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I have been suffering from gout since I was 21 years old. I am now 45. I have frankly grown tired of trying to identify exactly what triggers my attacks. I have attacks with normal and elevated uric acid levels. I have had attacks on low purine diets. Interestingly, I did the low carb diet for years and during that time I never had an attack.
As far as exercise is concerned, I say exercise is a must in any healthly lifestyle. I have experienced gout attacks because of exercise. However, when this has happend to me, it always occurs after a period of inactivity. When I return to regular exercise, an attack is triggered, usually because I simply try to do too much too quickly. I do not run any longer which has helped me tremendously. I use an eliptical trainer for my cardio workout. I am now just getting over an attack which has lasted nearly three weeks. As I get older, I have less tolerance for treatments like Indocin which, though effective, makes me very sick. I am now back on the allopurinol which has always proved very, very effective for me. My problem has been that I do not like to take a pill everyday when I get attacks a 3 attacks every 4 or 5 years. But this latest attack has prompted me to return to the therapy. This current attack was prolonged by exercise. I treated the attack, thought I was up to return to the gym, but then retriggered the problem which extended the agony.
Thank you for this website. It is very informative. Have you read about the newest treatment for gout which is waiting FDA approval? Fubuxostat?
I'll try to reassure you then, especially as I am in a similar position.
The indomethacin may have helped with pain, but it does nothing to help gout in the long term. In fact, as it masks the symptoms, one could argue that pain relief makes gout worse, insofar as it may delay the start of urate lowering therapy.
You now have 6 years of uric acid crystals to get rid of. Put it off for another year, and it will be 7 years worth. Put it off long enough and tophi will burst through your skin and cripple your joints.
I am also considering allopurinol, or other uric acid lowering treatment. I've put it off longer than I should have, in the hope that I could control gout by diet.
I've struggled against the thought of a daily pill for life, but now realise it is far better than the alternatives. Much easier to deal with this in our fifties, than endure a decade or two of increasing pain, and try to deal with it when we are older (I'm 50).
I'm not sure if I've reassured you, but I can assure you that you have helped persuade me to take allopurinol for life, in both senses of the phrase.
My gout returns so often. my gout is in the tops of my feet and sometimes my big toe and others hurt so much, I try to eat properly ,take my medicene it comes back so much one day here one day gone I walk reguardless of pain unless its so bad i cant walk what the heck are we suppose to do there are so many foods we cant eat i am going to try the swimming thing and lots of water I do drink soda so il cut it down im glad i found this site thanks all
I've had a suspicion that vitamins might be responsible for some of my gout attacks. I've had gout for a number of years now – at first it was rare – every 6 months but now its increased to almost twice a month. I think I am increasingly sensitive to triggers. Also there must be damage in my joints – mostly ankle – but also knee and of course the big toe. I started taking vitamins this spring and my gout increased – I stopped them and have had less – but last week took just one ! And yesterday – kaboom…
Like you I have had gout since I was 18 and have tried everything under the sun to get it under control. I have my own fresh water chlorinated pool and go in it every day but it hasn't helped the gout in my elbow (had it for 6 weeks now). The cures for gout are all so unique to the individual which makes it even more frustrating to combat, man I hate gout.
That's great news about getting the kit. Now you need to be a bit more scientific.
The meter gives a very accurate digital reading in your choice of the two most common uric acid measuring scales (mg/dL or the other one – sorry I'm not near my monitor at the moment, and can't remember the exact scale). 'Low' is just an interpretation – and I can't interpret an interpretation.
For any meaningful analysis of these results the two most significant figures are the exact reading from the uric acid meter and exact dosage of any medications, or supplements. I know you are trying to avoid allopurinol – do you take anything else?
If 'Low' means below 6mg/dL, uric acid crystals (urate) will dissolve, but can take many months – depending how long you've had gout for, and how serious it is. Do you have any tophi?
