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I need a bit more info on that test result. Can you call to get an exact value?
If the result is the conventional mg/dL, then 4.6 or 4.9 does not matter – it aint gout.
However, if the result is some variation on SI units (mmol/dL?), then 4.6 puts you at 7.7 mg/dL – definitely in the high risk group, though not conclusive proof of gout. 4.9 translates to 8.2mg/dL, not far from the “very high risk” count of 9 mg/dL.
1- Blood test? Which specific tests should I ask for?
Uric acid, but it is not conclusive. I.e. above 7 indicates high risk of gout, but below 7 does not exclude gout, as uric acid is lower in the blood if it has crystallized in the joints.
2- X-ray?
Yes – you need to rule out physical damage.
3- Too early to do the liquid from joint test?
No, but you are probably better seeing a rheumatologist for this, as few family doctors have the experience to do it painlessly and assess the results accurately.
gnarledwolf said:
My gout is getting worse.
If not treated properly, gout does get worse as time goes by. Each day spent with high uric acid is another day where you get more uric acid crystals building up in your body – you may not always get pain, but the chances of getting pain increase. More joints become affected and gout flares become more frequent.
Allopurinol I took for years, and it had no effect at all, so I stopped taking it with my doctors agreement.
Allopurinol only works if the dose is right. Did your doctor check your blood regularly and ensure uric acid stayed below 6mg/dL? If not he was wasting your time completely.
I'm now considering taking generic colchicine
Colchicine eases gout pain, but does not lower uric acid. Use it during the first few months of uric acid lowering treatment. Once all uric acid crystals have dissolved, you will not need to use colchicine, but you must continue with allopurinol and keep checking uric acid levels.
I'm lost and looking for direction.
Read GoutPal once a day, and write in this forum whenever you feel the need.
GoutPal said:
I asked Bill for a little more information, and he replied
On the gout thing, I'm extremely interested to find out whether it'll work for anyone else because it stopped my gout dead in its tracks. I'm not kidding or exaggerating in any way. My toes used to throb a warning at me almost every week and at least twice a year I'd be on a walking stick completely unable to put my foot down. When it hit I kept a washing bowl of ice cubes by the bed so I could numb my foot then catch a few minutes sleep before the throbbing started again. I munched codiene phosphate, diclafenac and naproxen like they were smarties.
Then I started swimming once a week and that was it – gone. Stopped just like that never to return except for the one time I missed for three weeks. believe me – I've never missed since.That kind of pain sound familiar? Yes, me too.
So has anyone else noticed this? Does it matter if the water is chlorinated (as it was in Bill's case) or not. Is an hour a week enough?
Lots of questions about this, and I would love to see it repeatable. In fact, given the state of my feet today, I wish I'd gone swimming this morning.
I believe it may not to specific to swimming, instead the overall coordinated motion upon various joint, especially with the lower body joints which has residual uric acid crystal deposits or areas suseptable to gout attack would produce a certain chemical or lubrication antigen which will either reduce or eliminate joint inflammation, of course this theory will be defeated if straneous pressure were act upon the joint, which will cause an attack. Anyone agree?
First off, thank you for posting your uric acid test result. It is so much easier to respond when I have the exact number. Yes, your conversion is accurate, and you've inspired me to add a page that explains the different measurement scales of uric acid levels.
It is standard practice to start at 100mg, and increase until your level drops to .4 mmol/L. I believe this cautious approach lessens the risk of a serious reaction if you are one of that very rare breed of allopurinol intolerant people.
The weight loss is a great plan. Combine this with regular uric acid tests, and you can be sure that your dose is kept to the lowest that you need. I have anecdotal evidence that this could allow you to stop taking allopurinol, but no proven data. Let's hope someone else has some relevant numbers.
Frequent uric acid tests, and the possibility of continuous allopurinol are a way of life now. Much better than increasingly painful gout flares and more dangerous bone and tissue damage.
I have had several occasions when gout has affected my whole foot. Sometimes this has been quite persistent, though 4 weeks is a long time for a gout attack. Because:
the common theme is stubborn or prolonged gout that lasts much longer than the usual three days to a week.
The best thing to do would be to get gout confirmed by a rheumatologist. Analysis of fluid from the affected joints can prove gout. Also check for other diseases with gout-like symptoms.
The real issue, assuming it is gout, is what are you doing to control uric acid so that future attacks subside? Unless you guide your medical advisers to come up with a plan for maintaining your uric acid below 6mg/dL, you will suffer increasingly painful gout attacks in your feet and increasingly more joints. Because:
there are significant consequences if you ignore your uric acid level. Because gout pain gets worse. Then gout pain affects more joints. Also, each attack lasts longer until you are in constant pain.
