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I second @cujo’s helpful comments
I’ve see 2 studies about gout and warfarin. One says warfarin raises uric acid. The other says it does not. I guess all you can do is talk to your doctor about alternative anti-coagulants, but there is a far more important issue. Untreated high uric acid is dangerous, and the longer it is left, the worse it gets. Uric acid crystals grow very slowly, but over the years, they attack every part of your body. You must get uric acid below 5mg/dL. In order to get rid of existing uric acid deposits as quickly as possible, I recommend aiming for a lower level for a year or so.
There are many things that can increase uric acid. Rapid weight loss = cell death = high uric acid. Serious illness = cell death = high uric acid. Bad eating habits can lead to increased uric acid in two ways. Uric acid can come from food, but most of it comes from our own bodies as cells die. If poor nutrition, or fasting, leads to lots of cells dying quickly, then uric acid rises. These factors are relevant, but if you have gout, it is not likely to go away just by eating sensibly. There are a few people who have gout just because their diet is bad. In those cases, healthy eating can stop gout. For most gout sufferers, improving diet is not enough to make uric acid safe. At the next gout attack, take your doctor’s advice and get back to him so you can control your uric acid.
Fantastic to know you’re gout free @jasper65. Also fantastic to know you’re helping other gout sufferers find their Gout Freedom. Like with many diseases, some doctors take the trouble to learn what’s best. If they don’t, as you say, a rheumatologist is the best option.
I don’t know about more competent, @cujo. You pretty much said it with “Reducing the dose of allopurinol is possible only if the uric acid level is maintained at a level of 5 mg/dL or less.”
Maybe I can emphasize the “or less”
Everything I read before I went on allopurinol told me that it is best to aim as low as possible. It’s simple biochemistry, if ever there can be such a thing. When uric acid concentration is lower in the blood, uric acid deposits dissolve faster. Yes, there are complications where tophi are locked into solid lumps of dead cells, but those tophi are unlikely to trigger attacks anyway. The problem is caused by uric acid deposits that are spread throughout the body. These have taken years to form, but they dissolve quickly.
I have seen hundreds of discussions here where uric acid levels are floating around the 6-7 range. They are all tales of misery as crystals start to dissolve, then reform. I had something of a battle with my doctors when I started allopurinol, as they were easily satisfied with a 300mg dose that brought me down to 7mg/dL. In my group practice, I eventually found one doctor who listened to my thoughts on the crystallization point of uric acid. He agreed with me that maximum dose was best in order to flush out old uric acid deposits. I’ve been on 900mg allopurinol per day for 2 years, and I never get any twinges. There are still signs of a tophi in my elbow, and I will maintain the max allopurinol as long as my doctor prescribes it, in the hope that the one remaining sign of gout will eventually go.
Everything that @sorepaw says sounds normal. Normal for most doctors, but not acceptable to me. And, to return to Chris’s points, there is ample evidence to show that, once you dissolve all the old crystals, you can take a break from allopurinol. I might risk that with my doctor monitoring me. I doubt I would with yours.
Annual tests for uric acid with liver and kidney function tests are an absolute must. More frequent until you get stable.
If you have recently started Uloric, your doctor should also have prescribed preventative colchicine for a few weeks until uric acid has stabilized below 5mg/dL. That’s not really the main issue. Uric acid crystals cause damage to tendons, cartilage, and bones. Until you have gone 6 months without a flare, whilst maintaining uric acid below 5, you should avoid any exercise that stresses the joints. As I’ve said in another recent topic about gout and exercise, I’m do not have the skills to advise what the best exercise is. Swimming appeals to me. Walking should not cause too much joint stress, but as with all forms of exercise, moderation is important.
Exercise is vital for a healthy life, but you should not overstress joints that are already gout damaged.
Am I alone in wondering what this is all about? The original post seems relevant to gout, if a little quirky. The follow-up comment makes me wonder if I’m losing my mind.
Thanks for sharing that @sean-white. I’ve read many accounts of similar gout presentation, but it is less common than the typical red, swollen joint. I’ve certainly experienced that feeling of general discomfort in my feet without the isolated single joint gout flare.
I’d be interested in knowing your uric acid numbers. Thousands of other gout sufferers will be interested in knowing the location of your DECT scanner, if you don’t mind sharing.
Nice profile pic, by the way. I love bonsai.
Thanks for that, @goutron. Very interesting.
Getting gout attacks in previously unaffected joints is a real insight into the nature of gout. Uric acid crystals grow very slowly. Recent research has shown that uric acid crystals alone rarely (if ever) cause gout attacks. It seems that our immune systems need something else to trigger the massive inflammatory response. The most likely candidate is Free Fatty Acids. Whatever the mechanism, we can see that slow uric acid crystal growth is often painless. Hence the reason why some people get horrendous tophi growth yet never experience gout. But when uric acid crystals start to dissolve, they do so very quickly. The white blood cell coating drops away, and the resulting large number of crystals can provoke an immune response. This often happens in multiple joints at the same time, including places that have never troubled us before.
