Great question, Mark:
My question is – does your UA% go up during debulking?
To me, logic dictates that it must go up slightly, unless uric acid excretion rises to compensate. That’s the opposite of the phenomenon we often see in diagnostic uric acid tests during gout flares. By which I mean blood uric acid drops during gout flares. Because uric acid has gone from the blood into crystals.
Unfortunately, I can’t find any specific gout studies that show uric acid levels when crystals are dissolving. So far, the most useful report I’ve found is “Gout treatment: Should we aim for rapid crystal dissolution?”:
Monosodium urate crystal deposition in gout precedes the first attack and, while hyperuricaemia persists, it grows and expands to other sites. Fortunately, it is reversible and slowly dissolves when serum uric acid (SUA) is lowered below its saturation point of about 6.8 mg/dl [400μmol/L] and with certainty below 6 mg/dl. Crystals finally disappear from joints, taking longer in those patients with longer disease duration, probably because of a larger accumulated load of crystals. The SUA level achieved affects the velocity of crystal dissolution and tophi reduction. Accordingly, by deciding the SUA level cut-off point to be achieved by treatment we are determining the time of crystal disappearance and cure of gout. 6 mg/dl is the usual target level, but lower levels appear appropriate to us, particularly in certain situations.
So, that seems to be consistent with your gout recovery, Mark. In your situation, as a champion Gout Dieter, 5.5-6 should be effective. As nobody says (below), you may need patience. But, gout recovery is on your horizon.
In James’ case, I think it’s more borderline. 388 is too close to the 400μmol/L upper limit. In particular, as an allopurinol patient, there’s no need to settle for long periods of gout recovery that Gout Dieters may have to endure.