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Thank you for reporting your results of the effects of Purixa on uric acid. I look forward to seeing your next results.
Thanks @mike-trieu. It is important to note that, whilst uric acid meters are generally very accurate, testing a drop of blood from a pinprick is more open to error than testing blood drawn from a vein.
That is why I recommend a strict, consistent routine for testing the blood. It is important to think about where inconsistencies can creep in, and do your best to eliminate these. Common problems are:
- Contamination from unclean skin
- Different droplet size
- Inconsistent time since last meal
In addition, a small droplet size, compared to a lab test blood draw, is more prone to variation from localized changes in uric acid level. There is little you can do to avoid this, other than focus on averages, and omit results that are abnormally low or high.
Not currently, as allopurinol is controlling my gout effectively, and I have had no flares for over a year.
In the past, I used exactly that combination to stop gout pain. If you search for “pain freedom” in the box near the top of each page, the results will explain more. In a nutshell. Colchicine stops inflammation spreading. Taken early enough, it was often all I needed, but if inflammation got hold, I took ibuprofen after a couple of hours if pain persisted. On a few occasions, inflammation did not reduce quick enough for me, so I took paracetamol after 2 hours. If necessary, I repeated the two hour cycle of ibuprofen and paracetamol, but only rarely did I need to repeat.
My doctor advised me to take 1 colchicine for at least two weeks after an increase in allopurinol dose, then take another at the first sign of an attack, to a maximum of 2 colchicine per day. I had very few attacks, but when they happened, I either coped with the pain, or took an anti-inflammatory, occasionally supported by a compatible analgesic.
Your doctor or pharmacist should advise you about the best combination. In my case it was ibuprofen and acetaminophen (paracetamol), but other combinations also work. Do not be tempted to self-medicate, as most pain relievers should not be mixed. Who ever advises you must be told about any other drugs you take, and also herbal remedies and diet supplements.
After a few hours, I’m still not seeing anything. Maybe I’m impatient, as delivery is usually only once per day.
I’ll post more, and keep testing.
Thank you for your patience.
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My view of beer is that you should be able to drink within generally acceptable limits without affecting gout too much. It’s very much a personal thing, as it depends on your intake and on your uric acid levels.
Managing gout is all about managing uric acid levels. Ignore people who say its all about beer drinking. It isn’t.
You need an assessment of current uric acid. Assuming it’s too high, you need a plan for lowering it. That means a personal plan that can be based round medication, lifestyle improvements, or a mixture of both.
for gout pain, take no more than 2 colchicine per day. if pain persists take naproxen or other anti-inflammatory. if pain persists after that, see doctor or pharmacist for analgesic that is safe to take with naproxen. Search for ‘pain freedom’ for more info. don’t do this for a long time – you need to lower uric acid to 5 mg/dl or less to avoid permanent joint damage.
Thanks @ane-zr. If you want to start a new topic, please fill in the add new gout topic form.
To find old responses, it’s usually easiest to use the search box near the top of every page.
That’s an interesting diagnosis of goutlike symptoms, and I’ll try to remember it for future advice. I’m glad you’ve got a proper diagnosis and now you can get proper treatment. I hope you enjoy the yoga. 🙂
Glad you’ve found help for your dad. If he needs any specific guidance, please ask.
Also, I should have answered your subsidiary question. Yes, tophaceous gout can occur silently. Uric acid crystals usually grow very slowly, and not everyone gets the gout pain, especially in early years.
4.6 is a little low, but it does not rule gout out, as levels drop during and immediately after a gout attack.
The most sensible thing you can do is consult a rheumatologist and get those lumps tested. If they contain uric acid crystals, that will be an immediate confirmation that you do have gout, and you can easily get treatment for it.
When I started on allopurinol, the doctor also prescribed preventative colchicine. I found little discomfort, and soon dropped the colchicine, except for when I noticed a twinge of gout. On a few occasions, I had to resort to ibuprofen, but these attacks diminished to zero after about six months.
Everyone is different, and much depends on how long you have had gout, and on untreated uric acid levels prior to the start of allopurinol.
