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Every day that you spend with high uric acid levels is another day spent increasing uric acid crystals.
Some days you might not notice. Other days you get the gout flare wth a few days agony. Most days are somewhere in between – a little numbness or stiffness, but you just work through those.
Gradually, uric acid crystals increase, and each gout attack becomes worse. Every year, the number of gout attacks increase.
If you are really strict, cut out all alcohol and reduce your weight to low-normal BMI, then you might be able to maintain your uric acid below 6.8mg/dL. You must get frequent uric acid tests to check this. You cannot rely on pain control, as even painfree days with high uric acid levels are just days that will lead to severe pain in future.
Whilst cider vinegar, cherry concentrate and celery seeds will do you no harm, they are unlikely to reduce uric acid levels enough to make a difference.
Only a doctor with access to your medical records and the ability to perform a thorough medical check can be certain, but everything you say tells me that you need proper treatment to lower your uric acid. That way you can live a normal life.
When you get gout in a joint, the area around that joint becomes inflamed as your immune system attacks the uric acid crystals.
The resulting swelliNg will usually cause joint restriction.
In the case of an ankle attack, this swelling often makes the achilles tendon tight.
In my experience, pulling the foot back lessens the pain, so it seems likely to me that achilles stretching exercises, done carefully, might well ease gout pain in the foot/ankle area.
However, you must be gentle with tendon exercise. Because tendon damage, including Achilles tendon, is common with gout.
Actually, I am a big advocate for aspiration, or arthrocentesis as it is also called.
OK, if you are diagnosed with gout, take allopurinol to maintain uric acid level below 6mg/dL for 1 year (and this MUST be monitored), then the chances are that you have gout, but you no longer get gout attacks because you are controlling it properly.
This happy situation is all too rare. Misdiagnosis is common, so I say, if in doubt, get your joint fluid checked. It's a certain, straightforward process that gives you the best indication of gout from the outset. Why take the risk of mistreating pseudogout, septic arthritis or some other gout-like condition?
Maybe I am waiting to long into the process. Do you take the colchicine at the very moment you feel any discomfort – even slight?
I have had at a minimum of 10 plus the last year….5 I have used the steroid for.
I generally have taken one a day…then one an hour AFTER the process gets along fairly well. Maybe I need to pull the trigger on the colchicine sooner….will give it a shot “next time”.
Hi all. I am 44, first attack at 35 (after prawns in garlic, loads of oil, red wine…) Probably 2 stone overweight, slowly coming down. In UK. Father has gout.
RC, I had the same issue, tried to manage it through diet but had infrequent attacks. Then I noticed a small spiky bony protusion on my foot – aargh! – tophi! Plus my left big toe was becoming distended. I had surgery to scoop out the white gunk – crystals. Scared the @@@@ out of me. Now on Allopurinol – 300s – and the toe has gone down. I agree entirely with the view that we have years of build-up to flush out. I was browsing as I've just had a mild attack (right ankle) and wondered why. My GP says hey ho, it will happen. Only been on it properly since Oct so still settling I guess. Good call to get regular uric acid level checks. And I drink lots of water!
This looks like a great site, will have a good read!
You say that “smaller toes are forming tophi. Pain, redness, swelling in ankles, knees, elbows, ears. “
I do not understand why these cannot be tested for uric acid crystals, especially the tophi. An attack is an attack, no matter what it's severity, so if you are in constant pain, you are in a constant state of suitability for a fluid test or tophi investigation.
I believe the link between gout and food is very overrated, and often misunderstood. In fact, I've commented on this at length in my reply to a gout sufferer who seems to have similar experiences to you.
If you are experiencing problems within minutes of eating problem foods, then it sounds more like a food allergy to me, or possibly psychosomatic.
By the way, can I please ask all contributors to stop referring to blood uric acid test results as “normal” or “high”. The range that some labs choose to label normal, is anything but. You need to consider specific numbers before you can draw any conclusions. Even better, is to have the results from a series of tests, so that you can identify trends.
First off, you need to get away from the often spouted notion that food = gout.
Uric acid levels rise and fall from many factors, of which food is one. Fluid intake, temperature, trauma and use of medications are a few of the other factors.
With gout, a significant factor is the cycle of a gout attack. 6.8 mg/dL is the normal saturation point where crystals can form, but it is common to have levels higher than this without crystals forming (hyperuricemia).
Assuming a normal saturation point, all things being equal, as soon as crystals form, uric acid is removed from the blood stream, and so the level falls. However, all things are not equal – we continue to eat, drink, urinate, and metabolize more (or less) uric acid, and so the levels fluctuate.