Finally, the best interpretations involve time – tracking uric acid level, medications affecting uric acid, weight and tophi assessment on a regular basis is vital.
Total diet is important, so I will bring news of a free food diary
tomorrow that also allows you to track the other variables mentioned.As you see, rarely a short answer with me, but I would advise:
- what do I do now – measure as regularly as you can – daily, weekly or whatever suits you.
- if they do? – yes gout pain disappears when all your urate has dissolved, usually 6 to 18 months, depending on all the above.
- Wiil I have to live so strictly – by monitoring your uric acid, you are giving yourself the best chance to see exactly what effects foods that you like are having on your body.
It may take some time to test everything, but you may well find that red meat and alcohol in a well balanced diet, supported by adequate hydration, do not affect your uric acid as badly as you thought. My own experiments are not conclusive enough to share, but then I know that I need to lose weight before I can expect any meaningful results.
I don't know about ACTH specifically, but corticosteroids are widely available from doctors.
They cannot be used for long periods, but they are an ideal solution for gout sufferers who just need to lose the pain for a few days, and get a chance to keep mobile.
Stacy S said:
Please excuse the bullet points but it is the easiest way to get the facts down quickly and succinctly.That's good – I love bullet points.
is it even possible for a healthy 30 year old (obviously pre-menopausal) woman to get gout?
Yes
is it possible to have gout in multiple joints?
Certainly, this is typical.
could the swelling be caused by the uric acid crystals dissolving in my joints and the related immune system reaction to that process?
The immune reaction to uric acid crystals happens first when they form (uric acid level too high) and second when they dissolve (uric acid level low enough to improve your gout). First tends to be one or two joints, second tends to be many joints, but this is not conclusive. Uric acid monitoring can help here (see Uric Acid Test Kit), but please note this is quite complicated. Occasionally obvious, often clouded in doubt. Focus must be lowering uric acid.
if so how long does that process take? weeks? months? years?
Hours (1 – 5), possibly minutes.
is there anything else I should/could be doing to speed my recovery? I cannot stay off my feet as I live in NYC and a great deal of walking is a daily necessity.
Walking, in my experience is good. But be a friend to yourself. Try not to overdo it. Rest when you can. Keep circulation going as best you can with knee bends (stairs not elevator). Wear most comfortable shoes you can. When resting, raise feet as high as you can (dare?), and keep anklles rotating, toes twitching. Take water.
Pre-menopausal female gout is usually due to kidney's under excreting uric acid, but you really need a rheumatologist to confirm this.
Many claim that cherries help their gout, and I have reported some scientific evidence that supports this on my cherries and gout page. It has to be said that this research is not particularly thorough and not particularly inclusive of gout sufferers.
The research I have found on strawberries is inconclusive – one claiming an increase in uric acid, the other a decrease. Again these are very small studies and not aimed at gout sufferers.
Uric acid metabolism is extremely complicated. The kidneys, when functioning normally, make compensation for changes in uric acid in the blood stream.
It is almost impossible to say how different foods will affect different people, and is largely pointless for most gout patients.
Why do I say pointless?
Because, if you have a uric acid level fluctuating between, for example, 10 and 13 mg/dL, then the small reduction of 1 to 2 mg/dL that you might achieve through changing foods is meaningless. You will never lower your uric acid through eating a few more cherries.
That is not to say that diet is not important, but you have to put it into context of how severe your gout is and how long you have had it. And you have to consider everything you eat, not just one or two fruit snacks.
If you are going to tackle gout properly, you must have:
- Regular uric acid checks
- An assessment of whether you are a uric acid over-producer or under-excreter
- A diary of your food intake, including fluids
- A diary of your weight changes
- A diary of your gout attacks
And ignore any diet that says no to this, or yes to that, without a proper explanation. Most so-called gout diets that I have seen are complete and utter nonsense. See the gout diet section for best explanations.
Sounds like you are doing everything just about right to me.
Diet and water help stop uric acid stones forming, and taking allopurinol should stop this completely. But only if the dosage is right. Insist on regular uric acid level tests.
