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IF the uric acid is a correct 216 micromoles per Liter and you are a woman and you have not been medicating to inhibit uric acid, then you most definitely do not have gout. Remember though, labs DO make mistakes. Have you ever had another Uric Acid test? Numbers?
Alas, NOW the fun begins where you must find out which of the laundry list of joint diseases might be causing your pain.
Tell us what your symptoms have been and I'll try to steer you.
Have you had you ANA run recently? Results? (ANA is high in a GREAT many autoimmune joint diseases and a low ANA is a good sign.) I went through a huge pile of tests to rule out Lupus, so I am a bit familiar with the process.
Let me try to pull your old posts.
Algout,
I think we have a case here for Dr. House.
Tell me how they came up with the original gout diagnosis?
Tell me how your rheumatologist decided your pain was now from psoriatic arthritis…other than the fact that you have psoriasis.
I have no clue how they do a differential diagnosis. If purely on the basis of SUA then it should be measured after being off allopurinol for several weeks?
Are their specific markers for psoriatic arthritis?
Is there any indication you suffer from BOTH conditions?
Poor zip is very confused here…and not completely unskeptical.
Elsevier has a differential diagnosis between the two but they want a FORTUNE to read it.
Medications
Using medications for gout can be complicated, because the treatment needs to be tailored for each person and may need to be changed from time to time.
Obviously this is highly slanted. Can ANYONE honestly say that taking allopurinol every morning is more “complicated” than the laundry list of life style changes required by non-medical care? Clearly avoiding fish, meats, gravies, organ meats, beer and taking bicarbonate, blueberries, cherries, black bean broth…and all this FOR LIFE has to be seen as somewhat more complicated than popping a cheap pill once a day
Okay ouch,
Now that I know we are talking about micromoles/Liter I have to echo GP's request as to how you are getting numbers so low with gout. While brainstorming the possible units for the 216, I thought of micromoles/Liter and dismissed that guess because nobody could have a gout attack with numbers so low and probably no men could have it ever without multiple drug therapy.
So give us the particulars of your case (again for those of us who have forgotten…I am not particulary adept at searching back posts on this board.)
My take on gout is a little simpler:
Purines are breakdown products of cell nuclei, whether from lean body tissue or from diet. They can further be used as food by a readily available enzyme xanthine oxidase (XO) and the purines are readily converted to uric acid. Uric acid is not very soluble in the body and settles out in the coolest parts if even slightly too high. The immune system treats these deposits as foreign bodies and attacks them with inflammation…a gout attack. Some people attack the deposits more furiously than others.
Animals have another enzyme which can break down uric acid but humans lack this enzyme (uricase) presumably because high uric acid has given us an evolutionary advantage somehow.
So we can treat gout by either lowering our purines somehow or interfering with conversion of purines to uric acid or by getting rid of urate faster. There really is no other way of dealing with gout.
We can lower production of purines by cutting back drastically on meat and fish consumption and eliminating organ meats and gravies. Or we can tie up and neutralize XO by taking daily allopurinol. An alternative is to take a uricosuric drug to pee out more uric acid.
Whichever method we choose to deal with gout, measuring the uric acid content of blood is the way we determine our effectiveness.
That's gout in a nutshell.
Juliana,
SUA of 6.0-7.5 is a terrible place for a gout sufferer to be at. It is just too high.
His problem is that he cannot stop the gout long enough to get onto Allopurinol (not that he relishes the idea of drugs) but realises he has to get on top of this.
He should just bite the bullet and get on allopurinol today. It is NICE if it can be in a gout free period, but if it cannot be, it cannot be. It is quite possible that the ful dose, 300 mg. allopurinol will put a stop to all this “is it or isn't it” suffering.
Suffering for months to find a good window to start the drug seems foolhearted to me.
The number 216 has no meaning without UNITS. Ask doctor what they are. If he doesn't know right off hand, get a new doctor. (It is most definitely not one of the common measurements except perhaps in Zaire or Kazakhstan?)
Like buying an apartment:
Q: How big is it?”
A: “Eleven.”
Makes no sense.
All that is necessary Paul, is a SOUND diagnosis of gout. Allopurinol is perfect and inevitable if gout is the cause and terribly sad if it is not. Nothing is worse than a lifetime of an unnecessary drug.
Some of us are “luckier??” than most in having the sure-fire, absolutely confirmatory attack of podagra in the bunion joint. If I had to ascertain gout or not from my awful knees or my always painful shoulder rotaor cuffs, or mangled lower back, I'd not be able to ever be sure if I had gout or the normal wreckage of age and injury. But once you see that big purple toe, there is no doubt left.
So the worst of the worst of pains is perhaps a blessing, WELL disguised.
I agree, allopurinol is a life-saver. But each person must be convinced in his own way. Some will need a boss who says if you take any more sick time this year, that's IT, goodbye. Others will live through 20 episodes of moderate pain and then WHAM, get hit with a swollen foot that can not bear ANY weight without excruciating pain. Others will wait even longer till their fingers begin to look like something out of a horror movie and they are in renal failure.
