October 28, 2016 at 8:42 am #2923
Hi Keith / Patrick, I’ve done as much research as possible reading websites and trying to piece together what goes on in the body before, during and after a gout attack and I am really confused about all this crystallisation process. I thought I’d ask a few questions and hope your responses can help me and potentially others who are also slightly confused in the technicals.
1. Assuming uric acid is high in a patient and crystals form, do these actually get trapped in joints or do they get consumed (coated) by white blood cells? I can’t seem to understand what happens during the crystallisation process. If they are coated by white blood cells, why aren’t they then removed from the blood by the kidneys or stool? If they are not removed then what is it exactly that is getting trapped in the joints? surley it’s not the now coated crystals?
2. Now Allopurinol lowers the levels of Uric Acid so assuming they are coated by white blood cells then why would they dissolve? Why would allopurinol have any impact on ‘already’ ingested or coated crystals? It’s wrapped up already and should bare no impact?
3. When (if I understand the above answers) crystals do get stuck in joints, is the consuming of these crystals by the white blood cells the actual pain we endure? If so when they are consumed (coated) do they remain coated and stuck in the joints ready to dissolve again when uric acid concentration levels drop therefore getting the attack in the same place? If not then what is causing the pain during the attack? The Crystallisation or the dissolve? It’s so confusing? Or maybe I’m slow and dumb:)
4. If 380 ummol is dangerous because that’s the level of concentration required to form new crystals and dissolve existing ones (depending on the answers above), what is the deciding factor of dissolving or crystallisation? Is it body temperature? Cold = Crystallise or Hot = dissolve?
5. If gout and crystal forming around joints takes many many years then why after an intense 1 or 2 years of allopurinol usage and complete removal of crystals does it only require a few months for a new attack to occur?
Sorry for the time it may take for you guys help answer the above.
Thanks everyone, I’m sure you’ll help us ‘techies’ or those who are really interested in gout understand the confusing bits further!
October 28, 2016 at 8:42 am #2184
Can anyone advise me on how long it should take to reduce uric acid to safe levels through diet alone.
About 5 weeks ago a blood result came back at 0.44 mmol. I immediately changed my diet, eliminating 95% of meat and fish intake, staying hydrated at all times, completely abstaining from beer and having a breakfast (I never used to do that).
My latest blood test shows I am at 0.38mmol (which is still too high – being above 0.36mmol). So a 0.06mmol drop in 5 weeks.
Can someone help, I’d really appreciate it.
March 27, 2017 at 11:03 am #2929
LanceParticipantŦallars: Ŧ 17.55Rank: Historian
Thanks dq, you’ve covered 3 or 4 questions on my bucket list! I found the UDRP Pain Pathway article helpful in explaining the lifecycle of uric acid in a user friendly way. Anxious to hear the science behind the concepts!
March 27, 2017 at 10:08 pm #2931
Hi Lance, I’m glad this post might be helpful to you.
I’m extremely anxious of what the experts have to say too!
I’ve been completely confused about the above and would love to get the insights as to how it all works in more details.
Thanks everyone 🙂
April 5, 2017 at 12:41 pm #2967
Keith TaylorKeymasterŦallars: Ŧ 1012.34Rank: Scholar
Again, quickly, then I’ll return for more detail if needed.
1) Osmosis! Crystals, coated or otherwise won’t pass through most membranes that stop your entire body falling out of your arse. Apologies! – I’ll look up the right words later.
2) More osmosis. All to do with organic compounds reacting to differential concentration. It’s molecular. Somewhere in the old forum there’s an explanation I gave to an inorganic chemist who refused to believe it could happen. I’ll find it when I return. (try searching for combinations of urate, monosodium, crystals, organic, inorganic, chemistry, hansinnm, zip2play)
3) Inflammation is all about the immune system calling for reinforcements. I’m discussing it ith myself at the moment in http://goutpal.net/forums/topic/free-fatty-acids-ffa-and-gout/#post-2872
4) Temperature is often the main factor. But, there are others. I just can’t think of the main ones now. They cease to matter if you get below 300! (Sorry to harp on, James).
5) Because your rheumatologist is an idiot. I.e. it is simply not true. (maybe search for ‘allopurinol vacation’). [Quick check – yes it’s there! 3rd result – Is allopurinol a lifetime drug?]
Tell me which bits need better explanation.
April 6, 2017 at 1:28 pm #3008
Thanks for your response mate. I’ve got the general gist to what you explained but still a little confused.