They may fluctuate at first as uric acid crystals in the joints dissolve, but you are aiming below 6mg/dL. Once the level stabilizes, testing frequency can be reduced, but all allopurinol takers should have a test at least once a year, preferably twice a year.
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.
Not heard of this specifically, but I do recall reading somewhere that vitamin C can lower uric acid. If this causes existing crystals to dissolve, then this process can cause pain – even though you aare actually fixing (at least partially) your gout.
Another thought is that if you are anything like me, your decision to try and improve health with vitamins is backed with other improvememnts in lifestyle. Perhaps a combination of different things is bringing on the gout.
As I've said before, pain is really no indication of whether your gout is improving or not. Regular blood tests for uric acid, plus visual examination of tophi, if you have them, are the best ways to see if your gout is getting better.
I cannot add much to my earlier post.
If it really is the antioxidant content of tomatoes and other ingredients of the uric acid reducing soup, then it makes sense to switch some of your diet to high antioxidant foods.
Note that I say switch – not simply increase your food intake by adding a few berries. Weight control is probably more important than types of food for gout.
I don't know about allopurinol and pH, so I'll do some research and see what I can find.
While I'm looking, can you say what foods you are eating to promote alkalinity?
Do they include foods from my list of most alkalyzing foods?
I have been concerned with the possibility that the pain this gout sufferer experiences is due to gout. This is fairly common, as allopurinol is rarely monitored properly, and so gout continues to cause pain much longer than it should.
My concern today, is that there is a perfectly valid explanation for pain caused by allopurinol.
Though this is rare, it is an acknowledged side effect of allopurinol, though it's rarity renders research via the Internet difficult.
I have determined that allopurinol can induce a condition called xanthinuria, especially if you do not drink sufficient water. One of the symptoms of xanthinuria is pain in the hands.
Further research on PubMed reveals a small number of studies related to allopurinol and pain. Those that I have checked indicate that if pain is allopurinol induced, then stopping taking it will relieve the condition. One case indicates 7 weeks, but these cases are very individual, and time will vary from person to person.
It is almost impossible to generalize with this type of rare allopurinol side effect. However, it would appear that this type of reaction (as opposed to hypersensitivity) will go away in a fairly short period of time if you stop taking allopurinol. The problem remains in identifying allopurinol as a definite cause.
Wow, it's not often I get praise for a quick response. You've just been lucky!
I hate trying to second guess a qualified rheumatologist who has access to all your test data, but something here does not seem right to my unqualified brain.
I have heard of the idea of an “allopurinol holiday” before (unfortunately I can't remember where). The idea is that, having carefully monitored uric acid levels over a number of years, and being certain that no uric acid crystals remain in joints or body tissue, then allopurinol may be discontinued for a while, subject to regular uric acid blood tests.
The crucial point here is that uric acid must have remained low enough for all existing uric acid crystals to have dissolved. There is no exact formula for this. On the scale that I think you are using (mg/L?) this would mean a level sustained below 55 for at least a year, possibly longer. Sorry , I can't remember the length of time involved. There may not even be a standard length of time, as getting rid of all the uric acid crystals will depend on how many crystals there are, how low your uric acid levels fall, and how long you sustain the low level.
Despite the common advice, purines from food are only a small proportion of the amount of uric acid in the blood. Most of it occurs from cell death that is a part of normal human metabolism. Conditions that can make this worse include obesity, starvation, dehydration and other trauma such as surgery. This over-production is the most common cause of excess uric acid, but kidney problems causing under-excretion of uric acid is also very common.
Allopurinol only lasts in the body for about a day, so as soon as you stop taking it, you are exposed to whatever uric acid levels your body naturally produces. As soon as you stop taking allopurinol, you run the risk of increasing uric acid level to the point at which crystals form. This point varies from person to person, and I do not have enough expertise to know if crystals have started to form in your case. The only way that I know to test for this is to analyze fluid from an affected joint – a process known as arthrocentesis.