On a practical note, my doctor knew of this possibility, and prescribed preventative colchicine for two weeks with every dose change. It usually prevented gout attacks for me, though I occasionally had to help it with 800mg ibuprofen.
Your feverishness has been reported by many gout sufferers. I guess it’s quite common when the immune system has gone into overdrive. Plenty of hot tea is my best advice. Or celebrate your path to gout freedom with liberal doses of your favorite alcohol!
I look forward to reading about your October results.
Tendonitis is definitely a problem with gout, and I explained how this happens at Do Gout Crystals Kill Tendons, Or Just Their Babies?.
The theory has maintained that once uric acid crystals have dissolved, the natural healing process should restart, and damage, at least partially, should be repaired. It’s great to read that you have experienced this benefit, Geoff, and I look forward to your challenges against Andy Murray. 🙂
Much more importantly, I’m delighted that you have recognized the importance of 5mg/dL as the safe upper limit for uric acid. You’ve inspired me to start an award that I’ve been thinking about for months. This award scheme is obviously very new, and I’ll be posting more details about it when I’ve prepared them.
@geoff, you should get an email soon with your official badge. For anyone else that wants one, simply post something that shows you recognize the importance of 5mg/dL. Please note that it is a personal award, so like Geoff, you’ll have to provide a personal account.“so that mentality is still out there” Yes, it’s a shame. Anyone else in this situation, the best approach is to insist that your doctor checks out “Initiation of allopurinol at first medical contact for acute attacks of gout: a randomized clinical trial” from the November 2012 American Journal of Medicine. More info in my Start Allopurinol Quickly, But Carefully article. It depends on the doc, but it’s usually best not to say you read it on the Internet. Just say your friend’s doctor told him about it, or something similar.
@goutron, I hear what you’re saying about the uric acid number, but you are probably going to have to become more aware of it – probably to remind your doctor that it must be 5mg/dL or lower. Indeed, I would suggest much lower for a year or so, to get rid of old crystals as soon as possible.Thanks for sharing your experience. Please keep us informed about your progress with allopurinol. Personally, I’m sticking with my 900mg per day for as long as I can to clear out the old uric acid deposits. The only gout pain I ever experience these days is what visitors tell me about here in the gout forum. 😀
Environmental toxins are covered in a new report: Persistent organic pollutants and hyperuricemia in the U.S. general population. It concludes:
This study is consistent with our hypothesis that the risk of hyperuricemia relates to background exposure to a mixture of POPs even among persons without MetS. There should be further research about whether avoiding exposure to POPs and otherwise decreasing body burden of POPs would be helpful to prevent or manage hyperuricemia or gout.
That sounds to me like there is a link, but we need more research to identify how to manage the problem.
Speaking of links – the abstract is at http://www.ncbi.nlm.nih.gov/pubmed/23958244 with links to the full report. I can’t afford to buy the full report, but if anyone has access to it, I’d appreciate a copy.
I’ve also asked Does uric acid really cause gout? on my main gout site to try and encourage more people to join this discussion. I believe this is important for how we understand and treat gout, so I’d like to get more opinions from interested parties. Please pass it on to anyone you know who is interested in managing gout, especially your doctors and other medical professionals.
This discussion about allopurinol for life is now closed. Please see Is Allopurinol A Lifetime Drug?. If you still have questions, please start a new topic in this gout forum.
This discussion about powerade and gout is now closed. Please see Foods That Cause Gout. If you still have questions, please start a new topic in this gout forum.
This discussion about gout monitoring kit is now closed. Please see Uric Acid Test Kit. If you still have questions, please start a new topic in this gout forum.
This discussion about gout and iron is now closed. Please see Gout and Iron Revisited and Alternative Treatment For Gout ? Blood Letting. If you still have questions, please start a new topic in this gout forum.
This discussion about coffee as a gout cure is now closed. Please see my coffee and gout page. If you still have questions, please start a new topic here.
This discussion about prophylactic colchicine is now closed. Please see my colchicine dosage guidelines for more information about colchicine as a preventative and weaning off colchicine. If you still have questions, please start a new topic here.
This discussion about Colcrys scam is now closed. Have you tried the new cheaper alternative to Colcrys? If so, please share your experiences by starting a new topic in the Gout Store forum.
This discussion about diy uric acid blood tests is now closed. Please see my Uric Acid Test Kit page. If you still have questions about testing your own uric acid levels, please start a new discussion.
This piroxicam topic is now closed. In it, we learned that piroxicam is one of many NSAIDs that can be used to reduce the painful swelling of gout. See more information in my article about NSAIDs for gout. If you still have questions after reading that, please start a new discussion in this forum.
“I would think that if the 10.8 is accurate you would be having one attack after another so I am skeptical of the number.”
That’s an interesting point. Does higher uric acid level = more attacks? I have no solid information one way or the other, just interested.