Jaswir Panesar said:
I am a vegetarian (no fish no eggs) tetotal. Cannot understand why. Please help me have been suffering for a Full month. Waiting blood test results.
Firstly, if you are still waiting test results, are you sure this is gout? In fact, blood tests might be inconclusive, and you may need further investigation to confirm gout or a disease with similar symptoms, e.g. pseudo gout or septic arthritis.
Being vegetarian does not prevent you from getting gout. You are surrounded by the meat that is the main source of uric acid – your own body. Far more uric acid is produced by the normal life-cycle of human cells than could ever be got from diiet. There are many reasons why we get too much uric acid. The main ones are:
- Being overweight
- Losing weight rapidly – e.g. fasting or illness
- Surgery or other physical trauma
- Kidney problems – from disease or hereditary
- Dehydration – from lack of fluid intake or diuretic medicine
Step 1 is to wait for the test results. Once you know your uric acid level, you can come back here for more advise about keeping it below 6mg/dL
You must seriously start managing your uric acid levels.
If your doctor will not put you on a proper uric acid lowering regime, then get another.
It is absolutely pointless fooling around with cherry juice, ACV and other stuff. Even if it has any merits, how would you know if you cannot measure the result?
Get your uric acid below 6mg/dL and keep it there for a year.
Are you drinking enough water? “Tightness around the kidneys” sounds a bit of a problem that really needs some proper medical attention. If you cannot get it from your doctor, then I can only suggest the emergency department of your local hospital.
More information would be useful – what is “all the normal medication?”
That's good, but it is not a painkiller, it is meant for lowering uric acid.
Have you had a blood test to ensure that it is keeping your uric acid level below 6mg/dL? If not, then it is just a waste of time.
James Humphreys said:
Try extract of black cherries, found at holland and Barrett taken as a drink throughout the day works and I find Apple cider vinegar mixed with raw honey as a hot drink at night works wonders. But just a tea spoon of the vinegar.
I refuse to go down the tablet route.
Just edited it to get rid of a problem smiley.
Please note that this is a thread about lowering uric acid. There is absolutely no evidence to show that cherry drinks or ACV and vinegar can lower uric acid. If they make you feel better, then that is fine, but only if you are also keeping uric acid below 6mg/dL. If not, you are storing up some serious medical issues that will cripple you at a time in your life when you are probably unable to deal with it.
Jaswir Panesar said:
I am a vegetarian (no fish no eggs) tetotal. Cannot understand why. Please help me have been suffering for a Full month. Waiting blood test results.
Try black cherry extract from Holland and Barrett.
Try extract of black cherries, found at holland and Barrett taken as a drink throughout the day works and I find Apple cider vinegar mixed with raw honey as a hot drink at night works wonders. But just a tea spoon of the vinegar.
I refuse to go down the tablet route.
Yes, this is very common.
Gout can affect any joint, and as it gets worse, it seems that more joints get involved.
I’ve often wondered about the foot to foot thing. I think it might be due to putting extra strain on the unaffected foot due to limping.
The absolute best thing you can do is see your doctor about lowering uric acid – or talk about it here before you go
You haven't said what treatment you are receiving.
It should be daily allopurinol to get your uric acid below 6mg/dL. Gout flares will still happen for a few months, though they will decrease in frequency and intensity, and you need gout pain treatment for this.
You also need to loose weight slowly. No need to worry about special diets (though more fruit and veg is helpful) – just try to eat a bit less and exercise a bit more. Gradual improvement means you are more likely to change habits (most people never stick to rigid diet plans, and often gain weight after a few weeks). Also, rapid weight loss can generate more uric acid.
Now that the pain has gone, you need to get on allopurinol, or some other uric acid lowering treatment, to get rid of the uric acid crystals that have buit up in your body.
Ensure that your doctor checks your uric acid level, and adjusts the dose to make sure that your uric acid level stays below 6mg/dL
The uric acid test kit comes with a device for pricking the finger which is adjustable. At the right setting, it just breaks the skin surface and is panless. Start with a low setting and increase until you get a large enough blood droplet – it only needs to cover the small hole in the test strip. In any event, you should be getting uric acid tests from your doctor.
There is no correlation between uric acid and pH, except that uric acid is more soluble at higher pH. Alkalyzing will help prevent the formation of kidney stones.
Losing weight is good – I wish I could find it easier.
