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There are many factors that will affect how long it takes to get rid of old urate deposits.
The biggest factor is how low can you get your uric acid.
Some of the gross pictures we see are really exceptional, and will probably need extensive surgery as well as maximum urate lowering therapy. How on earth were they allowed to get to that state?
Anyway, thank you for prompting me to write about the need to lower uric acid to remove tophi quickly.
ok got it. I did some more research and I found an article explaining that probencid lasts like 8 hours in the body at effective dose; so I was taking 1 every 12 hours at 500mg; so it was in these 4 hour gaps where the uric acid was building up in my body or so it felt like it. I switched to 500mg every 8 hours and now I have mild pain in many joints but not the intense burning I had before. I will go in at the end of next week to check my levels to see where I am at. I hoping it is close to 3mg/dl.
Like all in this group I have seen the gnarly looking gout pics on the web; are you telling me that these guys can clear out in a couple months? I read a study online done by New England Journal of medicine that based on test studies stated it would take 3 years for all the crystals to be gone from people who suffered from chronic type gout with gout symtoms for 15 years or more. I tried to find the study again so I could link it but could not.
email their customer service (see their website). I have always found them very helpful.
I’d love to know how much you save (being in the UK myself, I’m still trying to get a handle on US medical procedures)
We've been using the UASure for a year now. We check the UA level once a month and then fax it to the Dr. Saves time and money as insurance doesn't cover the costs of monitoring the level nor the meds. By monitoring the level we realized my husband didint' need 300mg of Allopurinol a day. We took the dose down by a pill a week and he is now down to 1/4th of a 300 mg tab once a week and for months his level has been below 5.
The only problem is that we are running out of strips and as the site says they are only good for a year I wouldn't need 25 strips at once a month, esp. as the shipping is high.
Anyone want to split a shipment? Anyone know of a a US source for strips or osmeone who has strips that last longer than a year? I have paypal.
EJackson
cjeezy said:
I have however eaten a very large seafood dinner and washed it down with beer while walking miles and miles and did not feel anything the following morning (maybe I got lucky). In fact I tested my UA levels that same evening a few times and the odd thing was they ranged from 4.3- 4.7 so I still don't understand this entire gout thing.
I don't think anybody understands the entire gout thing.
I'm getting a bit closer with the allopurinol thing.
I've said before that logically, if you are on allopurinol, then purine intake should not matter because the enzyme (xanthine oxidase – XO) that is required to turn purines into uric acid is restricted by allopurinol. Of course, things are never that simple, and there might be something about purine intake that prompts more XO to be produced.
There seems very little research on the effects of diet when on allopurinol, but I've just tried again, and come up with a couple of interesting quotes:
“allopurinol intake seems to be effective in controlling the rapid increase in plasma uric acid caused by ingestion of alcoholic beverages”
“With respect to uric acid lowering effects, these results are in accordance with findings in patients overproducing uric acid endogenously and suggest that the uric acid lowering effect of allopurinol is enhanced with increasing concentrations of purine bases”
Both of these are surrounded by almost incomprehensible jargon, which I'm still trying to decipher,
They seem to support the view, which I have heard from other allopurinol takers, that on allopurinol, you can eat and drink whatever you like.
Personally, I believe that antibiotics should only be available in hospitals, where they can make absolutely certain that infection has gone before medication is stopped.
Keeping warm and well hydrated helps the body fight infections. Inappropriate antibiotics just make the bugs stronger.
Please note, this is just my personal opinion – I'm happy to be disagreed with, as long as it's respectful.
Here's the link for gout and stress.
Remember guys, if you are searching for gout info, include GoutPal in your search terms, and you'll probably find what you are looking for (and if not – I want to know)
Interestingly, I am taking Augmentin for a sinus infection as well. My doctor told me not to stop the allopurinol. He simply said do not take the antibiotic at the same time as the allopurinol.
And whilst you are in Spain, from Nucleosides, nucleotides & nucleic acids:
Asymptomatic hyperuricemia: impact of ultrasonography.
Puig JG, de Miguel E, Castillo MC, Rocha AL, Martínez MA, Torres RJ.
Divisions of Internal Medicine, La Paz University Hospital, Madrid, Spain. [email protected]
Thirty-five patients (23 males) with asymptomatic hyperuricemia for at least two years underwent two-dimensional ultrasonography of knees and ankles. Urate deposits (tophi) in tendons, synovium, and other soft tissues were detected in 12 patients (34%). Increased vascularity (inflammation) was evident in 8 of these patients (23%). Tophi were more frequently found in knees than in ankles and were especially prevalent in the distal patellar tendon. The presence of tophi was unrelated to the known duration of hyperuricemia (mean, 5 years). Ultrasonography allows detection of tophi and inflammation in a third and in a fourth, respectively, of asymptomatic hyperuricemic patients.