Of course you can start allopurinol now. The old advice was simply a doctor’s con trick. If you meet with resistance, ask your doctor to check the November 2012 edition of the American Journal of Medicine. http://www.goutpal.com/4853/start-allopurinol-quickly-but-carefully/
NSAIDs are fine for a while, but all have long term risks associated with prolonged use. Uric acid control is the only option, and I particularly like your approach of combining allopurinol with diet.
Certain food items have been shown in studies to lower uric acid. Skim milk and vitamin C are particularly effective.
Personally, I think it is wrong to alkalize urine using chemicals. Probably better than doing nothing, but I believe the healthiest option is to alkalize by making the right food choices.
I’m always very wary of quoting Internet sources to doctors. Some are receptive, but most have ego problems that make them believe your trying to usurp them. I find it far better to quote medical sources. The American College of Rheumatology have excellent guidelines backed by scientific research. In this country I refer my doctors to the British Rheumatology guidelines. Some don’t like it, but they cannot refute it.
That’s a sad and sorry tale. Unfortunately not unique. I still haven’t found time to go through all the points, but I want to assure you I’m here to help as much as I can.
You raise many interesting topics that I’ll discuss in more detail later. For now, the most important thing we can do, in my opinion, is to get a plan together to fix your gout. I’m guessing the first thing is to persuade your doctor to update your dose. In my experience, the best way to do this is to find out why they are reluctant to do this, then shoot each argument until you get your way.
That’s a general rule – specifics will vary from doctor to doctor. How do you feel about this? I’ll definitely find time to support you on specifics – just can’t find time for general chats at the moment. (Not an excuse – I’m trying to recover from websites hacked).
Good point @cujo. However, it is not a perfect test. Presence of uric acid crystals confirms gout, but absence doe not deny it. I’m assuming that MickMick’s rheumatologist did actually take a joint fluid sample and analyse it immediately. Anything less than that disbars him/her from calling themselves a rheumy.
I’ll get round to answering the other points when I get time, but where has common sense gone in the medical profession?
The American College of Rheumatology make it quite clear that, unless kidney problems or other health problems indicate a higher level of up to 6mg/dL maximum, the maximum level for safe uric acid is 5mg/dL. For people exposed to prolonged cold (e.g. fishermen) it should be a lower maximum.
As allopurinol is so safe and cheap (as long as latest dosing guidelines are followed), it seems sensible to me, to take sufficient allopurinol to maintain uric acid below 5 for several months. If symptoms persist after several months, then look for something other than gout. A simple common sense solution that gives diagnosis and treatment in one go. In exceptional circumstances it might not be enough, but in most cases of elevated uric acid, it will work.
MickMick’s homework is to read http://www.goutpal.com/972/allopurinol-medication-why-it-hurts-to-get-rid-of-gout/ – easily found if you type Why does Allopurinol cause gout attacks? into the search box near the top and bottom of every page. That article was fairly novel in gout circles, when I wrote it many years ago. It seems many in the medical profession have not caught up yet.
Thank you for those test results. To me, they say that it is highly likely that you are experiencing gout. As your doctor says, uric acid in the blood often falls during a gout attack, so you are almost certainly experiencing gout.
As far as diagnosis is concerned, you can accept that you have gout, and start treatment for it, or you can continue looking for something else. The types of disease that are commonly confused with gout are not reliably confirmed by blood test. They really need the skills of a rheumatologist.
The symptoms you describe are typical of gout. Though extreme painful swelling in one joint is commonly linked to gout, the processes that cause gout pain can produce a range of other symptoms. Itching and numbness are common, as is redness and feverishness. Pain can fluctuate around the body. We tend to notice the extreme episodes, but an attack can be less painful sometimes, often a dull ache or joint stiffness.
In my opinion, it is best to assume that you have gout, and focus on maintaining uric acid below 5mg/dL. If symptoms persist when you have had uric acid under control, then that would be the time to suspect something else, and call in a rheumatologist.
I’m not sure what to suggest next, as I do not know what your doctor has advised. Generally speaking, in your circumstances, I would advise gout suspects to arrange monthly uric acid tests. It is often possible to reduce uric acid 1 or 2 mg/dL with lifestyle changes, otherwise uric acid lowering medicine as soon as possible will prevent further joint and tissue damage.
There has been discussion about that supplier in the past. Personally I would never do business with someone who tries to spam these forums and mislead gout sufferers.
I suggest you take up your concerns with your supplier.
I’ll investigate my links to see why it is necessary to wait 28 days. The Easy Touch kit that has had positive discussions here is available in a few days as far as I can tell. That, and other uric acid test kit is available if you search amazon.com.
Thank you for your comprehensive report on the difficulties of a gout diagnosis. You’ve reawakened my determination to finish my I Have Gout program, and the related programs for managing treatment and diet.
I’ll devote as much time as I can during August to get these gout management plans to a useable format.