1. Ok I think I understand, but I’ll wait for the right words when you have time.. Thanks 🙂
2. Osmosis makes sense on this one. Concentration levels outside the coated crystals meet levels inside and therefore will move to the less concentrated zone (blood stream) exposing the now dissolved crystals as a result UA levels increase in the blood I assume.
3. I’ve read your discussion and love it thanks. I think I may have something to add to this one. My thesis is reasonably straightforward. They dissolve with the lower levels of UA and then the UA levels would naturally increase in the blood because of the dissolution of the crystals increasing the overall UA level once again which in turn may or may not cause new crystals. Depends on the UA level when they dissolved (thus another attack may occur)..?
4. I’m almost positive and agree that temperature is a big factor as my attacks generally start after a hot shower and not as often in the middle of the night. Potential increase in blood flow to the feet when showering which in turns cause a little expansion which may or may not dislodge a few crystals and an immune system attack is also imminent. What do you think on that idea..?
5. I’ve read that article before but it doesn’t seem to explain why it takes such a long time to build up and once they dissolve with treatment why it doesn’t take too long before they build up again and cause joint pain. I’ve had high UA for over 15 years and only got gout 2 years ago so it took 13 years to build up crystals and deposit them in joints and if I stop allopurinol it will only take a few months or let’s say maximum one year for an attack to flare up again. How does that work? Unless I’m understanding your article completely wrong..? 🙂
Thanks For everything Keith 🙂
April 11, 2017 at 2:32 pm #3113
Keith TaylorKeymasterŦallars: Ŧ 1012.34Rank: Scholar
Hi again James,
I think this is a big subject that you have broached. Because, I can’t help thinking that it involves explaining something like the life-cycle of uric acid crystals. So, that would highlight factors that affect formation, location, duration, and resolution. Therefore, it’s a big project. But, I already have one massive project at the moment which is to complete the reorganisation of practical tips for different types of gout sufferer.
Now, I’m not shying away from this. But, I have to think of the value it will give compared to the time taken. So, I have 2 ways to tackle projects that involve explanations beyond a simple short question and answer session.
1. Create a suggestion to publish on GoutPal.com. That can be an enhancement to an existing page. Or, it can be a new page. Either way, you need to browse existing suggestions. Then either comment on a suitable suggestion. Or, start a new suggestion. Because, It’s Your GoutPal.
Or, 2. Create a personal plan to learn what you need to know. Although I assumed that service would mainly be used for treatment plans, it’s equally suited to learning plans. But, you have to start a personal gout diary first. Because, I have to create a meaningful space where we can run question and answer sessions to meet your goals. Ultimately, this might be a better option. Especially if you want heavy involvement in the direction of the project. Because whatever we produce, I can adapt for the millions of anonymous gout sufferers reading GoutPal.com.
I won’t lie. Both of these options require some effort on your part James. But, you don’t seem frightened to get stuck in.
Finally, for point 5, which I think is relevant to everyone on allopurinol. Irrespective of wanting to learn about uric acid crystal lifecycles.
Let’s imagine you recover from gout with allopurinol. It is true that uric acid crystals will start to grow again as soon as concentration breaches the crystallisation point. But, if you’ve had a good clear out, you can last for years without having another gout flare.
So, in the report attached to http://www.goutpal.com/1629/is-allopurinol-a-lifetime-drug/ Perez-Ruiz claims over 4 years. But, note this is entirely dependent on getting uric acid below 300 μmol/L during treatment. Then, the time depends on what it rises to when you stop allopurinol. Therefore, once again, we see that gout has to be managed on an individual basis. Who’s to say that you couldn’t last 13 years if you do 3 years on maximum allopurinol? Or, maybe you have to do 15 years on maximum allopurinol and 13 years off. It’s just a numbers game that nobody can predict. All we know is that uric acid crystals will form again if uric acid rises above crystallisation point.
However, before gout flares become obvious, the uric acid crystals cause a lot of damage. So, if DECT was more widely available, it would be easy to get an annual check that would tell you when to restart allopurinol. I hope that day is not too many years away. When uric acid control stops being a guessing game, and starts being managed based on exactly what is happening in our bodies.
April 14, 2017 at 2:12 pm #3183
Hi Keith, I’ll certainly work on a suggestion letter and the reasons why I think it would be great for the public to view. As a secondary gout sufferer I think I can help with other people who have my condition and as a result have gout. 🙂
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