This is normally done to diagnose gout in the first place, but I see no reason why it cannot be used to establish whether, or not, uric acid crystal have started to form again.
Quite frankly, I cannot understand how or why the medical profession do not make these simple tests more readily available. As far as I know, the results are fairly conclusive as to the existence of uric acid crystals. If you are not certain of the existence of crystals, how can you manage allopurinol dosage? Pain, numbness, swelling, redness or any other typical sign of gout are absolutely no measure of this. Why? Because uric acid crystals cause one or more of these symptoms when they form and when they dissolve. My article “Allopurinol Medication: The Gout Cure That Can Hurt” is crucial reading in this matter.
Unfortunately, this does not really answer your original question, but I do not see a way for anybody to answer that without clear proof that the discomfort you are experiencing is not due to uric acid crystal activity. Surely, with your history of gout, that is much more likely than RSI. Is there a reason why your rheumatologist is suggesting RSI?
I'm at a loss as to what to suggest next. I'll have a think about it and get back to you if anything else occurs to me.
Can any other readers suggest a way forward?
thanks for your quick response!I was taking the regular 300mg until Jan 2007. I then thought I had a pretty healthy lifestyle and with help from my GP I quit the Allopurinol for 3 weeks. Because it was winter and “healthy lifestyle” did not mean low-purine lifestyle, I had some joint pains during those 3 weeks (no real gout attacks) and my uric acid went up to 70 or 75 (65 is the norm?). So I went back on the Allopurinol but only a 100mg dosage, which worked out fine – except that I still have the pain in my hands!I hope this gives you more insight!I'm sorry, but I do not know about this side-effect.
More importantly, what are your uric acid levels during the time you have been taking allopurinol?
And what dosage have you been on?
To make any guess about what is going on here, it is vital to compare changes in uric acid levels with dosage of allopurinol over the time you have been taking it.
If any other readers want to look at this, please start with my allopurinol side effects page.
GoutPal said:
Welcome to the gout forum, scotsmale.
I’d never heard of piroxicam until you mentioned it, but I’ve now learned that it is a NSAID (Non Steroidal Anti-Inflammatory Drug). Feldene is Pfizer’s brand name for it, and apparently it is available as table or injection.
Presumably, the injection gets round the problem many gout patients suffer – NSAIDs can be difficult to stomach.
Most authorities that I’ve seen warn against long term NSAID use, so it is wise to get proper medical advice on this. As you may have realized, I am a strong advocate of consulting a rheumatologist.
I’m also a strong advocate of regular uric acid testing. The only way to dissolve tophi is to keep uric acid level below 6mg/dL. There are, of course, many ways to do this depending on how much you need to lower it by.
Thanks for the reply. I’ve only taken piroxicam in tablet form.. 20mgs,
for around 15years . Tophi has become a big problem in.. both elbows ..im going down the baking soda route…and after a week it certainly seems to
have dissolved the lumps of tophi…whether it can free me of piroxicam long term remains to be seen…heres hoping.
Welcome to the gout forum, scotsmale.
I’d never heard of piroxicam until you mentioned it, but I’ve now learned that it is a NSAID (Non Steroidal Anti-Inflammatory Drug). Feldene is Pfizer’s brand name for it, and apparently it is available as table or injection.
Presumably, the injection gets round the problem many gout patients suffer – NSAIDs can be difficult to stomach.
Most authorities that I’ve seen warn against long term NSAID use, so it is wise to get proper medical advice on this. As you may have realized, I am a strong advocate of consulting a rheumatologist.
I’m also a strong advocate of regular uric acid testing. The only way to dissolve tophi is to keep uric acid level below 6mg/dL. There are, of course, many ways to do this depending on how much you need to lower it by.
I started this discussion because of a comment to the original post about the possibilities of liver problems as a side-effect of allopurinol.
