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Let me pre-empt GoutPal on those questions( because I'm HERE)
I have precisely ZERO clear-cut attacks per year after almost 2 decades of allopurinol. I have occasional questionalbe TWINGES for which I pop 2 colchicine. Whether they are the start of anything or not I don't need to know. I think I have one remaining tophus on the small joint of my little finger which tends to give a slight ache once on a while but nothing a 60-some year old wouldn't expect. A larger one on my thumb has slowly gone away.
I suspected a connection between about 2 weeks of heavy beer drinking and an achy knee that lasted almost 6 weeks but I have 40 year old torn cartilege in the knee and still do heavy workouts on an elliptical trainer. THis pain DID NOT respond to colchicine but did abate with 2 weeks away from the gym. So I will chalk that up to NOT GOUT (I think.)
Summary: Allopurinol WORKS!
I started my allopurinol at 300 mg. and kept it there for almost 20 years. I didn't have any problems with attacks after starting.
I like what you say about “however I seem to have aching joints most of the time now which I believe is gout related.” I have more than a sneaking hunch that LOTS of arthritic type pains are uric acid related. In fact, a rather prominent orthopedic surgeon got excellent results with his severe back pain patients with regular injections of colchicine. So once you have gout you can never be sure when your shoulder or knee hurts, or you come down with a backache, what is causing what.
Do you have any tophi that you can see or feel?
Merago,
?
Here's the scenario. Given just the first attack, try to do what you can with diet?don't dehydrate, stay away from too much beer (spirits better) try to cut down on meat and fish in favor of alkalyzing fruits and vegetables. If you are lucky you won't have another atttack. BUT if you DO have one this year you will want to consider allopurinol.
?
I hope you never have another attack.
(Remember, the big toe is the MOST likely attack but attacks in the instep? or ankle are quite common.)
Most magnesium salts tend to be stong alkalizers..whether the oxide(hydroxide), the carbonate, the phosphate or the citrate.
So, if they have an effect on gout it will be a positive.
Your friend gives some good anecdotal evidence.
As for B-6, almost all claims of “cures” from megavitamin therapy are shown to be of no validity, B-6 included.
There's probably somehting to it, but the extent is not clear. If you are worried, why not have a sperm count done before and after the alllopurinol and ascertain for yourself. If the effect is noteworthy, then you can seek another path. But be warned, alternatives to allopirinol and colchicine for gout sufferers is hard to come by and gout is eventually very much a killer so it cannot be ignored.
I recommend a call yo your doctor for a prescription for colchicine. I think it works much better than indomethacin for an acute attack. You take 2 pills and then one an hour until you rach 16, have the pain stop, or have intense diarrhea develop (it's common so stay close to home.)
If you don't want to go that route probably indomethacin is second best but you need to take ENOUGH…and that means around 50 mg. three times a day. You need more for gout than other conditions.
Your first doctor is the worst kind of quack who diagnoses by AVERAGES, as in MOST of my patients don;t get it, WOMEN USUALLY don;t get gout = you don't have gout. I had one like that tell me that MOST upper repiratory inferctions are VIRAL>>>therefore I don;t have a bacterial infection.
A google search for averasges is more useful than doctors like this.
Dyazide causes Gout, plain and simple. It causes it frequently. Thiazide caused mine and hydrochlorothiazide is the main diuretic in Dyazide.
Of course a uric acid of 12.3 is GOut City…and so is the 7.6 for a woman.
What happened is that many crystal have crystallized out over the time you were on dyazide and it will take some time for the allopurinol to resolve this. It is likely that you will need to lose the diuretics (I know, not easy) so a search for another class of effective antihypertensive is your next order of business, perhaps an ACE inhibitorif you donlt cough from it…cheap and effective for the majority of people. If your old doctor persisits in the Dyazide nonsense tell him that “doctors should crack open a book every decade or so.” He'll get your point.
Now the problem: about 25% of the population is “salt sensitive” or “volume driven” and for this minority, no antihypertensives work as well as diuretics. If you MUST have a diuretic, I recommend a switcht Lasix, a LOOP diuretic, which retains less uric acid.
