June 12, 2018 at 3:10 pm #7148
I’m new here. I’ve been suffering from gout pain for more than 5 years. It attacks on the joint of my big toe of my left leg. I can’t even put on shoes comfortably. I visited doctors several times before. They just advised not to take meat. Recently I have visited a doctor, who prescribed faboxtat 40. Now I’m on this medicine. I have been taking this for about one month. But the pain is not improving so much. I’ve got my uric acid test which is 398.
Now can you help me to get out of this.
June 12, 2018 at 4:09 pm #7149
The test result you mentionned is too high. Was your blood drawn after one month on febuxostat?
If so, you have the choice between testing again to make sure (results can vary quite a bit) or increasing your dose without further delay. I think you could try one pill and a half (60 mg) per day. You’ll have to get tested again after a few weeks on the new dose to see if it works. You want your test results to read 350 or lower.
It’s also important you get tested for side effects and liver function in particular whenever you increase the dose and of course after starting the drug. Febuxostat is not an innocuous drug and serious side effects are fairly common.
It takes more than one month for febuxostat to work anyway. If you have as you suspect been suffering from gout for many years, it could easily take the better part of a year to eliminate gout pain.
You can however reduce gout pain and make it last shorter by bringing your uric acid tests under 300. You may even get extra benefits from bringing them under 250 though nowhere (to my knowledge) is that officially recommended.
While febuxostat greatly reduces the formation of uric acid in your body, it doesn’t destroy the uric acid which you are already burdened with. So while your body is slowly getting rid of the stuff, I recommend drinking plenty of water, regularly consuming milk or milk-based products if you tolderate that, abstaining from animal flesh (you can eat eggs instead to get a similar nutritional value) as well as alcohol and making sure you have drugs which suppress gout symptoms on hand. Some people even take a colchicine pill every day during the first months after starting febuxostat.
June 12, 2018 at 6:01 pm #7150
Thank you very much.
The blood was taken before starting febuxostat. Seeing the test report, the doctor prescribed me the above drug.
I will definitely follow your food plan. However, would you please tell me, as you said febuxostat doesn’t destroy the uric acid which are already burdened, how can I destroy it?
June 12, 2018 at 6:30 pm #7151
If you tested at 398 before starting the drug, you shouldn’t increase your dose! You should instead get a new test.
But in all likelyhood, you are already taking more than strictly necessary which means you are on the right track (assuming that gout is indeed what causes this pain).
That also means that there’s probably not much sense in avoiding meat in your situation. You need to verify my guess with blood tests but, assuming you weren’t taking another drug which also lowers uric acid when you had your blood drawn, I think that 40 mg is strong enough for someone who used to test at 398 that eating meat won’t matter much. Consuming milk and avoiding alcohol for a few months on the other hand, that should help even if you are taking a stronger dose than necessary.
The idea behind the febuxostat therapy is that reducing the amount of new uric acid created in your body will lower the average amount of uric acid in your blood. This can be verified with blood tests.
Then, since the amount in the blood is depleted, the troublesome stores of uric acid in places like the big toe joint will slowly dissolve in the blood.
Finally, the uric acid in the blood will end up in the toilet, same as always. Except that instead of mostly getting rid of newly created uric acid, you will be getting rid of a lot of old uric acid as well.
It should all happen naturally once the creation of new uric acid is reduced thanks to febuxostat. Only you need to give it time. You can help the process along by drinking lots of water (within reason: don’t torture yourself!) and making sure the places where uric acid is stored (like the joints in your feet) remain fairly warm (you for instance want to avoid clothing or chairs which would prevent blood from flowing easily to and from your feet).
June 12, 2018 at 6:42 pm #7152
I understood. You are really helpful. Thank you a lot. I will get a new test and will let you know the result. One thing, should I stop taking medicine before getting blood test?
June 12, 2018 at 6:52 pm #7153
You shouldn’t stop the medicine because the point of the test is to observe the effect of the drug.
In addition to measuring the amount of uric acid in your blood, it is very important in your situation to get standard liver function tests. The drug is known to affect the liver. People usually tolerate 40 mg daily but that dose was too strong for my liver. There are a few other routine tests like kidney function that are worth doing to make sure your body tolerates the drug well.
June 12, 2018 at 6:59 pm #7154
Would you please name the test of kidney? What are the other tests? If you tell me the name I will do the test.
Thank you again.