Hi Gary,
Before any of the measures you have mentioned, the most important thing is to know your uric acid levels. There are hundreds of ways of reducing inflammation and minimizing pain, but none of that matters if uric acid levels are high. You risk more long term damage from uric acid crystals by focusing on pain relief – the crystals can still build up slowly even when pain is minimized.
Whilst using PRAL values to controlling diet may well promote a healthier body, success depends on balancing nutrients, not just aiming for the lowest PRAL value. 25-30% of food intake should be positive PRAL, and variety ensures the best mix of all nutrients. PRAL values have absolutely nothing to do with uric acid. There is a chance that higher pH values can make uric acid more soluble, but any effect is likely to be minimal. There are many vegetarians with gout.
All gout therapies must start with measuring uric acid. You can then use whatever methods you choose (medication, diet, alternative) to try and control it, but only your uric acid value can tell you if those methods are working.
The whole point of taking allopurinol is that it allows you to lead a normal life. In the beginning, you may need pain relief until all existing uric acid crystals have dissolved, but after that period (usually a few months) all you need to do is keep taking the allopurinol, and have a uric acid test every few months, as advised by your doctor. This continued testing is imporrtant, because if your situation changes in some way, and uric acid starts to creep up again, you can soon be back where you started.
Compared to allopurinol, dietary changes have little effect on uric acid levels. Excess alcohol is to be avoided, as it reduces the effect of allopurinol. Also, and alkalyzing diet may be beneficial to decrease the risk of kidney stones. Your allopurinol label should also recommend sufficient water.
Beyond that, it obviously pays to eat a healthy diet. Statistically, gout sufferers are in a high risk group for many other ailments, and a healthy diet with moderate exercise is your best chance of avoiding these.
chthomas said:
Am taking Allupurinol (prescribed by doctor) for the last 1 week. The pain increased, then came down a lot. But not cured.
This is as expected. Keep getting blood checked, and dose adjusted to keep your uric acid below 6mg/dL. You'll be permanently free from gout pain before you know it.
Raising LFTs is one of the side effect of Allopurinol. Once you stop using Allopurinol it should raise to normal. But in case of long term usuage of Allopurinol effects lever functions and thats where raising LFT counts.
It should steadily increase over a period of time once you stopped using Allopurinol. LFTs has nothing to do with Uric acid levels.
Previous discussion on high blood pressure treatment on gout focussed on ACE inhibitors as a better alternative to diuretics.
Whilst ACE inhibitors seem preferable to diuretics, it seems they are not the best solution for those prone to gout.
In “The effect of ACE inhibitor and angiotensin II receptor antagonist therapy on serum uric acid levels and potassium homeostasis in hypertensive renal transplant recipients treated with CsA”, Schmidt and colleagues found a slight rise in uric acid after administration of enalapril, an ACE inhibitor. They compared that with losartan, which has several mentions around here (type losartan in the search box above or at the foot of every page).
Their results show that, after 3 weeks of treatment, the losartan subjects average uric acid level reduced from 7.8 to 7.3, whereas the enalapril subjects increased from 7.8 to 8.2.
This isn't a perfect example, as it studies kidney transplant patients. If anyone has more information, I'd love to read it.
In the meantime, Roy, I suggest you, your son and your nephew have a word with your doctors about changing the blood pressure meds.
I used to suffer from gout quite often. I learned that taking FOLIC ACID tablets worked. I eat what I want and take folic acid once a day with my vitamins. My friend was paying $80 a month for prescription medican to treat his gout. He quit the prescription and started folic acid tablets and no more gout.
Folic acid is $4.00 a bottle of 300 at any CVS or Walgreens or any store that sells vitamins.
The folic acid nutralizes the uric. THIS WORKS!
Whoever told you that gout is not multi joint is a fraud. Please do what you can to report that person to the appropriate authorities. It is dangerous nonsense, and you just might be able to prevent the lies affecting other patients lives.
If you do have gout (and this is easily confirmed by a rheumatologist), one month's allopurinol is simply not enough. You must take this seriously, and have frequent uric acid tests whilst taking allopurinol to make sure the dose is enough to bring your uric acid level below 6mg/dL. Anything less is a complete waste of time effort and money.
As you can see from your experience, gout sufferers often have to take control of their own treatment. Do not let buffoons ruin another 20 years of your life.
Thank you for that – very interesting results.
It just goes to show how important the right dose of allopurinol is, and how important it is not to miss it.
Allopurinol does not last long in the body. I believe that doses above 300mg should be divided during the day, but of course this needs to be discussed with your doctor. Drinking plenty of water is important, as is alkalizing the urine, so the baking soda should be useful.