For flairups of pain ask your doctor for an Rx for colchicine, it stops the attack in its tracks.
charlton,
Prednisone has two methods of acting in gout, like many analgesics. One, it directly cuts down pain and swelling. Two, cutting down INFLAMMATION prevents the continuing acidification of the area which causes more urate precipitation.
I think colchicine is a better agent for doing this…and less dangerous than prednisolone over the long haul.
I would wait until the pain is gone and then start the allopurinol and I'd start with the 200 mg. right away…it's a small dose.
(As your doctor for an Rx for colchicine…it's a good emergency aide for your medicine chest.)
Lyn,
I've seen none in myself. I can eat aspirin like candy although other NSAIDS give me problems like gastritis from ibuprofen and dizzinelss from Indocin.
My reasearch has shown that aspirin has markedly divergent properties: in small doses it retains uric acid; in HUGE doses it expels it.
But, if you're implying that aspirin helps gout and that those who cannot take aspirin are thus more at risk, I think there's no linkage there. Aspirin in normal doses is not a drug to be taken for acute gout, nor as a preventative and there are few people who can take the 4+ grams/day necessary for its uricosuric action (like 16 aspirin.)
Kvalhion,
That's a decent plan, BUT I think you would be better off using colchicine rather than indomethacin. I've used both and there's no comparison. Cochicine gives you diarrhea, true, but Indocin can REALLY chew up your stomach, it's perhaps the very worse NSAID on your stomach lining. For me, it also caused a lot of dizziness (I took it for backache.)
Prophylactic colchicine will really prevent any attacks which is far better than dealing with them when they start.
Okay, that's the downside; the UPSIDE is that you may get the results I did…after starting daily allopurinol with nothing else I NEVER had another acute attack. Small tophi soreness yes, but never the horrors of the crippling purple foot! So maybe you'll never need to know how well the Indocin works or doesn't work!
Good Luck!
Charlton,
I have been on allopurinol for about 20 years and only in the last two years have I been hearing that there are side effects, probably the worst claim was immunological damage, the lesser one's talked about RASH. I have also heard firsthand from people on boards like this that they CANNOT take allopurinol becasue of hypersensitivity reaction…but that's a different thing. But I have never had a single bit of evidence of anything untoward and I take either 300 or 400mg./day.
Before that time, allopurinol was considered among the SAFEST of drugs for long term use, with virtually NO side effects. Puzzling 😉 .
How's THIS for conspiracy theory. Development of $$$febuxostat$$$ as an alternative to allopurinol has been in the works for several years and this wouldn't be the first time a drug company MASSAGED the facts a tad to generate future profits for a NEW development. Remember, the more badmouthing of allopurinol the more people willing to pay $5 a pill for the new stuff. Furthermore since allopurinol has LONG been a cheap generic, there's no money behind it to defend it's reputation. I'm not saying I have any facts, but having long watched the lies and half truths to spur drug profits, I think that there's likely more than a grain of truth here.
IF long use allopurinol is rife with problems, let's see the STUDIES…I haven't seen one yet!
Untreated GOUT is a killer and treating the pain of acute attacks is NOT treating gout. Even without acute attacks, high uric acid is doing insidious damage to the kidneys and arteries and probably joints and organs. THe end point of gout before allopurinol was death. So don't content yourself with the “natural” treatments…they do not lower your uric acid.
So, do not be afraid of allopurinol because the odds are STRONGLY in your favor that you will never notice a single side effect becasue the huge majority of users never do and your dosage is very low. Perhaps after febuxostat goes generic and is tested in the general population for half a century, a switchover might be advisable. But here's a prediction from me: febuxostat will show MORE side efffects than allopurinol as the years go on…that's ALWAYS the story with a new drug.
There are cheap alternative URIICOSURIC drugs, that have more problems than allopurinol, like probenecid and phenylbutazone. For people with hypersensitivity to allopurinol they are an option. THey work by causing the kidneys to eliminate uric acid rather than by preventing its production.
You CERTAINLY need to be on colchicine for a FAR longer period than 2 weeks while the allopurinol gets a chance to stabilize your gout tophi because allopurinol can “shake up” those deposits and cause an attack even while lowering your uric acid load. That doctor should be THROTTLED for giving your colchicne for only 2 weeks. But, in his defense, MOST people don't have attacks after starting allopurinol…but then who needs diagnosis by averages, eh?