June 12, 2018 at 7:15 pm #7155
The standard blood test for kidney function measures creatinine. You will probably need the help of a doctor to interpret the result. And a doctor who knows you well will know what other tests might be appropriate in your situation.
But everyone should get standard liver function tests. There are a few of these and you might as well get them all but the most useful in order to observe the effect of febuxostat are called ALT and AST. If you have no other illness which is affecting these values, they are a bit easier to interpret than the kidney test but it would still be best if you had access to older test results for comparison. There is also a test called bilirubin which is not standard everywhere and may be relevant as well but I don’t think there’s much point in insisting on it as long as your ALT and AST values are OK.
Long story short, best arrange the blood test with a doctor! Febuxostat is not such a common drug so doctors can not be expected to know all about it, but any doctor surely is familiar with standard blood tests so you can simply ask for liver function tests and they’ll know what to do.
June 12, 2018 at 7:39 pm #7156
Ohh.. Creatinine. I did this test before taking drug. The test result was good. 71 umol/L. Besides this I also did Hemogram/CBC and glucose test. All test results were good according to the doctor. Should I need to test ALT and AST?
June 12, 2018 at 8:00 pm #7157
Yes, I think everyone should get ALT and AST tested at least once after starting febuxostat.
The liver is of course a vital organ and it’s common enough for febuxostat to cause liver problems that preventing damage is well worth the cost of testing. Liver stress isn’t painful so it can get quite bad before you notice it. This is why people are told to be very careful with common painkillers using paracetamol: excessive doses or prolonged use can cause liver damage and by the time people realize they are getting seriously ill, sometimes it’s too late to save them.
June 12, 2018 at 8:04 pm #7158
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June 12, 2018 at 8:26 pm #7159
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June 12, 2018 at 8:31 pm #7160
Okay. I will do that.
June 19, 2018 at 6:43 pm #7197
According to your advise I have done the following tests, whose results are as below;
June 20, 2018
Uric Acid 207
ALT (SGPT) 30.70
AST (SGOT) 26.90
My previous test result was as below:
May 2, 2018
Uric Acid 398.90
During this period I took febuxostat. But I wonder despite the improvement in uric acid level, my pain is not improving. Sometimes, it seems to me that the pain is rather increasing. Is it like that the pain will be relieved gradually?
Would you please advise what should I do?
June 19, 2018 at 10:12 pm #7199
Assuming we use the same units, all your values are great. If febuxostat caused even a little stress to your liver, your ALT should become much greater than your AST which is obviously not happening so as far as I can tell you’ll be able to keep taking this drug without concern for a very long time.
If your problem is indeed gout as your doctor suspects, you’ll have to be patient.
But in the meantime there are drugs you can take to suppress gout symptoms such as colchicine and ibuprofen. You should discuss that with your doctor. Based on your blood test, there is no reason for you to avoid taking more than one drug at the same time (but of course your doctor may be aware of other reasons for you to be especially careful… all I’ve seen is a few numbers!).
If the pain is increasing a lot or your see something wrong with the painful part of your body besides the redness and swelling you can expect to get from gout, do see a doctor just to make sure you aren’t neglecting a completely different problem.
Gout pain should be relieved gradually after starting febuxostat, but that process doesn’t start immediately. What you might notice at this stage is shorter but more frequent painful episodes as well as pain in locations which were rarely painful before you started febuxostat.
Since the blood test confirms the drug is working very well, you can be confident that the cause of gout is being removed from your body. And as long as you keep taking 40mg daily, you can eat whatever you like.
If your pain finally goes away, I recommend waiting a few more months before lowering the amount of febuxostat you take. If on the other hand your pain does not improve by the end of the year, you’ll have to ask your doctor to investigate other disorders.
June 20, 2018 at 4:22 am #7204
Thank you very much for your reply and giving your valuable time.
The units were as below;
Uric Acid umol/L
ALT (SGPT) U/L
AST (SGOT) U/L
Just to be confirmed-I had a belief that after starting febuxostat, gout pain will be relieved gradually in directly proportion to the level of uric acid be decreased. Now it seems wrong. Uric acid may be decreased immediately, but the pain take time to be relieved. Is it like that?
In my present situation, should I continue febuxostat? If so, how long?
Thank you in advance.
June 20, 2018 at 12:46 pm #7205
Yes, you’ve understood correctly.
People who have deformed hands and feet because of uric acid should see an immediate improvement as uric acid is removed from their body in proportion to the decrease of the level in their blood.
