anne,
Can’t see your post until the Administrator approves it.
And nobody will see it, if I can help it.
Silly bloody spammer telling you all how you will be saved from gout if you eat some “healthy chocolate” concoction. Apparently “science” tells us that this is true.
Thanks for the posts – I am new tothis – I just know that I have had a high uric acid level in the past and the tumor was a tophus. The surgeon told me to follow up with my primary but I am thinking about going to the rheumatologist – he has been working with me on the psoriasis and pointed out the elevated uric acid level. I am not on the meds for gout yet – but I guess that might be the next step. I have had foot problems all my life – so glad to finally know what may be behind it – I was told by the foot doctor my feet are filled with arthritis and looks like the feet of a 60 year old – great to hear at 30. You mentioned bck problems as well – I have a bi lateral pars defect on L5 – I just wish there was someone out there that could treat me by looking at everything. By the way – I didnt start having the more serious health problems until i lost 115 pounds – i was healthier when i weighed 315 pounds – the irony! O well – on to the next step – thanks again.
Randy
The aching could be due to old uric acid crystals dissolving. This is a good thing, but it can cause temporary discomfort. This is often accompanied by feverishness, or general “unwell” feeling, as your immune system is fighting a battle. If it gets too bad, or continues much longer, see your doctor.
Personally, I’ve never been keen on dietary supplements, but if your diet is poor in fruit and vegetables, it might be an option.
I can’t add much more to zip2plays response, except a small point about the psoriasis.
It is possible for small urate crystal deposits to form just under the outer skin. These are not as large and noticeable as the tophus you experienced, but they are enough to cause the skin to flake.
Jaffa said:
Nurofen and Votrol has brought me instant relief
Nurofen is simply ibuprofen in a fancy box and 10 times price tag.
Is Votrol an alternate brand for Voltarol, i.e. diclofenac? I wouldn’t think it wise to mix the anti-inflammatories.
chthomas said:
Thank you. I thought the use of baking soda brought down my uric acid level, the body then took off the covering sheild for the coated uric acid crystals already present. Am trying lemon juice now and if not successful will revert to baking soda treatment.
Good day Chthomas
my story is the same complettly-from the beginning …Will you please share with mewhat happen to you after you starteda arthritus treatment
all the best
barabas
I’ve found an interesting report – “Influence of vitamin C diet supplementation on endogenous antioxidant defences during exhaustive exercise”
It compares two groups, one with vitamin C supplements, and a control. It notes:
Uric acid and lactate dehydrogenase increased after the competition only in the control group.
Unfortunately, there is no mention in the abstract, or first page, of the amount of vitamin C required.:frown:
Thought provoking indeed.
Now that you point that out, there is a similar effect on the hand image in my previous post, particularly on the right hand forefinger (click on the image for larger view).
There are two more uric acid deposit images on MD Consult, but these are not as large, so difficult to make out the detail.
I?ve emailed Siemens to try and get more images, but still waiting response. If I can strike up a dialog with them, I?ll ask about the calcium interpretation.
A few things strike me about interpreting these images.
Firstly, we are looking at reproduced photographs of indeterminate quality. These images are an interpretation of electronic data that the operators / diagnosticians will have access to.
Secondly, we have no physical examination process to support interpretation.
Finally, these images are quite possibly part of the work-in-progress, i.e. they may not be part of the study that accompanies vegetarianGuy’s first DECT image. In the text, they are very positive about the diagnostic quality of the process compared to traditional means.
I want to highlight what I think the most important part of this post in my mind….it gets better when you start peeing like crazy.
Think about the possiblity of a water retention problem. Some foods can cause a water retention problem like you describe, anemia, protein and mineral deficiencies can also cause those same symptoms. My brother has the same problem when he is exposed to palm oil in certain foods. Its a type of allergic reaction (i.e. a build up of histamines) but happens more slowly instead of an immediate reaction such as a peanut allergy might cause. (if you are female it can happen with certain hormone changes)
The first thing you should do when you have an “attack” is write a list of everything you have eaten for the last several days. Look for common ingredients or foods around those episodes.