Though gout is typified by uric acid crystals forming in the joints where they cause the inevitable painful swelling, crystals can also form in the skin tissue causing psoriasis. I have had this in varying degrees, and I can see how it might viewed as eczema.
Goldman, in “Uric acid in the etiology of psoriasis” writes:
The potential etiologic relationship between uric acid in its microcrystalline monosodium urate form and psoriasis was examined by 1) substantiating the reported correlation between hyperuricemia and psoriasis using the phosphotungstate method; 2) examining psoriatic tissue samples for the presence of urates under a microscope using polarized light and a compensator; 3) attempting to induce psoriasis-like symptoms in laboratory animals with purine-to-uric acid metabolism by increasing serum uric acid level; and 4) observing psoriasis-hyperuricemic patients following treatment for their hyperuricemia with Allopurinol. As expected, both men and women psoriatics had higher uric acid levels than did their counterparts in a control group. Monosodium urate crystals were found in samples from psoriatic plaques by both methods used. They were clustered particularly around sweat pores and Munro abscesses, but were found only occasionally in epidermal tissue taken from nonpsoriatics. Psoriasis-like symptoms were induced in laboratory animals (the South American boa, Constrictor constrictor) when they were fed doses of uric acid. Patients with psoriasis and hyperuricemia showed marked improvement in psoriasis when treated for their hyperuricemia. Psoriasis, like gout, may be, at least partly, a result of disorder of purine metabolism and monosodium urate crystals may be responsible for the cell proliferation that is characteristic of psoriatic plaques. Monosodium urate crystals were found by the author to be strikingly segmented. This structure may result in ease of fragmentation, thus increasing the difficulty in identifying urates in any tissue.
The most common view is that allopurinol has no long term side effects. One person has complained to me about itching, but this seems very rare.
Please feel free to post anytime. If I waited until I had something substantial to say, I'd never post anything
The only way you are going to move forward with this is to get a proper diagnosis.
In this forum, we focus on gout, and it is easy to pick out some gouty indications from your tale, but you need a more objective view.
For example, cracked lips are (amongst many other things) a possible sign of dehydration. I have experienced the hand / wrist / arm pain after long days on the computer coupled with extensive driving. Many gout sufferers experience the middle of the night pain in a chilly foot.
But equally, much of your description is not particularly gout-like. If physio massage relived all gout pain so effectively, we'd all be sending our partners on training courses.
As you are not presenting all the classic signs of, you should consult a rheumatologist at the earliest opportunity – when you are experiencing joint pain. The rheumatologist can examine fluid from the joint, in a quick, relatively painless procedure called joint aspiration or arthrocentesis. This will tell you clearly if you have gout, so you can plan appropriate treatment.
My husband has suffered from severe gout attacks (knees, toes, ankles, hands and possibly his shoulders) for more than 25 years. He is now 73. Colchicine has given him the fastest, most complete relief. He has had 2 total knee replacements. After all this time, we have at last figured out what triggers these attacks: tomatoes – of any kind in any products.
I've learned to make 'fake' tomato recipes by using ripe red bell peppers as a substitute. He has not had a single attack ever since. No other foods cause him any problems at all.
Regards
Cherry
I'm also skeptical, but not yet quite at the point of total disbelief.
I doubt it can have any long term benefit in terms of lowering uric acid, but it might well be beneficial in blocking pain.
The explanation put forward is that the low frequency waves interfere with the passage of pain signals along the nerves. A kind of electro-acupuncture.
If it works, then it might be a useful complement to the early stages of urate lowering therapy such as allopurinol. Without this, it simply masks a potentially dangerous situation – i.e. failure to tackle the underlying uric acid build-up is leaving gout patients at risk of serious kidney and bone damage.
Do not worry too much about the section – part of your question is diet related, and this is as good a section as any.
Starting at the end of your post, if you are seeking a specialist, go for a rheumatologist rather than a foot doctor. Gout often starts in the foot, but will eventually spread to just about every joint if left unchecked.
It is vital to find a doctor who takes managing uric acid seriously. You need to know your level, and have a plan to reduce it below 6mg/dL. Maybe your current doctor can do this, but if you do not get a positive response then it is probably best to find a rheumatologist. This is vital whether you choose control by medication, or diet – you need to know where you stand now, and whether your weight loss is helping or not.
Everyone has a right to their opinions on beer and seafood, just as you have a right to ignore them. Such opinions (or any other guesses about your specific gout management program) mean little unless they are backed up by frequent uric acid monitoring.