My best advice is to work with your doctor or pharmacist to find a pain treatment package that suits you. Some or all the elements of a gout pain package are important:
1. Limit the inflammation – colchicine is best here. It limits inflammation spreading, but does nothing for existing inflammation. This will reduce naturally in a few days, or you can use…
2. Reduce inflammation – NSAIDs such as ibuprofen, naproxen, indomethacin, etc are best. These reduce inflammation in a few hours, and should soon stop pain. If you want to stop pain faster, supplement anti-inflammatories with …
3. Stop pain – any general analgesic that is compatible with NSAIDs will help kill pain faster. Be certain to tell your pharmacist about all medications and supplements you are taking so that they can advise a safe pain-killer.You should find that, as the weeks pass, the frequency, duration, and intensity of gout attacks will reduce. You have to be patient. Every gout sufferer is different, so there is no definitive answer to “How long is this still going to last?”
I have a theory that a rough guide depends on how long you had untreated gout. Let’s say in your case it was 17 years – the same as mine. I’d expect gout attacks to be drastically reduced in about 17 weeks, and I’d expect them to be zero in about 17 months. Obviously, there are personal factors that could make this quicker or slower. Medical history will certainly affect it, but you can do nothing about that.
You can maximize current treatment for best results. As well as upping allopurinol to the maximum permitted dose, you can keep joints warm, and drink plenty of fluids. As well as improving diet with vitamin C, you can also get benefit from non-animal protein. Milk protein has been shown to be useful, so skim milk or casein supplementation may help.
Stick with it a few more weeks, with proper pain control where necessary. If there is still no improvement, we have to look at other issues, so come back later if this is needed. In any event, please keep coming back to report your progress.
I do not have doubts about the meter, but I have strong doubts about the ease of use for people who are not naturally methodical.
When you take a professional blood test, the blood draw takes place under strictly controlled conditions. These are difficult to replicate at home, but there are things you can do to give yourself the best chance of a consistent, uncontaminated test sample.
Starting with clean hands, always test at the same time each day (unless you are trying to investigate the effects of certain lifestyle or other changes). Also test at the same time related to your previous meal.
Always use the same setting on the lancet, but adjust this if the blood droplet size is larger or smaller than the recommended droplet size described in the instructions. Once you have pricked your finger, always test the blood immediately.
Try to test in consistent temperature. Above all, be aware of your test conditions, and try to keep everything the same.
You can usually discount the first few tests, until you have established a consistent test routine.
I maintain that your first port of call for blood testing is your doctor. If that is inconvenient, or you want more frequent testing, then consider your own test kit at home. But only do this if you can be confident that you can develop, and consistently apply, your own personal test routine.
Don’t stop Uloric. Once started, uric acid lowering medicines such as Uloric (febuxostat) and allopurinol must be taken every day.
Colchicine stops inflammation starting, or if it has started, slows it from getting worse. Though it is a common necessity for early months of uric acid lowering, it should not be necessary for gout after six months of safe uric acid levels. By safe, I mean uric acid blood tests showing consistent results no higher than 5mg/dL, and no visible tophi.
If your uric acid levels have been tested regularly, and all results in the past six months have been in the 4’s, and if you have no visible tophi (lumps under the skin), I do not believe the pain you are experiencing is gout. My best advice in those circumstances is to consult a rheumatologist who can investigate other causes of inflammation and pain.
There are newer medical alternatives that your rheumatologist should know about. If your rheumatologist can’t help, I suggest finding one who is up-to-date with the latest gout medication developments.
For borderline uric acid levels, dietary control might be effective, but that depends on your starting uric acid level. If either of the 2 contributors to this topic would care to share their recent uric acid blood test results, I might be able to suggest some answers.
I won’t repeat my belief in the “new recommendations” re colcrys / colchicine, but I will repeat the “new recommendations” re uric acid.
5 is the upper limit.
Low 5’s might simply be not low enough. The new recommendations give a better margin for daily fluctuation. Fluctuation of uric acid can be from big diet changes, or changes to other meds,Fluctuation of crystallization point could be from low temperature, or pH of synovial or other body fluids (blood is well regulated for pH, but I think this makes other fluids a more volatile buffer – don’t quote me),
I’m pretty much grasping at straws here, because I thought you’d got this gout thing nailed.
Did you ever get any of the free colchicine from Derek via Hans? I can initiate an email conversation if you’re interested.
Sounds good.
High uric acid can definitely cause gout in your twenties. My nephew started around 25. It’s almost certainly genetic with him. I believe gout is often a mixture of genetics and lifestyle.