Continue to investigate gout since that was the default diagnosis….the others on this forum can provide better armchair analysis on that front.
It might be gout…it might be something else…it might be gout AND something else.
Keep us posted because everything shared here helps further the knowledge of the whole gout community.
I do believe that this is actually a great breakthrough. I had seen the press release a few days earlier, but it wasn?t until I saw the Siemens page that I realized the true significance.
Their description is clear ? red = urate, blue = bone or calcium.
The real beauty of this is that the technique, by my understanding, simply involves loading the scanner with the right settings to scan the unique wavelength for uric acid deposits.
From a brief look, it seems the technology is truly revolutionary. Much easier to detect the early stages of gout. They note that they frequently found unexpected uric acid deposits around tendons and ligaments. This happens before any clinical manifestations of gout, but renders affected tendons and ligaments susceptible to tears.
So it looks like the beginning of the end for joint aspiration as the most reliable gout diagnostic. Probably a good thing. They note that one of the weaknesses of joint aspiration is the difficulty in performing the procedure when there is inflammation. Vindication for my earlier comment questioning the inability to test when there was NO swelling!
Here to help the heartbroken.
Stating the obvious, you need a proper diagnosis, or you risk wasting time and money.
I would advise that, whether you return to a doctor, or find a new one, insist that the pain is destroying your life and you must have a diagnosis. Do not offer opinions until you have that diagnosis, simply state the symptoms, but exaggerate the effect they are having on you.
Do not be seen walking. Get wheeled to your appointment, and if you must get to your feet, hobble and limp. I know you’re British, and a wince is too emotional, but we really need (stifled?) screams. When confronted by people who have perfected the art of faking concern for your health, you must play your part and take your role of the needy patient seriously. Do not disappoint by being anything less than the perfect patient.
If you feel a relevant point might have been missed, you must express it in the form that “Dr X said I might have …” or “Dr Y said if nothing improves I might be tested for …”
The clear diagnosis for joint problems, when X-rays reveal nothing is to invade the joint. Normally this is done painlessly with joint fluid aspiration, but might extend to surgery. CAT scans are a possibility, and a growth area for gout diagnosis, but I do not think the techniques are mainstream enough to expect anything yet.
The other alternative is to try zip2play’s colchicine diagnostic test – if colchicine fixes the pain, the chances are that it is gout.
Thank you for the heads up on Krystexxa (pegloticase).
How I wish such exposure could be got for the Gout Diagnosis Scandal, or the even nastier Allopurinol Dosing Scandal.
Trev, I think you are right about gout sufferers preferences for dietary cures.
I just wish they would treat it more seriously and methodically.
Perhaps thy will read a better approach to gout and diet.
That is a very good pair of questions. Certainly, the first one has got me thinking.
The background is that:
- We know levels fluctuate through the day.
- We know that, for reasons being pondered and researched, people can have uric acid levels above the 6.8 saturation point, with no obvious signs of gout.
- We know that most “official” tests are performed in the morning after a fasting period.
- We know that most gout flares are noticed during the night, or after long periods of inactivity such as a journey, or sat at work.
I, like you, have usually tested myself in the morning before eating. On reflection, I think that it is probably more useful to do this at night.
Ranges depend on status.
For diagnosed gout, had an attack within 6 months. Below 6mg is good. The lower the better in terms of speeding up the time it takes to get rid of old uric acid crystals. We all need some uric acid, so I would be worried enough to seek professional advice (or do a bit more research) if my level fell below 4.
For diagnosed gout, not had an attack for 6 months or more. Below 7mg is good. If on treatment such as allopurinol, some people take a break. OK, but then you never want to go above 6.5 – do not waste all that time on allopurinol. If you get back to the 7’s, you’ll soon be back in pain.
For undiagnosed gout. Whilst 7 to 8 is seen by many as “normal”, I would still recommend caution. You might suffer some crystal build-up without the exquisite bite of an acute gout flare. Watch for numbness, tingling, pins & needles, unusual lumps under the skin, or red blotches / rash on the skin. These could be attributable to many things, but are also among the signs of gout.
