First time gout flare up - lots of questions

Sorry to jump on this thread. I was told by a rheumatologist that some people can have a high Urate throughout there lives but never have a gout attack. Does this mean that they are in the same catagory for heart desease than someone who's had an attack?

If so it's almost like a blessing in disguise if that's the case

The rheumatologist was correct. As a whole men tend to have higher blood urate than women, and it tends to be excessively high in men (women are protected till menopause)...until recently there is no clear academic research indicating if hyperuricemia alone is bad and should be treated.

Today however we can say that getting gout is a favour - if you heed the warning. I'll send a link to this on the next reply: =Compared to individuals without gout, we found that individuals with gout died earlier and experienced a 42% higher risk of death. Similarly, individuals with gout experienced a higher risk of dying from cardiovascular disease with a 58% higher risk of cardiovascular death.

We did find that individuals with gout had a greater abundance of many known cardiovascular conditions and risk factors compared to those without gout as others have demonstrated previously. Nevertheless, even when we took these factors into account, individuals with gout and elevated uric acid had higher death rates....Indeed, the unadjusted analysis confirmed that subjects with gout had a 4-fold risk of death and over a 5-fold risk of cardiovascular death. These findings just cannot be ignored.

The prevention of gout and its debilitating consequences is based on reducing serum uric acid concentrations below 300 µmol/L. Treatment is indicated when recurrent gout attacks (>2/year) or tophi are presented by the patients.=

Conclusion gout sufferer with untreated high blood urate is at a substantially higher risk of mortality than those without. A good part of that risk is cardiac, but there's also an increase risk in certain tumours and kidney issues. Gout is the first shot across the bows of mortality, it's a warning to look after yourself. Drink less alcohol, reduce weight, exercise more...and maybe - enjoy every day!

Alternatively you can take a few cherries and pineapple extract every day as advocated by many.

Here's the link I promised, but it will be vetted by the patient.info system to check it's not advertising I think:

http://www.news-medical.net/amp/news/20130726/Gout-uric-acid-levels-and-risk-of-death-an-interview-with-Professor-Austin-Stack-Graduate-Entry-Medical-School-University-of-Limerick.aspx

The first thing I picked up on was the blood test. Blood should not be taken for about 6 weeks after an attack. The average person on here probably knows twice what most GP's know, so don't presume everything the doctor tells you is correct. There are many myths about gout, and many reports contradict each other. You will find some posters on here disagree with each other on several points, and this is quite often based on their own experiences. I had 4 attacks in 3 months a year ago. I am now on 1 allupirinol a day, drink what I want and eat what I want (I am a vegi though). Some days my foot aches a bit, but I haven't had an attack since my body got settled with the drugs. I am afraid you will have to suck it and see. You may be lucky like me, or you may be one of those poor soles where nothing really works.

Good luck

And I must say that my experience is pretty much like yours. I take my 300 mg of allopurinol, I take the occasional colchecine and I get on with life. I try to drink more water than normal, and am especially careful when in the tropics. I eat meat and fish and anything that comes my way. I completely ignore if something is high purine or not - the allopurinol is breaking all purines down to something to what my kidneys can easily handle. I havent had anything more than a twinge in a long time. 

It is my belief that everyone could sort their gout as long as they can tolerate the allopurinol (and the overwhelming majority can) - it just take a bit of discipline to keep taking it in the first months when it triggers the attacks.

Yes, when I started on Allupirinol it triggered  a very bad attack, but I stuck with it and all was OK. I have to stay away from the Colchesine though, as all my internal organs desolve and come out of my bottom

Gotta laugh at that response. Glad you're on the road to recovery 

So Rusty. What you're saying is that people with untreated gout or people that don't follow the treatment are people that fall into that category of high mortality. Whereas the people that change their lifestyle and take treatment to reduce Uric Acid levels to an acceptable level are no longer suffering from gout and as such reduce that mortality risk?

 

The recommendation by NICE is that gout (two or more attacks in any 12 months, or tophi or other symptoms), should be treated aggressively, and the blood urate should be pushed down towards what is normal in a 20 year old (3ish) rather than the top of the normal as in most 40+ year old men.

Diet changes can reduce the blood urate by up to 1.5, but that won't bring it down to 3.5 - in many it will however stop the gout flares, but not the insidious inflation of the arteries.

The problem is that any urate lowering therapy (e.g. Allopurinol), is that (somewhat counterintuitive you), cause gout flares, which usually stop after a few months of treatment. The reason for the flares is that the there are stored pockets of urate in the tissue which slowly leak into the joints, causing flares before they are flushed out. This cleaning out process will eventually stop at which point the level of allopurinol can be reduced (to probably 100 mg). The standard flushing dose for most is 300 mg (still <50% of max dose). During the flushing it's a good idea to have some colchicine at hand - my experience is if I take one at the first twinge of gout, the attack never happens).

To return to your question- treated hyperuricemia reduces risk of heart attacks. It is however impossible to know if the treatment alone did it. As only 30% stick to the treatment long term, those that do may be the most health conscious - maybe they are the ones who buy a bike, and lose weight and get a bit fitter.

Oh - one side effect that everyone forgets is that it reduces LDH (bad cholesterol), so maybe that helps too. Reducing inflammation in the body is good and that probably helps.

All this stuff is a numbers game - we just have to go with what the science shows is best for most.

I personally- after a few slight issues in the first couple of months (initial tiredness cured after a few weeks, then stomach issue cured by hiding the tablet inside a bit of banana), after a couple of months it's a total non issue. I take 300mg allopurinol with breakfast and forget about gout. My blood urate is now low, down from 9, 10 or on one occasion 12.

Sorry this has dragged on.

an education and understanding go a long way to prevention and self-care I would say. With it being quite wide spread with no symptoms and such an increase in %mortality im surprised GPs don't check at the old 40yo service. 

 

I actually had a conversation with one (well several, but one was very frank) - I asked them why is there not a bigger thing made about gout ? And went as far as to suggest that if this were a disease mainly killing women then there would be a national campaign etc. His reply was that - that may be the case but to suggest there is any sexism involved would be a career damaging move. When I suggested that he had a moral obligation - he said that he does all he can within his professional organisation but as for going to the press - "I have a family to support." He also said that to suggest that GOs were not doing their jobs properly is criticism of other doctors and considered to be unprofessional. 

I suppose national campaigns for testicular and prostate cancer can't be classed as sexist then

There is another factors that he mentioned - the fact that gout hits older people, and suffers from being a bit of a joke, and there is still the hang over from the past where people including doctors who think its a lifestyle disease. The other factor he mentioned was that nobody has "gout" or "hyperuricemia" on a death certificate.

His point was that if this was a disease was killing so many programmes like Woman's Hour would be on to it.

As for example breast cancer and v prostate cancer. A man has a higher risk of prostate cancer  (15%) than a woman has of breast cancer (12%).  Yet the amount of money and research put into breast cancer is huge in comparison. In the UK there is a national breast screening programme but not a national prostate screening programme for example.  

I wonder why theres a slant towards the fairer sex? strange. Both me and @ross86462 are in our 30s