Of particular significance is the fact that gout flares can occur when uric acid levels fall, and old crystals start to dissolve. This is the most important point when managing gout. You must not value a treatment, or lifestyle change, against a change in pain – only a change in uric acid level.
You can still experience pain when uric acid levels are below 6.8 mg/dL, but they will reduce in intensity and frequency until they fade completely. Reducing the level to 5 – 5.5 will speed this process. A rise above 6.8 may not be immediately painful, but you increase your risk of gout pain sometime in future.
Over time, you can monitor levels and try to determine patterns, but it is extremely difficult to keep all factors constant, except the one you are measuring. Scientific studies have the advantage of several subjects from which averages can be taken, but even in these, you often see the rider that the conclusions are subject to reservations about factors outside the scope of the study.
By now, you may be wondering “What is the point of measuring uric acid ?” The main reason is to give you a record of your uric acid level so that you can see trends. It gives you factual data every time you do it, often allowing you to rule out factors that you thought were important.
If you lead a very structured, repetitive life, then the data you collect will be more useful than if you always eat, drink and exercise at different times, in different ways, each day.
The most noticeable point about Derek's results are that they are well within the normal range. My first advice would be to get tested by a professional, and compare your own results take immediately before or after.
In any event uric acid tests, for the reasons stated above, are not a satisfactory method of diagnosing gout. They are useful in management of gout for several reasons, but limited use in diagnosis.
I strongly recommend professional analysis of joint fluid. This process, arthrocentesis, is the only way to reliably diagnose gout. It is no more painful than a regular blood test, but it has the massive advantage of confirming gout, and testing for similar conditions.
Corticosteroids should never be taken for more than a few days. They are available in various medicines, as a boost to the body's own naturally produced corticosteroids. Unfortunately, taking them as medicines reduces the ability to produce them naturally.
The only research I can find relating to charcoal is a study showing that it reduces uric acid when included in the filtration process of dialysis machines, used when people have acute kidney failure. I can find no evidence to suggest that charcoal can help ordnary gout sufferers.
I woul be pleased to learn of any research that you may know about concerning charcoal and gout.
Though “simple” gout can often be treated successfully by most doctors, complex gout – i.e. gout with other medical conditions, must be treated by a gout specialist.
I strongly recommend an appointment with a rheumatologist – make one today.
fan2001 said:
The home tester is interesting, in the US they don't use those. They prefer you go through labs for some reason.
I should have been clearer – professional lab testing, organized and monitored by a gout specialist, is vital for all gout patients, even if they are not on medication.
The home testing kit is a useful extra – it lets you see how you are progressing between “official” tests. Though the kit is distributed from the UK, they sell a lot in the US, and most other places around the world.
Thank you for this interesting post, Eric. It raises many relevant issues.
- Your main question is difficult to answer. I do not know enough about human biology and nutrition to give an exact answer, but the principles lie in the fact that extremes are bad for gout. Extreme weight gain is bad because there is simply too much cell tissue around. The benchmark for gout weight is BMI, but this is only a guide, as everyone is different. Basically more body mass means more cell regeneration (metabolism) thus more uric acid from the cells that are being replaced. But rapid cell death can also occur when the body is under-nourished. 3 pounds a week doesn't sound too much, but if it is a result of gaining a pound a day for 6 days, then losing 9 pounds in one day for the next weighing day, then this extreme can produce a uric acid overload as your body struggles to get rid of the body tissue contained in that 9 pound weight loss. The best thing to do is monitor uric acid levels, but treat results with caution because results can fluctuate as uric acid crystals form or dissolve. Let's assume that your weight loss is reasonable at 3 pounds per week, and your uric acid is falling, which leads to a seconf important point…
- Though you have recognised 4 specific gout attacks, you can be sure that there have been many smaller gout attacks in between. These may have been minor, and merely resulted in a little stiffness, numbness or tingling (pins and needles). During this time, uric acid crystals have been slowly building up in your joints. When your blood uric acid falls, through diet or uric acid lowering medications, these uric acid crystals start to dissolve. As they do, they become exposed to the immune system again, and sufficient numbers of dissolving uric acid crystals can trigger another gout attack. This is very difficult to distinguish from a gout attack caused by excess uric acid. Uric acid monitoring and advice from a rheumatologist might help. One aspect that is more common in a “good” gout attack (blood uric acid levels falling) is that it tends to attack many joints at the same time. This is not conclusive, as “bad” gout attacks can also do this, so it is really a question of seeing the big picture, guided by frequent uric acid tests.