…However I do have stiff joints especially after a long drive, I am also being checked due to raised liver function tests which never seem to become normal although the tests are now stable.
Do you think I should go back to Allopurinol to try to bring down the LFT score? would you know if raised uric acid may be the possible cause of the high LFTs?
I must start by saying that I have no medical qualifications, and I maintain this site simply to share my experience of gout, and the experiences of others.
Liver Function Tests monitor a range of substances that can indicate liver damage, but normal LFT does not mean that there is no damage – i.e. the tests cannot spot all forms of liver damage.
The tests monitor several substances, and my understanding is that you have to look at individual results in detail to glean any meaningful information. So raised LFTs in total may indicate a problem, but only a study of the specific values for each substance can point to possible causes. Of all the causes of raised LFT values that I have seen, none indicate any link to uric acid or gout.
There may be a link, but I do not have enough information to research this further. Use my Internet Search Engine to search for "Special Considerations in Interpreting Liver Function Tests". This will give you an idea of how complicated LFT analysis can be.
It is not wise to approach allopurinol in this way. I.e. it should not be seen as a method of controlling the results of Liver Function Tests.
My advice would be to consult a rheumatologist. This should be a routine for anyone who has ever been diagnosed with, or suspected of gout. A check-up each year, or as advised by the rheumatologist, is the best way to avoid slow build-up of urate in joints or other tissue. This can occur slowly without the full blown gout attack. Stiff joints are an indication that this could be happening, but not yet bad enough to be causing you serious pain.
The rheumatologist can advise you if it is wise to start allopurinol again. They might also be able to explain the LFT issue, or at least advise you who you should see to interpret the results.
The trouble with feet is they are made from many bones. This means many joints for gout to attack. Gout pain is mainly due to inflammation as the immune system reacts with uric acid crystals.
Secondary pain can come from nerve and circulation restriction resulting from the swelling.
Some of the hings that help me are:
- Keep feet warm – bedsocks are not very romantic, but when you’re in that much pain, you probably don’t care.
- Try to keep walking. It hurts, but it is surprising how quickly you can walk through the pain barrier if you persevere. I find gout attacks go much quicker if I keep mobile.
- When resting, try to keep feet above the heart.
- If you have to drive, or sit at a desk, keep taking regular breaks and walk round for a while. Drinking plenty of water not only helps your gout directly, but also causes frequent toilet trips – a chance to keep those feet moving.
To my knowledge there are no foods that have been conclusively proved to lower uric acid.
I have seen some references to herbs used in traditional far eastern medicine that might reduce uric acid through natural compounds that act like allopurinol. I need to research this further, so if anyone has seen any recent research on this, please share it here.
I have a theory, backed up to some extent by research, that a diet rich in antioxidants can reduce uric acid, which is our own natural antioxidant. There is more about this on my Gout and Tomatoes page.
Please note that everything I have seen relates to fairly small reductions in uric acid, and is far from a proper clinical gout trial. Most gout sufferers have uric acid levels way in excess of the required 6mg/dL, and it is unlikely that food products could produce a big enough uric acid reduction.
I’m sorry that your tophi have reached the stage where an operation is necessary.
Removal is a fairly standard procedure, and is normally successful. My experience from friends tells me that the sooner it is done, the better, because tophi that have broken through the skin can become infected.
As with any surgery, their is a risk that anesthetics can trigger a gout attack. I’m not an expert in this field, but I believe treatment with alkalizing medication before the operation can reduce the risk of this.
Post operation, your priority should be lowering uric acid levels to below 6mg/dL to help dissolve any remaining tophi, and stop more forming.
I know you have also asked about uric acid reducing foods, and I will address that in the gout diet forum. Please be aware that, at this advanced stage of gout, diet will not be sufficient to lower uric acid enough to prevent further tophi build up – see gout diet section for best explanations.
You must get medication for this – traditionally allopurinol, but there are alternatives, with new uric acid lowering drugs slowly becoming available.