Go to a rheumatologist and ask for a combo of allopurinol and colchicine for several MONTHS. Don't stop the allopurinol. After a couple months you will be able to drop the colchicine without fear…but always keep a bottleful on hand.
Yes, get a blood test as soon as possible (AND the colchicine) and make sure that with every routine visit you get your uric acid tested.
I have neverr noticed the connection but then I have only a can of Diet soad a day or two very occasionally.
THe problem, if there is one, is that carbonic acid is a potent acidifier.
I have always had a LOT of trouble with this acid-base stuff. IT's because my background is heavy training in chemistry.
Thus to my way of thinking, citric acid is an acid and it matters not whether it's in an orange or a lemon. Sugar is NEUTRAL becasue if you dissolve sugar in water the pH is 7.0 and if you soak a steak in water the water will NOT turn acid. This “New Age” stuff has always seemed silly to me and I have always suspected it is for selling stuff under the guise of “chemistry.”
Related but in a slightly different direction: Another effect, for gout, is that uric acid is more soluble in alkaline conditions. Though the pH of the blood is tightly regulated by the body, a tiny percentage increase in alkalinity is probably enough to dissolve slightly more uric acid. (from the PRAL link)
I too have read the above but then have always thought : THEN WHY ARE TOPHI DEPOSITS ALWAYSMONOSODIUM URATE???? If Uric Acid is the insoluble form then we should expect uric acid deposits but such is not the case. A corollary…to remove alkaline tophi wouldn't the most acidifying agent work the best…like a nice hot cup of sulfuric acid first thing in the morning.
So this concept of the most soluble form crystallizing out is most baffling to me.
ROFL,
“It is the Procounsel, Oh Caesar, along with his aide, the Probenecid! They crave audience to herald their defeat of the HUN chieftan, Uric the Terrible!”
Alright, what can you do with Paul Bunion?
Firstly,
I LOVE your name. Like a Shakespearian character with a sore foot!
Yes, it is normal and unfortunate that these attacks tend to accelerate a bit when allopurinol first starts to do its work (I was lucky and had no major attacks from day one of allopurinol.)
Yes, it is fine and WISE to take colchicine at the first tingle of an attack. You can get quite good at learning the exact minimum of colchine to abort the atttack…sometimes ony 2 at the first sign, sometimes 4. Wait too long and its LOTS of colchicine. It seems the more tophi you have the longer it takes for allopurinol to get completely in control.
I assume you're on the “generic” dose of 300 milligrams/day?
I think you could start eating “normal” food now and trust the allopurinol top do its work. It was for times WITHOUT allopurinol that people got these dreary stringent dietary restrictions. Just don't go overboard with booze, small fish, and organ meats…but even they can be eaten in moderation. But lots of veg and fruit never hurt anyone either.
metamorph,
What kind of uric acid numbers are you running?
The reason that I ask is that it seems that you might be too close to the cusp of gout attacks and thus suffereing some of the OTHER problems a high uric acid presents like arterial damage. Have you ever done or considered allopurinol (forgive me if you said earlier and I forgot!) perhaps just STOPPING incipient gout attacks not might be treatment enough.
A similar situation might be be mine: I KNOW I can stop an attack the instant it starts with colchicine but I choose to keep a buffer so an attack never really gets started.
matt,
Another alternative route is to use uricosuric drugs (probenecid, phenylbutazone etc) that dump large amounts of uric acid out through the urine. Some people use alone or use them them along with allopurinol to get astoundingly low serum uric acid levels…like 3.0 mg/dL.These drugs might be of even more use to “underexcreters” who have less benefit from allopurinol (which deals solely with OVERproduction of uric acid.)
What could be happening if you have loads of deposits all over is that your serum uric acid won't go down much until a lot of the deposits are reduced. Take it from me, it can take YEARS to get rid of a tophus.
Ask your doctor about probenecid.
It seems to me that, absent a past history of gout that was treated with high doses of allopurinol, your doctor has overprescribed.
The standard of treatment is to begin with 100 mg and titrate UPWARDS and the standard is also for a maximum doseage of 800 mg. For most people, even 600 mg. is too high. THe problem is that allopurinol useage can have unpleasant side effects and these side effects are dose dependent…you DON'T want to take more than you need.