- You mention that you can now almost walk normally. This is typical of gout attacks – they tend to go away in a few days. If you are on a trend of falling uric acid levels, then the attacks will become less frequent, and less intense, as more existing uric acid crystals resolve. Again, the key is uric acid monitoring, to reassure yourself that you are following the right course of action, and the end is in sight.
- Finally, you mention winter attacks. Most gout sufferers, myself included, see attacks worsen in cold weather. This is simply due to reduced circulation – as the weather gets cold, blood vessels constrict and blood flow becomes slower in the extremities. In these circumstances, it is much easier for crystals to form and trigger a gout attack. The best course of action is to keep joints wrapped in layers of loose clothing.
There are two reasons why gout patients choose to try and control gout by diet, rather than daily medication with allopurinol or other uric acid lowering treatment:
- They do not like the idea of taking a pill every day for the rest of their lives.
- They do not have medical insurance, and cannot afford the urate lowering treatment.
There maybe a third category of people who have never been advised of the need to lower uric acid, but this is more of a reason for changing doctor.
It is not my place to advise if diet or medication is the best choice for you. In most cases a combination of diet and medication is the best choice, but this can only be discussed and planned with a gout specialist who has access to your full medical history.
There is one piece of advice I can give to all gout sufferers, irrespective of how you choose to manage your gout.
You must have frequent uric acid tests.
Without monitoring your uric acid, you have absolutely no way of knowing if what you are doing has any effect. Many gout sufferers make their lives miserable by cutting out things they enjoy. This is pointless if you do not check if it is lowering your uric acid level.
Even with monitoring, it is pointless if you only succeed in lowering uric acid from, say, 11 mg/dL to 9 or 10. This will do absolutely nothing to help your gout – uric acid must fall below 7 to prevent uric acid crystals forming, and below 6 to dissolve old crystals.
Until you do this, gout attacks will increase in frequency and severity. Get tested today.
I'm 29. First detected with high uric acid when i was about 25 too….
The flares come in probably once or twice a year… as yrs passed, the flare got frequent. So frequently that now it flare continuously every week. I tried to control my diet, drinking habits but still it persist on.
2weeks back, I had a flare on my left wrist, it swell and it hurts…. then since Christmas, I had another flare on my left ankle, the next day, the flare came onto my right wrist concurrently. Now my left ankle is in less pain, it moves to my knee and it swell when i see from behind.
The pain is really unbearable and i cried in the middle of the nite. It hurts so much that i wanted to juz amputed my wrist. My movement have slowed down at least 50% coz i cant walk any faster. The more i walked the bigger the swell is.
Dietary restrictions with gout only make sense when part of a managed program to reduce uric acid.
This means frequent testing by a doctor, preferably a rheumatologist. You might consider supporting this with your own uric acid monitor.
Now if uric acid is only 8, or maybe 9, mg/dL, you might be able to lower it enough with diet. There is very little food you need to avoid completely. Obviously avoid food that you are allergic to. With meat and other fish, ensure that at least two thirds of the meal consists of vegetables or fruit. And ensure that total daily calorie intake is just enough to maintain your weight in the low-normal BMI range.
Other dietary tips are to eat smaller meals more often, and drink pleanty of fluids.
If your uric acid is higher than 9 mg/dL, then no amount of dieting is going to help. Get allopurinol or other uric acid lowering treatment from your rheumatologist.
If you are prediposed to gout (i.e. high uric acid levels), then anything that retricts blood flow can trigger a gout attack.
Trauma as a result of a fall or sprain is common, as is restricted movement for long periods such as long-distance driving or flying.
Jimmy said:
I called the office back to talk to the nurse, and asked how often I needed to have my uric acid levels tested. She said that I did not have to. I was told if I had another flare up to come back to the office and get a blood test.
You must (must must must) find a better health care provider.
The most important thing about gout is getting uric acid down. Get over the pill a day for life complex – it is better than pain every day for the rest of your life.
You cannot manage this without frequent uric acid tests. Try covering up the fuel gauge in your car for 12 months and see what happens.
Why are some medical professionals so stupid?