Uric acid should also be in the process of being removed from your body but the amounts are much smaller in your case. Even a very small amount can cause a lot of pain so you may not notice much difference until most of the uric acid has been eliminated. Also, small amounts can be isolated from the blood and persist for a long time. So in your situation the improvement is more in proportion to the duration of the treatment than to the level in the blood.
So far as I know, there is no reason for you to stop febuxostat so yes, keep taking it! Gout patients normally keep taking it for the rest of their lives.
The dosage seems too strong for you so what you might want to do is to switch your dose to 20mg. But the latest recommendations for gout I’ve read say it’s OK to have uric acid that low for a year or so I recommend waiting until the pain has gone away before lowering your dose.
Of course if your doctor ends up finding a completely different problem and decides you never had gout, they’ll tell you to stop taking febuxostat. If you want to quit the drug for any other reason, you should first look into other ways to prevent the amount of uric acid in your blood from going back to 400 or so after you stop taking it.
June 20, 2018 at 3:35 pm #7209
Gout patients normally keep taking it for the rest of their lives. Omg!!
Doesn’t it have any side effects? Moreover, if I keep taking it for long time, wouldn’t it lower uric acid level to near zero? If so, would it be good?
One more thing to be mentioned that I am feeling more pain than before. Is it normal?
Thank you again.
June 20, 2018 at 4:11 pm #7210
All drugs have side effects but they do not always affect everybody. It’s a relatively new drug but some people have been taking febuxostat for many years. Based on your blood test, you seem to be having no problems. Did you notice anything unusual?
You do not want your uric acid to fall to zero but it should not fall much lower anyway. Since it’s very low already, you shouldn’t keep taking so much febuxstat for several years. If you were to take 20mg for instance, it would probably rise to a more normal value while remaining low enough to ward off gout.
The pain should vary so it should sometimes become stronger.
But pain is difficult to explain in writing. I don’t know exactly what you feel so I can’t rightly guarantee you it’s normal. If you feel something very different from what you’ve experienced these past years, best see a doctor just in case this unusual pain is caused by something else requiring a different treament such as antibiotics.
June 20, 2018 at 5:15 pm #7211
Somehow I came to know that after taking febuxstat, pain could be increased. That’s why I have asked whether it is normal.
However, you have given a lot of advises, which seem to me vary rational. I am greatly indebted to you for your consultation. I don’t know where are you from. In my country, doctors are not so co-operative, with few exceptions. They don’t like to hear from patient very much. They provide treatment on traditional way, thinking all patients’ cases are similar. They don’t to think that some cases might be different. I have visited about dozen of doctors during last couple of years due to this pain. None of them treated me properly. Even one doctor, who is a professor of the best medical college of my country, told me to change my shoe, which he believed was cause of my pain, nevertheless, uric acid level was 390+. How funny! I have changed several pairs of shoes, but no improvement. My last doctor seemed to be a good doctor. He advised me to x-ray the joint and gave some tests. After seeing the report, he identified that it is gout arthritis. See, after six years and visiting dozen of doctors I came to know that it is gout. There are many examples of malpractices done by doctors in our country. If you interested, I will tell you one by one. Therefore, I don’t have much trust on doctors of my country. Sorry, told you a lot of negative about my country’s health sector.
June 20, 2018 at 8:44 pm #7212
Pain often becomes more frequent after starting febuxostat. That would be normal. But if your pain actually became more intense, that’s not so normal. It’s not a big surprise but it’s not typical.
You are a special case anyway. The way you reduced uric acid is definitely not normal. Most people take a more gentle drug than 40mg febuxostat to begin with. And most gout patients start with more uric acid so they never go as low as 200. This must have created a unusually strong chemical imbalance in many parts of your body. There is research showing that when uric acid is lowered gradually (the opposite of what you did), there is less pain.
I wouldn’t fault the doctors you’ve seen too much. Typically people who have gout test higher than you did. Many doctors around the world would not consider gout when uric acid is under 450.
My uric acid used to be higher and many doctors still wouldn’t consider gout because my uric acid was “normal”. I’ve seen so many mostly clueless and non-cooperative doctors from different countries (all of them Christian countries though) and have been given so many explanations for my joint problems over the years! I was told my shoes were the problem, sure. But I also apparently have several different bone deformations not to mention nervous problems. Even my veins/arteries were supposed to be diseased at one point.
I don’t doubt that medical malpractice is a problem in your country. But when it comes to gout, medical malpractice is everywhere.
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