Update 22 :)

This topic contains 4 replies, has 3 voices, and was last updated by  Keith Taylor 5 days, 1 hour ago.

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  • #5987

    d q
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    Ŧallars: Ŧ 216.33
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    So after over a month or so of intense work I have finally found time to myself and wanted to visit my favourite gout ‘pals’ 🙂

    A lot has happened in the last month, I cant remember were I left off but I stopped the allopurinol because of my personal suspicion of a haemoglobin drop. Haematologists are not convinced that allopurinol was the culprit because at the time I was in the midst/end of a gout flare and put it down to inflammation and infection and even suggested the possibility of pseudo gout (that was exciting). All that information was relayed to the rheumatologists which said there is no need to risk re-trying allopurinol since an alternative exists (Febuxostat). They also went on to say if Febuxostat fails we can then try allopurinol again.

    Anyway, I’ve been on Febuxostat for 2 weeks splitting the tablet twice. So a total of 20mgs. I’ve got my blood test due next week to check ALT and hgb. If these are good I’m increasing to 40mgs. This time I am doing this SLOW. Sticking to under 330ummol but no less over a period of whatever time. That express drop before caused me a serious flare in which I am still mildly enduring today. About that flare, I had an ultrasound and an MRI and both have come back as clear for gouty erosions and ‘inflammation’ however they have found thickening of the skeletal muscles (hypertrophy) and a slight collection of joint effusion. Finally, expert operators and machine that believes me. @nobody, I wanted to point out that although the ultrasound is a fantastic and reported similar results, an MRI is out of this world and was able to point out a slightly more information (like joint effusion).

    Rheumatologist wants to put me on 500micrograms of colchicine alongside 80mgs of Febuxostat for 6 months but little does he know that I wont be going anywhere near 80mgs until at least seeing my results on 20mgs. He mentioned that my ongoing pain might just be due to a constant overloading of uric acid in the region and he hopes for it to settle once the area ‘dilutes from this concentrated uric acid mess’ as such

    nobody, what I did want to ask you was will one see slight drops in uric acid and a slight raise in ALT being on just 20mgs of Febuxostat in 2 weeks? I just want to see where I am heading with this.

    Big shout to @keith, @nobody and @Patrick! 🙂
    Thanks guys!

  • #5990

    nobody
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    I’d say having been on the stuff for two weeks without being bothered by side effects is encouraging.

    As to test results, you’ll hopefully see more than a slight UA drop (though I assume it would take more than a couple of weeks for anything like the full effect to show).
    You might not see a clear abnormality by looking at a single ALT test because the numbers can vary quite a bit. I found the ratio to AST to be more revealing than ALT alone. Even with the ratio, there still is some noise so you’ll want to average several tests. A single test ought to be enough to tell if something is very wrong though.
    It took 40mg to produce alarming test results in my case (I also tried an intermediate dose between 20 and 40). A few weeks on 40 mg was sufficient. But everyone is different and you might do fine on 40mg.

    Something else the ALT/AST ratio might be useful for is if you’re taking another drug such as colchicine at the same time as febuxostat. In such a case, if your liver markers were seriously elevated, it wouldn’t be a given that febuxostat would be the main culprit.
    In my test results, colchicine raises ALT but doesn’t raise the ALT/AST ratio as much as febuxostat. But I don’t know if that would be a reliable clue in other people’s tests.

    As to MRI vs. ultrasound, maybe the doc talked up ultrasounds in order to steer me toward a joint fluid test?

  • #6011

    Keith Taylor
    Keymaster
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    Nice to hear from you @d_q 🙂

    Also, your latest information on slowly increasing febuxostat is very interesting. Because I recently noticed a study: “Stepwise dose increase of febuxostat is comparable with colchicine prophylaxis for the prevention of gout flares during the initial phase of urate-lowering therapy”

    http://ard.bmj.com/content/early/2017/11/08/annrheumdis-2017-211574

    I haven’t studied it in detail yet. But it seems to support your cautious approach. Actually, more cautious with 10mg febuxostat increments.


    Slow Steps to Lower Uric Acid without Pain

    Slow Steps to Lower Uric Acid without Pain

  • #6059

    d q
    Participant
    Ŧallars: Ŧ 216.33
    GoutPal Scholar Badge Rank: Scholar


    @nobody, good to hear from you mate. Yes, if you were in the midst of an attack then an ultrasound would have definitely been the better option as they could have did joint fluid aspiration. Another possibility is he wanted to give you some pain relief with an ultrasound guided injection. In any case the MRI has fantastic imaging capabilities pointing out a few thins the ultrasound couldn’t [The results that were shared between tests however were consistent]. Ok so I did my blood test today and should have the results back on Monday. It was a total of 16 days on 20mgs and as you say we may not get an accurate picture but at lease we will get an indication of where we are heading. I also made sure not to start the Colchicine with the Febuxostat to isolate any potential artifacts in results. I’ll update you on those results as soon as I get them.

    @keith, that is a fantastic article. I was shocked to see such a large percentage of people who did not experience a gout flare whilst increasing Febuxostat very slowly. Although it wasn’t as much as people using it with Colchicine as a preventative I still see a huge benefit in starting Febuxostat alone in low doses as you generally will have more granular control over your condition and potentially a reduced risk of attack. However it may be better to start taking Colchicine as preventative when you reach to doses of 40mgs and above. For that matter, it was a subject I wanted to discuss with you and will start a new topic on it later.

    I did have a few questions that require both your experience(s).
    With regards to the Colchicine, as you both know I am still suffering with ongoing pain and both scans reported thickening of the skeletal muscles and some joint effusion however no permanent damage. How does one approach this

    1) Short course of Colchicine or other NSAID’s?

    2) Continue with Febuxostat alone to see if the reduction in uric acid will lead to the pain disappearing eventually?

    3) Anything else your experiences can provide?

    I am sick to my neck dealing with this low grade and in few cases high grade debilitating pain and am now willing to try anything. Podiatrist has got me wearing insoles that provide support and says it will help correct and promote correct movement in the joints.

    Good to hear from you both.

    • #6066

      Keith Taylor
      Keymaster
      Ŧallars: Ŧ 870.25
      GoutPal Scholar Badge Rank: Scholar

      I’m not sure what “thickening of the skeletal muscles” means. Joint effusion (above average synovial fluid) is associated with inflammation. So, it’s common during gout pain.

      As for your choices, I’d say option 2 is best. But, if your gout pain is seriously reducing your quality of life, colchicine should help.

      Some people benefit from a pain journal. That is where you record pain levels each day, then review the weekly average. So, if this is reducing, you feel encouraged by your progress. But if it isn’t, you can take action through pain relief.

      Finally, you should also consider the action of diet on pain and inflammation. Because I’ve recently read an interesting article about diet and arthritic pain control. Now, while this isn’t strictly about gout, it is still likely to be relevant for gout sufferers. So, I’ll add the report to the PDF library in a moment click the image below. But, for now, you should know that the important findings for reducing inflammation with diet are:
      – Raw or moderately cooked vegetables (lots of greens, legumes).
      – Spices like turmeric and ginger.
      – Seasonal fruits.
      – Probiotic yogurt.
      – Avoid any processed food, high salt, oils, butter, sugar, and animal products.
      – Dietary supplements like vitamin D, cod liver oil, and multivitamins can also help.
      – Low impact aerobic exercises.

      Obviously, those are pointers rather than a comprehensive diet plan. But hopefully, you won’t have too long to wait for that (hint!).


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