I'm not disagreeing with goutpal, just presenting the view of somebody who prefers to act as his own doctor and starts off with the assumption, until proven otherwise, that most doctors are ill prepared to treat ANYTHING except hypertension.
(I'm in complete agreement with your headline: Cherries really ARE too expensive for daily use.)
I agree with you completely Mike. I think that diuretic prescription is the leading cause of gout today. I think that hypertension is overtreated and that MOST agents that lower blood presssure eventually lower it by ultimately causing diuresis. You were lucky in your choice of an ACE inhibitor but many of us cannnot take them because they readily cause incessant coughing. Even a beta blocker ultimately does it's work by causing diuresis (by blocking antidiuresis hormones.)
So the net effect is that one treats a RISK FACTOR, hypertension, and causes a REAL disease, GOUT.
I have found that Lasix, a loop diuretic is far less likely to casue uric acid buildup than hydrochlorothiazide (the preferred diuretic in the U.S.) so Lasix (furosemide) is what I take.
Personally, I think that it is quite wrongheaded to over treat systolic pressures in the 140-160 range but since this provides the bulk of patients for most GP's, the treatment regimine is aggressive…for a LIFETIME! I think the correllation between modest hypertension and development of heart disease is EXTREMELY weak and the benefits of a lifetime of TREATING someone with systolic of 150 NOT PROVEN, just ASSUMED.
I'm surprised they were so quick to judge gout in you with a low uric acid? I know that in an acute attack the serum UA usually drops becasue its precipitating out but STILL I wouldn't expect normal readings. After all, gout is caused by HIGH serum uric acid.
steve,
Yes, black beans and black TURTLE beans are synonymous. Give us a report on whether it worked.
I remain skeptical and still recommend a call to your doctor to call in an Rx to your pharmacist for a bottle of colchicine tablets…one an hour until cured, diarrhea sets in, or you reach a total of 16.
For those who like NATURAL cures, remember that colchicine is and has been for millennia the AUTUMN CROCUS though it is now far cheaper to synthesize the stuff.
IF you want to continue the Ibuprofen, remember you need an antiinflammatory dose, not the “occasional headache” dose. Thus you have to take a LOT:
Generally, the oral dose is 200–400 mg (5–10 mg/kg in children) every 1-2 hours, adding up to a usual daily dose of 800–1200 mg. 1200 mg is considered the maximum daily dose for over-the-counter use, though under medical direction, a maximum daily dose of 3200 mg may sometimes be used in increments of 600–800 mg.
debs,
I;m sure it will do no harm for hium to take cod liver oil. In fact, a prominant quack of a half century ago, Dale Alexander, prescribed it as a CURE for all forms of arthritis…he claimed it “lubricated the joints.”
In any case, it won't do any harm, but go easy on the sardines and little fish themselves because they are among the highest purine foods.
I checked several large drug chains online for Uloric availablility. Couldn't find it yet…I guess htere's a time lag.
What good news that the FDA approved Uloric…AND JUST THIS MONDAY! My hunch is to approach this newest development with caution since it has not been without serious side effects in clinical trials. It is also likely to be expensive for a while if history teaches us anything,
“The most commonly reported adverse events in Uloric's clinical trials were liver function abnormalities, nausea, joint pain, and rash, according to Takeda Pharmaceuticals.”
Jill,
I have never had the slightest hint of allopurinol side effects from 20 years of daily allopurinol. I wish I'd never read about possible side effects since it can spawn a case of imaginitis. I hope you and your husband MADE SURE that the allopurinol was causing whatever untoward symptoms he was experiencing, perhaps with stopping then restarting the drug to see whether the side effects abated and then recurred.
Alternatives are several drugs that work to remove excess uric acid rather than reduce its manufacture. These include probenecid, sulfinpyrazone and benzbromarone. Yes, your husband will need to be on something becaue untreated gout is a killer. Historically the easiest one to take has been our friend allopurinol.
Yes,
They prescribed EXACTLY the right stuff for you. (I'm AMAZED actually…so often they'll give you ibuprofen and brush you off.)
One warning: Don't take more than 16 colchicine in a 48 hour period…it will stop the attack but you'll feel like you are trying to lose all your internal organs in the toilet, diarrhea worse than CHOLERA! Stopping at 8 or 10 is probably wise…and you'll STILL get diarrhea so stay close to home.
