by Al O'Purinol Comment Closed

I have Gout on my right foot, big toe joint.

I can go a couple years in between flare-ups.

My question is:?? What is happening to the joint in between flare-ups. Is it rotting away at my joint?

Thank You, Jake

4 Comments

  • Hi Jake,

    I hate to be the bearer of bad news, but …

    Yes, gout flares are bad, but the slow destruction of joints is even worse.

    Uric acid crystals grow quite slowly, so we only notice flares occasionally early on in gout. Over the years, these attacks get more frequent, last longer, and attack more joints, as uric acid crystals spread through our bodies.

    Joints are affected first, then lumps start forming under the skin. These can grow to the point where they burst through the skin, risking infection. They commonly spread into the kidneys, causing kidney disease.

    I have known for a few years that gout flares are caused by our immune system attacking invading uric acid crystals. Earlier this year, I learned that other cells get caught up in the process. In our joints we have specialist cells that should grow to develop new bones, cartilage, and tendons. These young cells get caught up in the gout war, and cannot develop into joint repairing tissues, so our joints crumble.

    I got a bit carried away when I first heard this, and wrote about tendon’s babies dying (http://www.goutpal.com/4319/do-gout-crystals-kill-tendons-or-just-their-babies/). Maybe it’s a bit over the top, but it is important to realize that gout is more than painful swelling – there is a real destructive process going on all the time that uric acid deposits are growing. It is very slow, so probably will not have much effect until later life. That is exactly what you do not want, as aging bodies cannot cope with crumbling joints.

    The sooner you get uric acid under control, the better. Crystals dissolve when uric acid is below 6mg/dL. The lower you get it the faster they dissolve. 5 is a safer target since it gives a safety margin for daily fluctuations. I left my uric acid lowering too long, so I’m now on maximum allopurinol to get uric acid as low as I can for a year.

    • hansinnm

      “I have known for a few years that gout flares are caused by our immune system attacking invading uric acid crystals. Earlier this year, I learned that other cells get caught up in the process. In our joints we have specialist cells that should grow to develop new bones, cartilage, and tendons. These young cells get caught up in the gout war, and cannot develop into joint repairing tissues, so our joints crumble”

      As some of you know who have read my comments in the past on GoutPal Interactive, I have had attacks, Tophi on feet and hands, tophi removal by operation and lowering of my UA level to 3-4 mg/dl. I have been free of attacks for almost two years, now. However, I have also done something to combat what the above article refers to: Joint destruction and restoration. I have been taken daily doses of MSM powder since Feb. of 2012 and the results have been close to a miracle. Pain in shoulder and elbow joints, in particular, caused me to look into MSM (when it was brought to my attention by a friend who is into alternative medical solutions.) I started with 2.5 g (1/2 tsp) and I noticed a reduction of pain w/i 4-6 weeks, but it still was there. Then, after about three months, I increased the doses to 5 g (1 tsp) and w/i 3-4 days the pain was gone and it has been gone ever since. I have been able to convince 5 other people to try it and they all reordered when I placed my second order. (I am NOT making any money on my friends. It just reduces the S/H costs.)

      My advice is: Read the book to get an inside of MSM: The Miracle of MSM: The Natural Solution for Pain [Paperback]
      Stanley W. Jacob MD (Author)
      Amazon has it for $2-5, depending condition.

      I believe firmly in the restoration abilities of MSM. One other advice: Don’t bother with the capsules.. You’ll just spent more money for less results and line the pockets of the manufacturers and sellers. Remember Keith’s. constant “HAMMERING” doses, doses, doses!!! When it comes to using Allopurinol to control your UA levels, this holds true for NSM, too.

      Good luck to those who dare ignoring the MEDICAL INDUSTRY. (I am pretty certain; you’ll have a hell of a time finding a medical doctor who’ll recommend MSM to anyone.)

      • Very interesting.

        I had not heard of MSM before. Now, I know it is MethylSulfonylMethane. Apparently, it is popular amongst the wider arthritic community, so I wondered why I had not seen it during my gout research. Then I realized…

        It is only recently that the true damage of gout has become widely recognized. Having said that, I recently read a 1920 book on gout that describes tophi being removed from bone with a chisel, so perhaps I’ve been looking in the wrong place.

        Anyway, what we are really concerned with is osteoarthritis (bone damage) caused by uric acid deposits. As soon as I looked for MethylSulfonylMethane in a wider context of general arthritis, I found more relevant research. Specifically, “Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial” from Southwest College Research Institute, Tempe, Arizona.

        In order to overcome the paucity of evidence to support the use of MSM, they conducted a randomized, double-blind, placebo-controlled trial on 50men and women. Patients with arthritic knee pain were given 3mg MSM twice a day, or a placebo.

        MSM produced significant decreases in WOMAC pain and physical function impairment [WOMAC is the Western Ontario and McMaster University Osteoarthritis Index visual analogue scale]. MSM also produced improvement in performing activities of daily living when compared to placebo on the SF-36 evaluation [SF-36 is an overall health-related quality of life test].

        The report concludes:

        MSM (3g twice a day) improved symptoms of pain and physical function during the short intervention without major adverse events. The benefits and safety of MSM in managing OA and long-term use cannot be confirmed from this pilot trial, but its potential clinical application is examined. Underlying mechanisms of action and need for further investigation of MSM are discussed.

        The report does not specifically mention sailing, but I expect MSM makes that more comfortable.

  • hansinnm

    “The report does not specifically mention sailing, but I expect MSM makes that more comfortable.”

    Funny, interesting that you mention SAILING! See what happened to me:

    7/28/2012: Pulled Muscle/tore Tendon? This happened when 5 park rangers in uniform, chest-high in water helped me, other sailors and motor boaters put their boats on the trailers in 25-30mph winds.
    7/29/2012: Slight middle back pain
    8/13/2012: Back hurting when bending
    8/16/2012: Quit sailing 4 the time being
    8/20/2012: Quit cycling 2, 4 the time being; (stationary bicycle)
    9/14/2012: 1. time sailing since 8/16/12

    Today is 11/14/2012, two months later. I have sailed 21 times since then. True, I got some help with raising/lowering sails the first 4-5 weeks (to avoid undue force on my back, but for the last 3 weeks I am handling my boat all by myself again. My back pain is practically gone I feel some strain when stretching in the morning, but no more pain when bending. I attribute my relative fast recovery in part to MSM.

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