There is nothing you can to about the genetics, but improving lifestyle is vital. I’ve recently become aware that many of the bad diet habits that lead to gout also lead to heart disease and other health problems. It’s not just excess fat. Excess iron is also a major contributor to both diseases.
Exercise is good, but for gout it is important not to over-exercise. There are no hard & fast rules, but commonsense is a good guide. Pushing harder for the extra mile might be good if you are involved in competitive sport, but is not going to help gout.
Healthy diets for gout include alkalizing or Mediterranean style diets. These have the benefit of being varied, so you can always include foods you enjoy.
Finally, even if lifestyle improvements keep the painful inflammation away, it is a good idea to get tested for uric acid at least once a year. That gives a good history of what is normal for you, and an early warning if it starts to creep up.
Good luck.
There are a few issues here.
On pain, be aware that gout pain intensity varies enormously from person to person. Some people do not generate the same level of inflammation as others. Some people have better pain tolerance than others. Ultimately, with gout, pain control is not the issue – uric acid control is.
Drastic weight change up or down is a well known cause of increased uric acid. More importantly, it is a serious indication that your diet is out of control. Keep that up for a few years, and you wont need to worry about gout because you’ll be dead from heart disease. Sorry if that is harsh, but best to see gout as a wake-up call. I can help you with some resources to make dieting easier, but you have to make the commitment to stick to a healthy diet or it will not work. Healthy does not mean boring, but you have to balance calorie intake with calories burned.
Your uric acid is at the high end of what is acceptable. However, what is acceptable to your doctor is not acceptable to me. I believe the upper acceptable level is 5, but you may have difficulty persuading a doctor of this. Of course, if you can show uric acid crystals in a joint fluid draw, that would prove gout. You might have to wait for subsequent attacks, or you can try to control through diet. Diet control means a commitment from you and your doctor for monthly uric acid checks, or buy a home test kit.
On alcohol, from personal experience, and talking to friends, I am aware that prolonged drinking can cause stiffness that can often be painful. I have not researched the exact reasons for this, but I can repeat the problem at will. Exercise helps overcome this, and abstinence prevents it. The second of those is not an option for me, but I have found that walking more, combined with not drinking every day means I never have any serious issues. I guess you have to work out your own routines based on your social life. Bottom line is, if you can’t control alcohol intake to prevent health problems then you’re on a similar path to poor diet control, with heart, kidneys, and liver at risk.
I’m not trying to preach a diet of salads and abstinence, but you have to assess your diet and make improvements where you can. There is no magic plan, as every person’s needs are different. You should start wit the big picture and look at total calorie intake, total alcohol intake, total energy requirements, and the balance of major food groups. You follow this with looking at food and drink you really enjoy, and build personal menus around that. You make improvements where you can, and assess improvements in uric acid levels.
In answer to your headline question: do I have gout? I’d say probably yes, but your uric acid levels and poor diet mean you probably fall into the group that can control gout by diet – if you want to. I say probably, because I really do not have enough information to make a better judgment.
My best advice is to make a commitment to better diet, and hope this is enough to control your gout. If you cannot commit to that, then you can be certain that your gout will get worse until your doctor can make an obvious diagnosis. If you do decide to go for the diet option, I can offer more detailed help.
Personally, I’m a big fan of the *idea* of DECT, or equivalent. It represents a major advance on the treatment side to assess how urate lowering is progressing.
On the other hand, I’m just happy to see the tophi shrinking.
Welcome back. My lease of life just got renewed 😀
I’m confused, Dan. Have you had a blood test for uric acid or not? If so, what are the results. If not, why claim: “He isn?t a bad guy?” 😕
When you say “we haven?t gotten that far yet,” do you mean you have not been tested for uric acid, or you do not have results yet.
If you haven’t been tested, then that is poor given your family history, but it is not too late. I always think that anyone who suspects gout should arrange a blood test every 2 to 4 weeks. You might get some resistance from your doctor, but the reason for this is to get a good history of changes to uric acid level.
In most cases, a history of uric acid test results, a family medical history, and an examination of the affected joints is enough to get a reasonable diagnosis. A rheumatologist is not vital, but they are best if there is doubt, as they can run better joint tests to determine if it is gout or something else.
Family history is a strong indicator of gout, as it is largely genetic. Bad diet might make it worse, but that is not the same as hoping that good diet will fix it.