PMID: 18600510
Depo-Modrol? That steroid is supposed to be injected into the affected joint, though you wouldn't see me accepting it (steroids work against your natural pain management process). No wonder it did nothing for the gout.
It is perfectly normal to do 6 weeks allopurinol, then test blood urate. I wish all allopurinol doctors would do it. However, all that does is set you up for the uric acid crystal removal stage, around 6 months if you get your dose right. Only when all urate crystals have dissolved can you remove gout from the equation.
Either, you have misunderstood your rheumatologist, or, he is incompetent.
The problem with disagreeing with doctors is that you are in a very disadvantaged position. They control the diagnostics and analysis, so no matter how right you may be, they can say what they like, and you cannot disprove them.
I simply try to think what I would do in your situation. Since a doctor who specializes in rheumatics (inflammatory conditions) has stated that the problem is mechanical, then that implies to me that it is outside his specialism. Mechanical problem indicates orthopedics, so I guess the title might be orthopedic surgeon?
Sorry to be a bit vague, but it is completely outside my experience. As I've said before, I have no medical training, but a good knowledge of gout. I fear biasing my advice because of my limited perspective, so I am thinking what is best to do if it is not gout. I'm clutching at straws really, hoping that a specialist from a “mechanical” discipline might also want to pass the buck, and do a joint analysis to find out exactly what is going on in there.
Perhaps a holiday to Spain?
From Annals of the rheumatic diseases 2008:
First metatarsophalangeal joint aspiration using a 29-gauge needle.
Sivera F, Aragon R, Pascual E. Rheumatology Unit, Hospital General Universitario de Alicante, Universidad Miguel Hernándes, Spain.
OBJECTIVES: To asses the clinical feasibility of aspirating symptomatic and asymptomatic first metatarsophalangeal (MTP) joints with a 29-gauge needle in order to obtain a synovial fluid (SF) sample.
METHODS: All consecutive aspirations of first MTP joints performed within our department were prospectively recorded. The procedure was considered successful if SF volume was enough to perform a crystal search. Crystals were identified using a polarised light microscope (magnification x400) with a first order red compensator. Pain was recorded on a 10-cm visual analogue scale (VAS).
RESULTS: Aspirations were attempted in 33 first MTP joints in 31 patients. SF was drawn from 30 of the joints (91%), with little difference between asymptomatic (89%) and inflamed joints (93%). The technique was well tolerated (mean VAS 1.74). Urate monosodium crystals were identified in 22 samples (73%) and another sample contained calcium pyrophosphate dihydrate crystals.
CONCLUSIONS: A 29-gauge needle allows easy aspiration of the first MTP joint with only modest discomfort for the patients, and generally yields a SF sample of sufficient volume for crystal detection and identification. PMID: 17557892
[my bold] There are contact details for that study on the journal site: E Pascual, Dept. Reumatología, Hospital General Universitario de Alicante, c/Maestro Alonso s/n, 03010 Alicante; [email protected]
From the clutching at straws department – I wonder if Senor Pascual has any advice on what to do next?
From the interaction checker at drugs.com:
Coadministration of allopurinol with ampicillin or amoxicillin may increase the risk of skin rash. The mechanism of interaction is unknown, and it is unclear whether the condition of hyperuricemia or the actual exposure to allopurinol is responsible. In a retrospective study, 15 out of 67 patients (22%) who took ampicillin with allopurinol developed a skin rash, compared to 94 out of 1257 patients (7.5%) who took ampicillin without allopurinol. An updated study by the same group of investigators consisted of 252 patients who took ampicillin with allopurinol and 4434 who took ampicillin alone. The incidence of rash was 13.9% in the allopurinol group and 5.7% in the ampicillin-only group. Similar results were reported for amoxicillin. Specifically, 8 out of 36 patients (22%) treated concomitantly with allopurinol developed a rash, compared to 52 out of 887 patients (5.9%) on amoxicillin without allopurinol. There is probably no need to avoid concomitant use of these drugs in patients who otherwise can take these drugs individually.
If you stop allopurinol, your uric acid levels are going to rise again, but only you can weigh up the risks.