But, mark my words, everyone with gout, unless he is run over by a bus early in life, will eventually say yes to allopurinol or one of its alterrnatives.
Anyone can bear 3 attacks but it takes real “dedication” to bear 30.
Look at it this way: If you have diabetes, you don't wait until your retinas are shot and you have lost a few toes to begin treatment, why should gout be any different?
I don't know if a test is more valid or not with a fast.
It all depends on the rate in which the body metabolizes purines in food to uric acid.
The same doubt goes to the question of how long to wait after hard exercise (and the corresponding muscle breakdown to nucleic acid purines to urate.)
I can see the real possibility of testing a few hours after doing bench presses or a hard run followed by a meal of calves liver as giving a uric acid reading off the scale.
If I were doing at home testing, all tests would be on awakening before eating. That way I am comparing apples to apples. (And coincidentally that would match the conditions in my doctor's office for a blood draw…early morning, no food.) Maybe once in a blue moon I'd waste a strip on a test after the most awful conditions just to ascertain my peak (like the above exercise and liver meal with a six pack of Heinekin thrown in…oh goody, 18 mg./dL
)A problem with the above definition,
Cure, is manifested by the removal of the symptoms. Strictly speaking the removal of all the symptoms of the case is equivalent to a cure, but if symptoms disappear and the patient is not restored health and strength it means either that some of the most important symptoms of the case have been overlooked, or that the case has passed beyond the curable stage.
is that it should add, WHEN TREATMENT IS REMOVED. Thus a cure is penicillin for 10 days but a cure is NOT penicillin for 10 YEARS.
If this refinement were given in the definition, then clearly gout, like diabetes or arthritis is NOT ever cured, just successfully TREATED.
Bill Clinton's heart disease was not cured yesterday by installing two stents…just successfully treated, his symptoms were removed for a time.
I have noticed an almost immediate relief with the colchacine and my feet after two days feel remarkedly better.
If there is any doubt about whether it's gout, that kind of a reaction is pretty confirmatory.
I feel strongly that diving right into the pool with 300 mg. allopurinol is the right way to start. Look for itching anywhere or any swelling of the lips or eyelids, both rare indictions of allergy and if you see these symptoms, stop the drug.
I always did what I was able to do and that usually meant getting around with crutches. Only once was I completely bedridden.
DON'T put weight on an inflamed foot, nor wear anything except the softest cloth shoe or sllippers, but if you can make do with crutches (swinging the sore foot), do so.
The old saw is applicable here:
Patient: “Doctor, it HURTS when I do that.”
Doctor: “Well then, don't DO that!”
Yep,
Prednisone and Percocet will cure pretty much anything, or at least FEEL like they are cured. You are lucky you are in Germany, Nate, because in the states a couple prescriptions for percocet will have your doctor giving you the fish eye and Federal drug enforcement agencies probably monitoring you phone calls…unless you're Rush Limbaugh.
Prednisone is also a wonderful drug, proably the best antiinflammatory known, with a knife behind it's back. When cortisone was first used a half century ago to treat people with rheumatoid arthritis it was proclaimed A CURE…and then months and years later the patients began paying the bill. Treat the stuff very gingerly.
(Orthokine is used in Germany, but the U.S. FDA has not approved it. It sounds VERY experimental and I would be cautious. But if you want it done, do it while you're in Germany.)
Yep, I know crawling to the bathroom well…it's good it was only my toe because had my knees been involved also I'd have to have lain in an excrement covered bed.
I have my doubts about Vitamin C but am willing to dabble with the 500 mg. until I get a solid reference one way or the other.
Here's another shred of evidence from an ancient study from the Journal of Biological Chemistry (1952)
http://www.jbc.org/content/201…..7.full.pdf
SUMMARY
A study has been made on the relationship between l-ascorbic acid and
purine catabolism
in
vivo. High levels of ascorbic acid administered to
guinea pigs inhibit their liver xanthine oxidase activities to a minor degree.
Blood levels and rates of excretion of uric acid and allantoin, however, are
independent of the ascorbic acid intake.
ROFL. ROFL, ROFL…
Looking for fermented tea as the cause of serious new problems in someone recently diagnosed with HIV is like blaming a bad breakfast menu for the sinking of the TITANIC.
Yes, kombucha is indeed the kefir grain used to ferment almost any sugars into vinegar-like components. The kefir grain is filled with dozens of different probiots, principally lactobacilli (milk fermenters) but the acetobacters and yeasts come into play strongly with Kombucha. It really ISN'T a tea in the traditional meaning of the term.
So to an extent, I would imagine K could transplant some useful bacteria to the gut, but it seems a shame not to use all the lactobacilli that real kefir could confer.
But Kombucha, kefir, or any other probiotic will NEVER be a substitute for allopurinol in treating gout. When are they going to start you on alopurinol, Paul? What kind of uric acid readings did they get at the doctor's?
