I had a gout attack about 6 months ago in the typical big toe.? It is still swollen a little and hurts from time to time, probably just a slight buildup of tophi.? however i have not had another gout ATTACK since then.? i had my uric acid level tested recently and it came back at 9.0.? the doctor said that is so high it’s clearly not the result of just bad diet, but more than likely due to my body just not being able to break down uric acid level and/or my body producing too much of it.? she recommended i get put on Uloric and Colcrys to get the acid level down.? Do you know anything about these medicines and should i take them?? What about other options, do I have any?
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Uloric (a brand of febuxostat) lowers uric acid. Colcrys (a brand of colchicine) stops inflammation spreading during the first few months of uric acid lowering.
A better option to Uloric is allopurinol, unless cost is no object, and you do not mind being a guinea pig for a new drug. An even better option is to take a 24-hour urine test to see if you are an under-excreter or over-producer of uric acid. For under-excreters, probenecid is tried and tested. All uric acid treatment must be supported with regular uric acid tests to ensure uric acid does not go over 5mg/dL. the blood test should include liver and kidney function tests. Allopurinol should start at 100mg per day, then increase from test results until 5 is reached.
Colchicine can be taken daily for a few months, or as required. Personally, I took it for two weeks when I started allopurinol, and when dose increased, then I took it as required. Whichever way, if two colchicine tablets do not bring adequate relief, never take more – use appropriate NSAID or other pain relief as advised by your doctor.
In my opinion, allopurinol + colchicine + other pain relief as required is the best approach. It is vital that all uric acid lowering plans are monitored and managed properly. Good doctors do this automatically – others need to be pushed.
excellent response. thank you. does under excreter or over producer indicate that my diet is the source of the problem? people say diet can cause high uric acid, and others say your body just produces too much too. how do you know which one it is? i.e. how do you know if you NEED to be on medicine, or if you just need to change your diet. thanks.
The test for uric acid excretion rates does not define the cause of excess uric acid, but it helps to guide us where to look.
Under excretion points to a kidney problem, or genetic inability to excrete sufficient uric acid. However, this does not rule out a contribution from poor diet.
Unfortunately, there is a lot of nonsense about gout and diet. The Internet is full of it, but many doctors also spread some useless gout diet myths.
The first assessment of diet has nothing to do with gout. Start with http://www.choosemyplate.gov/, or similar from other countries. Is your diet healthy by those general standards? If not, there is no point in moving to a gout assessment. I do not know your specific situation, kiteman, so I must generalize here. Most people who consume a typical Western diet will fail the healthy diet test. Actually, I can be specific, and use myself as an example – I fail the healthy diet test.
I am overweight, and I eat more than the recommended daily allowance of animal flesh.
I have made the choice, after years of trying to control gout by improving my diet, to use allopurinol to save my joints. Actually, I hope to save more than just my joints. My growing library of horrendous gouty tophi is poised to include the parts you’d hope would be safe from gout.
I went astray for a long time, because I believed I could improve my diet to control my gout, and I also learned the best pain relief combinations to ensure I could always cope with any gout pain. Then I realized that the damage caused by prolonged uric acid deposits is way beyond the pain relief available for a gout attack. Crumbling joints and wrecked soft tissues are the inevitable outcome of not keeping uric acid at safe levels (that is safe, not normal – i.e. no higher than 5mg/dL if you have ever had gout. See Normal Uric Acid Levels guidelines for more information).
So, you NEED to be on medicine if you cannot get uric acid safe by diet control. This requires an individual plan that accounts for your current diet, height, weight, and uric acid levels. You have 6 months to get uric acid to 5mg/dL. You start by ensuring diet is healthy and you are within normal weight range (Warning: medical normal weight is much lower than social normal weight – fatter friends will complain you look malnourished)
Assess after three months. If it is unlikely you will meet your target, start allopurinol. You can still continue to improve your general health with better diet, but use allopurinol to halt the spread of damaging deposits. As you need to test at least once a year, results after significant diet improvement may indicate that you can reduce allopurinol dose in future.
To summarize:
If your diet is bad, you need to change it to avoid several health problems. If your diet is excellent by general health standards, then there are only exceptional circumstances where you need to change it.
Anyone who has ever had a gout attack needs to aim for uric acid at 5, with an absolute maximum of 6. If you cannot achieve this in 3 months by diet, start allopurinol, but continue to improve diet. In the long run, you might be able to reduce allopurinol as you reach good diet and lower weight, but you need to stay safe during the time it takes to achieve that.
My Uric Acid level was 9 in July of 2013, I started dieting in January 2013 as I had gout since 2002 on and off, and in 2010 till October 2013 I was having attacks every 2 weeks. The doctor prescribed colchicine which kept the pain away in between the two weeks, my ankle swelled up like a baseball and my big toe big as a golf ball, I walked in pain constantly for 3 years willing myself to work it was tough. I have not had gout since October 2013 almost 8 months this hasn’t happened since 2002, I stopped taking colchincine, kept working out adding some supplements, and eating healthy, now I still eat healthy I do splurge a bit on weekends and have a few drinks and still don’t get gout and I had a physical in March of 2014 my Uric Acid has dropped to 8.0 which is at the high end of the good range, yet it’s dropped one point from July 2013 to March 2014. So I believe in diet control, exercise and natural supplements as nothing else has worked since 2002, until I switched to natural supplements in October 2013.
You need to know that gout does not come and go, though gout flares usually do. Once you get gout, you’ve got it for life. We all know the terrible pain of a gout flare, and we are happy when it goes away. But that does not mean that gout has gone, it just means you have a temporary period of time without pain, until the next flare. The technical term for the period between gout flares is intercritical gout.
Unless you get uric acid to safe levels, each gout flare gets more frequent, more intense, and more widespread.
Worse than that, uric acid crystals in your joints stop natural repair and renewal. Eventually you get permanent damage to bone, cartilage, tendons and ligaments. But there’s even worse.
Uric acid crystals spread into soft tissues. The common problems are: tumors bursting through skin and restricting mobility; kidney stones; and heart disease. More rarely eyes and gall bladder are affected but all organs are at risk.
8 is not the high end of the good range. It is dangerous. The only good range is a level that stops gout spreading and allows old uric acid crystals to dissolve. The maximum level for safety is 5.
Please don’t leave it until you are older. Controlling uric acid gets harder as each year passes, and the affects of crystals gets worse.