One thing is absolutely certain – if you do take the Augmentin you must take the full course. Do not be tempted to stop once the sinus clears. If you do not take the full course, the infection will come back even stronger, and you will never get rid of it.
Standard practice is not to treat high uric acid with no symptoms (asymptomatic hyperuricemia). Your symptoms are definitely not typical gout symptoms, so you either go down the ultrasound / MRI route (which is improving, but still not perfect) or wait for typical gout symptoms to show. It is a sad fact of life that gout is very badly diagnosed. Aside from the times when pseudogout, bursitis etc is misdiagnosed as gout, there are many cases where atypical gout goes undiagnosed. We have a weird situation where advances in imaging are showing that tendon and cartilage damage is much more widespread than previously thought, yet the swollen red great toe remains the standard diagnostic event.
The path of gout pain is not so simple. What gives it the excrutiating edge over other painful conditions is that the cells that try to “kill” uric acid crystals soon get overwhelmed, and their call for reinforcements creates the conditions that take “ordinary” inflammatory pain up to the next level. This can be mitigated in an “anti-inflammatory environment”, just as it can be magnified in a pro-inflammatory one. Doctors are proud of their anti-inflammatory drugs, and new interleukin blockers (basically, stop the call for reinforcements). But many similar compounds, absent in meat, are plentiful in fruit and veg. They might not match the strength of commercially produced medications, but they can certainly have an effect. Obviously, I cannot say for certain that you have gout, but if you have, you are clearly doing too much good to get the sympathy of the medical profession. Don't wait for Xmas – get the prawns and pork, steak and sweetbreads on the table now!
Or perhaps not.
Irrespective of the gout issue, it seems quite clear that you have a mechanical toe problem. The foot has many tiny bones and other bits and pieces (note my overpoweringly professional medical terminology
). These are often hard to view on x-ray. I question whether a rheumatologist is the right specialist to see in these circumstances. If there is no improvement at the 3 month mark, I suggest a foot specialist rather than back to the rheumatologist.Please can you tell us the name and address of your rheumatologist so other people might avoid him.
Fixing gout with an intramuscular injection of something (wish you could remember what)!!!, or a 6 week run on allopurinol!!!
No wonder people mistrust doctors.
The checkout options for the uric acid meter look straightforward to me, and the shipping charge is highlighted very clearly.
For many, these pages are what gives them a life!
(OK – just me then)
I'm inspired by your message to realize a Great Truth about gout.
The absolute test of whether or not a medical person understands gout is how they tell you your uric acid test result.
If they tell you the number, they understand gout. If they tell you a low/normal/high grade, they do not.
Can anyone disprove this?
Hi chaco,
I concur with zip2play – you must get your uric acid below .35.
I believe tht you should view this with some urgency. At the moment, you are depositing uric acid crystals everyday. Your joints will become increasingly eroded, together with serious cartilage and ligament damage.
If you assume for the moment that excess weight is to blame, losing two stones (28 pounds) in a short space of time will increase your uric acid load. It is far better to take allopurinol at the same time as you lose weight, then review the situation.
I recommend 6 months on enough allopurinol to keep uric acid in the.20 – .30 mmol/L. This will protect you while you lose weight, and perhaps improve exercise if necessary. You are then in a much better position to review your alternatives.
It is a good idea to get a 24-hour urine test before you start the allopurinol. That will give you good information about your urate clearance rate, which will play an important part in planning long term approach.
This does not mean that you will not be dependent on allopurinol in future, but it is your best chance of eventual control through lifestyle changes.
Coincidentally, I am working on a review of this skim milk study.
It looks promising, but was done on only 16 subjects none of whom had gout. I look forward to the promised additional research with gout sufferers. Also, it would be nice to see figures for normal whole milk as well as soya milk.
One thing that puzzles me about the emedicinehealth review is the credit given to orotic acid (vitamin B13). Though this is a known uricosuric (promotes the excretion of uric acid), the study looked at three different types of skim milk. One (late season skim milk) is very high in B13, but another (MPC 85) is very low in B13. Both achieved a 10% reduction in uric acid after 3 hours, so the “active ingredient” is unlikely to be orotic acid. Maybe they didn't study the press release properly?
Anyway, it is good to see that the statistical research done some years ago that suggested gouty benefits for dairy products is finally prompting some practical research.
Make mine a skinny latte
rucyrius said:
does this sound like a plan?
It sounds like almost a very good plan.
