December 28, 2019 at 12:02 pm #9120Jack RustonParticipant
Exposure to cold virus increases uric acid dramatically
Since starting Allopurinol a few months back, I’ve seen the expected, steady drop in serum urate. I’ve been tracking it with the Benecheck, in order to see whether there were lifestyle factors that I could use to significantly influence my levels (I don’t plan to do this beyond the first six months or so).
With 200 mg daily, my levels dropped from peaks of around 600 to sub 300. My plan is to maintain this level for six months, in order to dissolve any deposits, then attempt to titrate back to 100 mg daily to maintain a safe level. We shall see.
ANYWAY…all was good, until around a week or so ago, when my levels went from that 290 ish sort of area, to 500. For the past few days they’ve been more or less at my pre-treatment average in the mid to high 400’s. Naturally, this put the heeby jeebys up me somewhat! I had not done anything that made sense dietarily, certainly not to account for such a big rise. I began to wonder if perhaps I had a bad strip of Allopurinol, and asked the pharmacist. Possible, apparently, but unlikely. To be safe that whole batch was sent back, and the GP represcribed. But I’ve checked on the drug recall site, and Allopurinol has never been recalled. Of course, it’s possible that nobody has ever noticed if batches were ineffective, because most people are not tracking it. Either way, I began taking a different batch, and nothing seems to have changed over the last 24 hours, certainly…
BUT, while I am fine, both my daughter and wife are suffering from a cold. It’s inevitable that I have been exposed to their cold virus. My daughter’s cold did start around the time my urate spiked. Having trawled pub med, I see that certainly in vitro, rhinovirus does increase the activity of xanthine oxidase, effectively undoing the action of the Allopurinol. That doesn’t mean that it happens in vivo, but it seems more likely.
So what are the other potential mechanisms here? Well I suppose it’s possible that an inflammatory response caused by the rhinovirus directly could precipitate an attack, OR that that same inflammatory reaction to the virus could increase ferritin, and thus modulate xanthine oxidase via that pathway.
So this is quite interesting. It explains perhaps why bugs like this can precipitate attacks. I know Keith has said in the past that urate spikes simply set up future attacks, rather than cause acute ones, but equally we also know that it can sometimes be the change in urate levels, either up or down, that causes an attack. I have significant pain in my knee and ankle following this spike, although no full-blown attack of the sort we all dread. Difficult on the stairs rather than up all night, shall we say.
I wanted to know if anyone else had experienced anything along these lines, and share this bit of information…albeit potentially misleading, which I do accept.
December 28, 2019 at 1:59 pm #9121Keith TaylorParticipant
So this is quite interesting.
Well Jack, I’d say it’s very interesting. Because it’s the first time I’ve heard this. So it’s something for me to look into.
Am I right in assuming you are referring to this?
Papi, Alberto, Marco Contoli, Pierluigi Gasparini, Laura Bristot, Michael R. Edwards, Milvia Chicca, Marilena Leis et al. “Role of xanthine oxidase activation and reduced glutathione depletion in rhinovirus induction of inflammation in respiratory epithelial cells.” Journal of Biological Chemistry 283, no. 42 (2008): 28595-28606. Free from publisher at http://www.jbc.org/content/283/42/28595.full.pdf
In any case, I’m always interested in references to articles about uric acid and gout. So I’ll read that properly soon, and also look at more recent articles that have cited it (only 51 to go! 😉 )
I like your approach to uric acid treatment:
With 200mg daily, my levels dropped from peaks of around 600 to sub 300. My plan is to maintain this level for six months, in order to dissolve any deposits, then attempt to titrate back to 100mg daily to maintain a safe level. We shall see.
And I believe lot’s of gout sufferers can learn a lot from your approach.
For people who don’t recognize the scale, it’s μmol/L where 300 is equivalent to 5mg/dL. So take a lead from Jack. Get uric acid low to encourage old crystals to dissolve. Then you can consider reducing allopurinol dose to maintain a healthy 6mg/dL for the rest of your long, happy life. Of course, I should add that you must discuss those targets with your doctor. Because other factors in your medical history might imply different targets.
December 28, 2019 at 4:59 pm #9123nobodyParticipant
What I’ve experienced is seemingly random changes in uric acid test results. I’ve given up on understanding them. Maybe this puzzling change you experienced was caused by a virus and maybe there is another cause. Lots of things can affect uric acid.
My solution is simply to look at averages. Of course that won’t satiate your curiosity but chances are, it’s all you really need to get rid of gout.
A spike cause cause problems during your uric acid lowering therapy but after the therapy, spikes shouldn’t be a problem anymore.
And hello Keith! Long time no see.
December 29, 2019 at 6:39 am #9125Keith TaylorParticipant
What I’ve experienced is seemingly random changes in uric acid test results.
That’s also my experience. And has been noted repeatedly over the years by many recovering gout sufferers. Mainly because you often get a “clump” of old crystals hidden by our immune system shield. Suddenly, that shield buckles as some old crystals dissolve. Then that cache of crystals is more open to dissolving in the bloodstream. Leading to a spike in uric acid blood levels.
But there are lots of other factors. Including weather, hydration levels, food intake, exercise levels, etc. So I guess we might add viral and infection reactions to that list. Which only add to the randomness.
My solution is simply to look at averages. […] after the therapy, spikes shouldn’t be a problem anymore.
That is a great takehome message to all gout patients. Because they can realize that despite pitfalls, their determined effort to control uric acid will definitely lead to long-term freedom from gout.
And hello Keith! Long time no see.
Thank you nobody! It’s been a very strange year for me since Gout or broken bones for maximum pain. But thankfully almost over since I realized I needed a little help with the mental scars.
December 28, 2019 at 6:44 pm #9124Jack RustonParticipant
Keith, yes…that’s the study I was looking it.
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