Without insurance in the United States Uloric is about $5 a pill for the low dose 40 mg. Few insurance companies cover the drug, and that's the few of the few who even COVER drugs at all.
Mr. Bell obviously has a very generous, and somewhat rare plan. May I guess, a public employee plan?
Excessive thirst might be the result of the drying effects of a cold NYC winter with dry steam heat. Excessive thirst = excessive urination.
I have a dry mouth while I am sleeping these last couple months but I attribute it to my water pills, Latex. Maybe I'll try a couple nights without allopurinol and see if I can sleep through without getting up for water.
Glad your feet are doing well.
Okay pigeon, whenever you get around to it a good approach might be to measure your uric acid after a day oif normal to light eating, then have another day of lighter eating and add to it 10 cans of brew.
Measure uric acid the next day and compare the two. We will be able to point to your exemplary experimental work the every time the topic comes up.
Perhaps submit your results to JAMA. (I've seen less substantial reporting.
)The reasoon I said eat light is that for D-Day you are adding about 1600 extra calories and it won't FIT with heavy eating.
That is the million dollar question guys, and in truty I think it will remain pretty much answerless.
Acid is defined as an excess of hydrogen ions over hydroxyl ions and alkalinity the opposite. It can be measured in the food we eat and the by products we elimiinate. The body maintains blood at a constant pH (Hydrogen potential) of 7.4 give or take almost nothing.
Okay that's really it scientifically but then we have New Age, the people who give you acupuncture, chakras, shiatsu and mega-vitamin cures for all disease. They turned acid-base on its head and now it can mean anything any particular author wants it to mean. Thus lemon juice can be acid, base, or both?
To my way of thinking, the only effect of all this on gout is for those people who form urate kidney stones indicative of an acidic urine in the presence of lots of uric acid. For them eating alkaline foods and taking alkaline drugs as measured scientifically is useful.
Other than that, I leave acid-alkaline discussion to the new-age gurus peddling their latest paperbacks at Barnes and Noble.
phofab,
I sing the praises of allopurinol to keep uric acid levels low enought to avoid new attacks. Alas, old tophi are isolated by the body, and it seems even from the joints. So though they are out of harms way, they are still there, often just under the skin.
I have read that SUA's around 3 tend to rid the body of tophi, the article specifically making that claim was advocating the use of both allopurinol and probenecidbut then I have also read that surgery is needed for stubborn tophi if they cause problems.
I think you can expect happy toes, mine are, but I cannot guarantee that old tophi will disappear. What I have noticed is that the feet are the sites of pain but the fingers are the sites of tiresome old tophi. I've NEVER had one on my foot but have had 3 on the back of my hands.
phofab,
You have that weepy toe tophus right? If so, it will probably weep itself empty. Weepy is GOOD!
My thumb, which was the size of a bean emptied completely, you'd never know it was there (that was about a decade ago.) My little finger is the size of a split pea half and the new one on my middle finger is the size of one of those fancy straight pin heads with the tiny white little plastic glob on the end…it's gonna get stuck next week. I think it's because of cold hands in this Northeast U.S. winter combined with 2 months of heavy beer drinking…don't ask! No pain but POP, a tophus.Either that or God's particular drink is a dirty Beefeater Martini (1 olive/3 onions.) THAT'S what he really did on the Seventh Day…about 6 of them!
Since I'm teetoalling from Jan. 1 to April 1 (as I do every year) and don't have a tester I am out of the running.
We gotta find somebody with a tester willing to do the 10 can of beer uric acid test! I always have felt that “the proof of the pudding is INDEED in the eating.”
Let's have some volunteers guys! Science NEEDS you!
I have only “cured” a tophus once…by opening it up with a red hot paper clip through my thumbnail.
I have two small finger tophi left, one new one this month which is going to get a needle very soon (needle need not be hot becasue these are just under the skin, not the nail.)
Shrinking tophi with meds is no easy task, even with <6.0 urate for 20 years.
I also think that dehdration is at the core of beer's gout indicing properties.
But then I'm always thown by the fact that I find spirits FAR less offensive…and I consume a LOT more alcohol when I am doing Martinis and Manhattans which never seem to bother me.
But my second month-long bout with too much beer in Nov.- Dec. actually raised my second finger tophus…albeit without pain unless I press on it. A teeny little f&*ker but a f&*ker nevertheless.
(I'll photograph it when I get ambitious.)
There is something differently special about beer besides alcohol content and it's not the purine level because it is not that high? For me it remains a mystery.
trev,
If you get the urge some day why not test your SUA before and after about 10 hearty ales?
Bagpiper,
After 3 years of suffering with serious and confirmed gout, you will soon be on allopurinol 300 mg. The sooner the better both for pain relief and to prevent further damage to your joints.
At the same time, get a script for colchicine, maybe 60 pills, to have on hand. That may save you an extra trip to the GP later. Everybody with gout should have a bottleful nearby just in case.
)