Make it perfect by returning for uric acid tests to check the allopurinol dose. It takes up to 2 weeks after starting or changing the allopurinol dose for uric acid levels to stabilize (though most of the effect takes place in 2 or 3 days)
odo said:
Gout monitor sounds like a good idea, but a fairly pricey bit of kit. How long do the strips last? It says you get 5 with the monitor and an extra box of 25 are recommended. A fuller explanation of the procedure and operating costs would be appreciated.
It's a bit like BUPA in the UK – you shouldn't need it, but some people like the little extras. The procedure could not be simpler – prick your finger with the lancet; drop of blood on the test strip: insert into test device and read the number; discard the strip and lancet. Cost (strip & lancet) is up to you – test every day if you want to (some even do more than one a day). Testing only makes sense as part of a clearly specified gout management plan. Quite boring, but you'd be amazed how excited you can get if you are trying to self-manage and you get a low reading.
If UA levels fluctuate so much, how valuable is a one off test from your GP?
Not a lot – uric acid testing should be quite frequent – e.g. every 2 weeks when you are establishing urate lowering treatment. Once a pattern is established, tests should be less frequent until you get to one a year.
(Great site btw GP
)Great Toe!
It took rather longer than anticipated, but here is an article on diclofenac & uric acid.
As I was reading your first paragraph, a voice in the back of my mind was crying “what about uric acid levels?”. Then I read your second paragraph.
There have been extensive discussions about home uric acid tests here – best look in the Uric Acid forum, or search for “uric acid monitor”, or UASure in the search box above.
Strictly speaking, they are different.
Apple Cider Vinegar is made by fermenting apple cider to the vinegar stage.
Apple vinegar is vinegar flavored with apples. The type of vinegar base can vary.
In practice, many people refer to apple cider vinegar (ACV) as apple vinegar.
Don't start worrying until you get a proper diagnosis – “looks like gout” doesn't cut it.
Gout has many causes, and in your age group, it is either kidney problems or genetics. In these circumstances, an inborn propensity to gout might be affected by trauma to trigger a first attack, but there are many other explanations – you won't be the first patient who has had sesamoiditis confused with gout.
Let your GP test uric acid to get a better indication. Below 5mg/dL (.3 mmol/L) and gout is highly unlikely. Above 6.5mg/dL (.38 mmol/L) and gout is likely. The diagnosis can usually be confirmed by a rheumatologist.
- Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout. Some of the lower uric acid levels in this study used a combination of allopurinol with benzbromarone, which is not available in USA. The study notes the case of an allopurinol user who acheived uric acid levels less than 4mg/dL who got rid of all urate deposits in 2 years. More importantly, it includes the best final sentence I've read – “There is much more to the therapy of hyperuricemia than simply prescribing 300 mg/day of allopurinol. How much? As much as necessary to obtain low serum urate levels.”
- No.
OK, maybe I should expand a little on answer 2.
For kidney disease sufferers, allopurinol is very good for the kidneys. Essentially, the reduction of uric acid helps the kidneys, but that is only really relevant to people who already have kidney problems.
Allopurinol does not cause an overload of uric acid as old crystals dissolve. The amount of uric acid released is much less than was previously hitting the kidneys when no allopurinol was taken. The uric acid from dissolving crystals is small compared to the decrease in uric acid production.
Most risk comes from allopurinol itself, or rather it's metabolite, oxypurinol. This passes through the kidneys, and can result in kidney stones – hence the advice from many authorities to maintain high urine flow, and alkalize the urine.
@Haldan – podagra is gout in the foot – stupid term really because it might start in the foot (for most people), but untreated will hit every joint.
@Dan – Isn't it strange how you can be protected from buying generic colchicine (which is perfectly safe) by government agencies, yet those agencies do nothing to protect you from allopurinol and other urate lowering therapies without adequate uric acid testing (which is imperfectly dangerous).
Hi Zip,
I am on AP300 a day from last 14 days (my Dr put me on 300 straight away.) work nights… little sleep during day… 38 yrs old… run equivalent of a marathon a week from last about 22 years…(split in 2 parts in my 2 days off) suffer no other known illness..
effects of AP on me:
- drowsiness (Big time…..)
- mild burning sensation in my Tommy almost all the time….
- strange feeling in eyeballs….(like being swimming in strong clorined water without swimming glass for whole day…)
But i didn't/havn't give/n up….. and nowadays i feel like the effects are slowing down(weakening…)
MY MAIN CONCERN IS AP HASN'T TRIGGER “FLEAR UP” YET… I wonder if it is working/normal….
sorry: English is not my first language.
