June 14, 2020 at 5:03 pm #9828
Got my first gout attack about 8 weeks ago – my left thumb was swollen and painful and was not able to move it. Took ibuprofen and next day was more or less ok. Now 8 weeks later the thumb is still a bit painful and it and it gets worse when walkig longer distances.
Got to doctor several weeks later when covid19 restrictions was a bit reduced. Blood tests where ok (Uric acid 402 (270-470) but x ray showed “initial signs of osteoarthritis”.
After rheumatologist visit got diagnosis “gout, gouty arthritis” – confirmed by USG (some tophi around the joint and and some more findings specific for gout) and suggestion regarding diets, checking Uric acid levels every 3 moths and take some meds in case of acute flare-up. But no Uric acid lowering meds as it is in range now and start thinking about it in case, if levels go way out of range.
After that checked my old labs and I have had raised uric acid levels (540) once more than 4 years ago and have done several tests later where levels bumped around 440-450 mark, that’s near the top of my labs range (470).
Now I’m wondering, should I ask my GP for allopurinol, as I have some tophi + already some findings in x ray or stay with advice regarding diets and hope that tophi will resolve with time wothout meds. Any advice would be appreciated.
June 14, 2020 at 7:24 pm #9829
402 is well outside of the range you want your uric acid to be in. That’s definitely not OK. If it was, you wouldn’t need to do anything about your diet, would you? Nor would you have gout. So forget about your lab’s range. It’s not even supposed to be relevant in treating gout.
The problem with UA lowering meds is that they have dangerous side effects. So you could start by trying to fix your uric acid problem with diet. But unless you used to have an alcohol problem or your diet used to be crazy bad, chances are you’ll end up on UA lowering meds anyway and some of the damage done by allowing the disease to progress in the meantime can’t be undone afterwards. This is in any case no emergency so you can afford to take your sweet time working with your doctor to make sure allopurinol is safe for you to take. You could also try very low doses at first, getting your doctor to check your liver function and stuff before taking potentially dangerous amounts. Doctors unfortunately often reason that since there’s no emergency, they might as well do nothing until your health has deteriorated so much that it unquestionably justifies the use of a potentially dangerous drug…
If you are going to try dieting, one problem is that the recommendations are typically useless. We can go over that if you want but allopurinol works so much better than diet that you might not want to bother.
June 29, 2020 at 6:38 am #9837
Thank you Nobody. I’m also wondering regarding possibility to lower my uric acid levels with diets alone, as my diet is more or less ok at the moment and I doubt, that I will see needed impact to my UA levels with diet changes alone.
But I’m wondering regarding excess weight. I’m 1.85 m (6ft 1in) tall and wight approx 101 kg (222 lb) at the moment. I have lost some 5 kilos in last several moths with adding daily exercises and some adjustments to my diet, but it’s all before I run in to gout flare up. I’m continuing with exercises (with some changes as jogging/running/walking stuff is a bit painful) and I’m wondering, how large could be weight loss impact to UA levels.
June 29, 2020 at 2:07 pm #9838
Weight loss and exercise can raise uric acid but what matters are the effects in the long run, and you’ll have to be patient and monitor any benefits with repeated testing over the coming years.
It’s definitely not as simple as a linear relationship between weight and uric acid. Your weight loss maintenance diet matters of course but there may also be weight thresholds. The effects may take a long time to appear as well because your metabolism requires time to adapt. Your diet may also change over time after losing weight, if you had pathological weight-induced insulin resistance for instance.
My guess would be that if you had no symptoms of metabolic syndrome, it’s the diet which matters rather than weight as such.
Long story short: in most cases, allopurinol is more effective and works much faster than weight loss.
June 29, 2020 at 6:50 pm #9839
My goal is to start with allopurinol to get uric acid levels below 300 and continue with exercises and diet improvements. I have GP appointment in few days and will ask for prescription for allopurinol, but as my uric acid levels are below labs max range (still to high for gout) and has been there for last 4 years, I doubt the my doc will agree to this. So I’m digging thru this forum and other internet sources for second option without uric acid lowering drugs.
June 29, 2020 at 7:26 pm #9841
There are many drugs which reduce uric acid, some of which might be more appropriate if you have other health problems.
But if your doctor doesn’t want to give you any drugs and you can’t see another, we can at that point go over all you could do in terms of diet… which is probably more than you think (but more inconvenient as well!). Some foods even work a bit like drugs, except you can’t control the dose properly.
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