I am 40 years old, about 30 lbs overweight and have just been diagnosed with gout. My pain came overnight and I waited 8 days before going to the doctor as I could barely walk. (Big toe). I was given 75Mg of indomethacin to take 3 times a day. The walk in clinic doctor said that if I did not get relief in 24 to 48 hrs to start taking colchicine .6 mg every two hours. Needless to say, the indomethacin did not do me any justice, and the colchicine took some pain away and boy I was sick. I did not like the after effects of the colchicine. I waited about 2.5 weeks and seen my PCP. I waited because after I researched gout, I thought I could manage it with diet changes and some Uricelax and G-joint supplements. In addition I was given a steroid pak that I had not taken, and had it in reserves if needed.The pain was tolerable without advil but never went away. He took a blood test and my uric acid level came back at 9.4mg/dl. He told me to take the steroid pak and that should remove the rest of the swelling and pain. It did to about 95%. The office called and I was told I would need to go on ALlopurinol 300mg for the rest of my life. I did not like hearing this. This ended up me finding this site. I called the office back to talk to the nurse, and asked how often I needed to have my uric acid levels tested. She said that I did not have to. I was told if I had another flare up to come back to the office and get a blood test. I plan on starting the Allopurinol and in March(3 months) I will meet with my doctor, and ask for a test. If another episode comes up, I am going to ask for a Synovial fluid test to confirm the crystals and make sure I am Hyperuricaemia. I still do not like the fact of taking pills for the rest of my life.
Anturan is a brand of a uricosuric drug called sulfinpyrazone (or sulphinpyrazone).
It works in a completely different way to allopurinol in that it encourages the body to excrete more urc acid, whereas allopurinol prevents the body from producing uric acid.
However, the aim of all uric acid lowering therapies is the same. Lower blood uric acid levels below 6mg/dL until the gout patient has had a 3 month period at this level without any gout flares. Dosage can then be adjusted to maintain uric acid level below 7mg/dL
If your levels are above this, then you are wasting your time. Now this may be a temporary situation whilst your dosage is adjusted to the correct level. If it is not, then your doctor is wasting your time, and the taxpayers money. See a rheumatologist.
rae66 said:
thanks for your answers to my question and i have some others but i will make a new topic for them
kind regards
ray
ihi again. i went for a blood test to how well the new tablets ( Anturan) are working. my serum urea level was HI at 10.6 and my serum creatinine was high at 131. i am not sure how long it takes for the drug to work. i have been on them already 1 month.
kind regards
Ray
Your husband should seek emergency treatment for the tophi – there is a serious risk of infection.
I hope the rheumatologist can finally get your husband on treatment that works. Perhaps you could write to him to ask if there is anything that can be done before December.
thanks for your answers to my question and i have some others but i will make a new topic for them
kind regards
ray
joe stalin said:
i`ve been taking a??opurino? for years but sti?? have the occassiona? attack, it a?so has some other side effects that i cant quite put my finger on. [retranslated for allopurinol-free readers]
Ha, ha. I love it.
After frequent periods of standing on my head,
?u????????u? s??????-?p?s ?s??? pu?? ?
Thanks to sherv.net/flip.html, my symptoms are improving daily.
?uo ???u?? ?? ?nd ???nb ?u?? ? ???? s?????? ?p?s ????o ??os s?? os?? ?? '?????? ??uo?ss???o ??? ???? ????s ?nq s???? ?o? ?ou??ndo??? ?u???? u??q ??,?
a few weeks back my doctor change my tablets to Sulfinpyrazone (anturan) tablets. 200mg each day, but i have had so many attacks recently that i haven't had a chance to see how well they work. however they did make me urinate much more frequently. after 25 years of gout my doctor has never sent me to a rheumatologist, maybe i will go to a private one. also can anyone give me advice on the home uric acid test machines?
kind regards
Ray
I've also noticed similar effects when driving extensively. The only way I could reduce it was to take regular breaks, and include as much exercise as possible. drinking plenty of fluids and keeping meals light also helps.
I've always assumed that this is from maintaining the same position for long periods.
I've also found the oppositr to be true. Extensive exercise, such as strenuous walking can also trigger an attack. This coulld simply be overexertion boosting cell metabolism leading to excess uric acid production. It might also be blood flow restriction from overtight clothing and footwear. Another effect of exercise can be dehydration through sweating, or simply not drinking.
Finally, your allopurinol dosage needs reviewing by a rheumatologist. It should not cause chest pains, and you may need a different uric acid lowering treatment. In any case, it is vital that the dosage of whatever you take is enough to lower uric acid levels below 6mg/dL. Anything else is a complete and utter waste of time.
It was probably the sessions with Mr Joseph Holt that brought your gout on 🙂 I'm sure he has been responsible for a couple of attacks of my own. Yes it seems like the jury is out on this one at the moment. I guess we wont learn anymore until other sufferers have tried this treatment and reported back which I hope they do. The fish spa could have nipped it in the bud for me but I guess it may be many years before anything scientific is proven. Week 8 now, symptom free. Im enjoying it whilst it lasts. Have a nivce evening. Steve.