Everybody raves about Tramadol for pain…I was disappointed and it keeps me awake. Different strokes, I guess.
(Routine cortisone shots can do more damage than help.)
FORM,
The WORST thing for gout is the the use of diuretics…they retain copious amounts of uric acid while dumping excess sodium and fluid. It's a Hobson's choice though because diuretics are invaluable in the treatment of hypertension and heart failure. I am convinced my gout is CAUSED by diuretics (especially 15 years on thiazides for hypertension.)
These erupting tophi are the bodies only mechanism for removing large tophi. It is similar to way the body erupts a BOIL to remove poisons or the body performing surgery on itself. The exudations can be awful to look at but are really a healing process and they won't be a problem unless they become infected. The eruptions are common.
Probably an antibiotic ointment and regular cleaning/rinsing and sterile re-coverings are all good ideas. I had my thumb joint erupt this way and after years of living with the bump and its soreness, it went away as a result of the eruption, not even a scar.
Ask his cardiologist if the diuretics can be replaced with perhaps a calcium channel blocker or a beta-blocker. Trouble is that cardiologists have never heard of gout since med-school during the Renaissance and will pooh-pooh the idea becasue they view the entire world as on big heart. And, like I said, very few drugs can rival a diuretic (probably Lasix/furosemide?) for heart failure treatment.
It is POSSIBLE that you are suffereing from gout but it is not likely. Women of your age RARELY get gout, but like I said, it is still possible.
Firstly, you should have a blood uric acid run every time you have a blood draw. If you show hyperuricemia, they might want to confirm uric acid crystals with a sample of joint fluid.
Have an arthritis panel run next time you go to the doctor. There are specific markers, like ANA, rheumatoid factor and many others for many of the arthitic conditions…a LOT of them.
I have been treating my gout without acute attacks for well over a decade keeping my uric acid low with allopurinol. I still have a few small tophi.
Here's my take on it:
When uric acid/urates come out of solution it causes an attack by the body (hence the murderous pain) and part of the heal;ing process is the body's “walling off” of the offending crystalline material. Once the bloodstream and lymph can no longer “see” the crystals, the inflammatory process abates. What you are left with is a deposit that is more or less visible to the bloodstream and thus some can be reabsorbed into circulation as serum uric acid levels remain low. But some is probably VERY WELL ISOLATED and will NEVER come in content with circulating fluids. Thus I expct a certain amount of tophaceous materia, once formed, will NEVER be dissolved.
I think that most people with tophaceous gout have seen this.
I had a really crazy tophi on my outside right thumb for years. It would periodically ache, not the screeching pain of gout, but a deep soreness of a wound. Slowly, over the course of a year this lump decided to migrate. It went down the last thumb segment month by month and then started moving under the nail. L:ittle by little this mountain formed and millimetered it's way under the nail making a 1/4 inch MOUNTAIN. It was achey and deforming as it went. I got sick of it and took a red hot paper clip and perforated the nail and I made a slowly oozing “volcano” that for about 2 weeks drained the slipperiest milky white fluid I have ever seen, more slippery than motor oil. I examined several drops as they dried on a microscope slide always into a mass of THOUSANDS of dendritic crystals. Almost the entire bulk of the original tophus exited through the volcan leaving only the teeniest little bump on the thumb joint, or none at all…I'm not quite sure.
Some people, even with well controlled gout must have their tophi surgicvally removed if they want them gone.
I am also fond of colchicine as diagnostic. Combined with a couple high uric acid readings I think it is reliable, even considering the possibility of pseudogout.
The worst that can happen is that pseudogout is diagnosed as gout and soon it is shown that allopurinol is useless or uric acid is consistently low even in the face of joint inflammation.
Joint aspirations always have some risk of infection and a joint infection is a medical emergency of the first order and probably more commonly, they have the risk of being done by someone who couldn't find the proverbial polarized dendrite in a haystack. Imagine if every severe joint pain had one's doctor probing for synovial fluid. I, for one would not trust MY doctor to be able to differentiate a crystal of uric acid from one of pyrophosphate under polarized light.
Gout was well diagnosed in times BEFORE the invention of the microscope or before Dr. Land discovered polarized light filters.