For anyone who cannot get a clear gout diagnosis from their family doctor, I strongly recommend a rheumatologist. Some family doctors know about gout, and some do not. All rheumatologists are trained in diagnosing and treating gout.
You must be aware that gout is not an intermittent disease. Acute gout attacks come and go, but gout is permanent. The gout attacks are a warning – the real damage comes from uric acid crystals spreading throughout your body, destroying joints and damaging organs.
Having said all that, it puzzles me that you have not mentioned your uric acid levels. The way to control gout is to control uric acid, so the medicines you have asked for might be correct, but what is your current level, and what is your target?
Here’s a warning for anyone looking to control gout through dietary control of iron: Be Careful What You Read!
I’ve been looking at current advice available, when I came across a quote from a book on Amazon called “Super Foods for a super healthy you” by Peter Kornfield. He reckons:
spinach in iron and other minerals, and the greens are helpful in cases of gout since the iron helps purify and oxygenate and your bloodstream
Hmm…
Doesn’t know Gout, doesn’t know Iron, and doesn’t know English Grammar.
To be honest, neither did I a few years ago, but I’ve learned a lot about gout, and a bit about iron. Who cares about grammar?
Thanks again, @tavery.
#1 Best way to find the links are to use the search box at the top of the page – just search for home uric acid test kit.
#2 Rheumatologists have recognized the issue about doctors not controlling uric acid properly, and are trying to raise awareness in their guidelines last year. They still have a long way to go, so it is up to us gout sufferers to do something about it. It starts with taking responsibility for knowing your own number, and directing your doctor to help you get it to 5 or less. If they will not accept that, I guess you have to insist on seeing a rheumatologist. I found that flagging the professional recommendations meant doctors took me a little more seriously.
I do not enjoy arguing with doctors, but it’s a lot easier than arguing with gout pain.
Cold of itself isn’t the problem. Uric acid crystals might form from a combination of low temperature and high uric acid. We have had similar discussions relating to the use of ice to relieve gout attacks. The consensus is that warmth is about as effective as cold for pain relief, so gout sufferers should opt for heat pads rather than ice packs. In this case, try warm water instead of cold.
It is good that you are improving diet and exercise, but that does not always help gout. Good diet is important for general health, but gout is usually down to other factors. Diet might be one of them, but I always feel that if you cannot get uric acid down with a healthy diet (I recommend Mediterranean diet or alkalizing diet for gout), then you need to rely on allopurinol or similar.
This is exactly why you need to get tests at least once per year, and understand the results. Please get your allopurinol up to a dose that gets your uric acid level to 5 or lower. Anything higher than 5 is putting your joints at serious risk of permanent damage, and eventually crystals spread to all organs, especially heart and kidneys.
That’s the trouble with London – never enough time to see everything you want, but I guess that’s true of any capital city.
I’m guessing that Beano is irrelevant for gout, but that depends on what is in it. Best talk to your doctor about it. It does not seem right to me that you have to take something just to allow you to eat properly, but as I’ve said many times – I do not have the medical qualification to make a valid contribution.
It’s just a sales page. Not much help in determining what dose is relevant for reducing uric acid in gout sufferers. 🙁
The purpose of allopurinol is to lower uric acid to safe levels. For most people, the safe level is 5 mg/dL (0.30 mmol/L) or below.
When you start taking allopurinol, you should get blood tested for urc acid, liver function, and kidney function at least once a month. As uric acid stabilizes at 5 or below, you can relax testing, but never less than once per year.
Once all old uric acid crystals have dissolved (which might take many years) you may find that your test results are consistently below 5. In that case, as long as you have not had a gout attack for six months, and you have no visible sign of tophi, you can reduce the dose by 100mg per day, then test 2 to 4 weeks later.
It might be possible to stop allopurinol completely, but it is dangerous to stop annual blood tests.
It’s absolutely fine to talk about PURIXA or any other gout products here. In fact, that is exactly what I want people to do.
I always maintain that everyone has different reactions, so what suits one person might not suit another. Having said that, we can all learn from the experiences of other gout sufferers.
What you are doing is exactly what I want to see – real results from a gut sufferer.
I recommend testing after you have taken PURIXA every day for two weeks. As I mentioned in your other thread, test results can vary, so it would be nice to see a range of tests. I hope you can keep coming back to update us all with your test results.