Thanks for denouncing my geographical heritage admin ..:)
Thanks for the reply too. Im really curious as to see if this has worked or aided anyone else. Also does anyone know anymore about these fish (Garra Rufa) and their capacity for taking toxins from the system? Would be really interested to hear any info. Obviously when I get a twinge in the toe it means that a uric crystal is forming or has formed. This could have taken weeks/months to evolve, who knows. What I do know is that with NSAIDS that twinge would have been with me for another few days before I had another attack. Im interested to know whether that crystal has now disappeared or been broken up by the action of the fish. I guess only an x-ray will tell. Also. do we know how long a uric crystal takes to form? I ask as Im trying to gauge how long it would be before I had another attack if im now feeling symptom free? Sorry for all the questions, Im just trying to make sense of this horribe and very painful affliction and would explore any treatment path that works for me. The cherries, cranberries, Ibuprofen, 2l of water daily etc etc just didnt help me. Thanks, Steve.
I wonder if your dose is right.
Presumably during the trials, you had regular uric acid checks. Are you still getting these now you're on allopurinol?
I would love some inside info on the clinical trials – a personal view, that might encourage (or otherwise) other gout sufferers to take part. I'm particularly interested in your medical care. How did it compare to the treatment you get from your regular doctor? Better or worse testing? Better or worse treatment? Clearly, the results were much better with febuxostat, but were there any downsides?
I'm going to take Allopurinol for the duration since the gout flairs have been coming back more and more frequently and lasting longer. I hate that the flairs have lately been moving from joint to joint in a progression – it may start in one foot or knee, but I KNOW that the other joints will be affected sooner or later – or so it seems! My last big flair was three weeks of misery which affected most of the joints in my body – including my wrists and elbows, which was new for me!
I will definately be taking febuxostat once it is approved – it works better than allopurinol. I was part of a phase III clinical trial for this med and was on it for more than a year – during which time I had no gout flairs at all! Too bad the study ended – allopurinol is only paritally effective for me.
Welcome Feenix.
With gout, you need to separate yourself from the statistics. Statistically, you are less likely to get gout before 40, but this does not make it impossible. In fact, there are references to juvenile gout, which is simply gout in a young person.
Everybody is at risk from gout, but several factors increase that risk. Statistically you are in a low risk group. But the facts point strongly towards gout.
First off, is to get a proper diagnosis to be certain it is gout. This involves a simple process called arthrocentesis (or aspiration). Some family doctors perform this, but it is usually done by a rheumatologist. Finding a good rheumatologist, with gout experience, is your best chance for proper diagnosis, treatment, and advice.
Gout often moves from joint to joint. It can affect all joints, and in my experience, it usually involves different joints. Sometimes just one elbow, sometimes a knee and a wrist. Every attack seems different after a while.
As uric acid levels rise and fall, uric acid crystals form and dissolve. Crystals will tend to form wherever temperature is lower, where blood flow is slower, or at the site of an injury or tight clothing which restricts bloodflow.
There is a natural tendency, when you have a gout attack in one joint, to forget other joints. Perhaps you limp a little (who wouldn't!) and place more stress on the unaffected foot. Gout attacks tend to clear themselves in a few days, but if your uric acid level rises again, you are at risk of crystals forming again. What better place for them than the foot that is stressed by doing all the work for a couple of days.
So now, my dear Feenix, it's time for some serious self analysis, some expert analysis, or – better still – both.
Why is the gout (assuming it is gout) happening? Do you produce too much uric acid? Do you excrete too little? Is it a mixture of both?
Is the uric acid very high all the time? Just high enough to trigger an occasional attack? Or somewhere in-between?
Can you fix it through diet and lifestyle changes? Do you need medication? Or a bit of each?
In short, do not waste years of time, money, energy and health trying to avoid some foot pain. Let's work together to find the right questions to ask, and find the answers that improve your quality of life.
We need a partner in this – your doctor. I'm neither qualified or prepared to give medical advice, but I am here to help you and interpret any advice you are given. From what you've told me so far, I get the feeling your doctor is working on some pretty out-of-date guidelines. Colchicine is a perfectly acceptable painkiller for gout in some circumstances, but I believe that the patient must be aware of those circumstances, the risks, the benefits, and the alternatives.
I'll pass the buck back to you, for now, and ask how you feel about consulting a rheumatologist. I know that circumstances vary from country to country, so I won't assume you have easy access to a rheumatologist. It's just the first important question, as we proceed differently according to whether we have a rheumy on board or not.
