I've had 'gout' for a year now - advice needed regarding medication

My consultant rheumatologist told me gout was only perhaps 20% lifestyle/diet related.

I suggest you wait for next attack and make a judgement then.

I've been on allopurinol for years... suits me... and I believe side effects are rare.

Your diet has nothing to do with level of blood urate. It is your (genes x age).  Most of the purines you have in your blood each day are caused by your body recycling dead cells - the equivalent of eating a couple of kilos of meat a day - I m sure your meat consumption is tiny compared to that. Even vegetarians regularly get gout.

Your doctors are giving you the correct advice. 

If you do not reduce your blood urate then you are looking at heart attack/kidney disease/stroke ten years down the line. Allopurinol has the added side effect of reducing cholesterol. Most people on allopurinol have no problems, but there is a period of adjustment for some people. Secondly, allopurinol (or any other urate-lowering therapy), has the effect of causing gout attacks as the stores of monosodium urate are flushed from the body. You can take colchicine as prophylaxis.  

Good health.

The doctors did say that cholesterol becomes a concern but they had tested that in my bloods and it was currently perfectly normal.

Part of my worry is that I've read a bit about protein being bad for gout, but I've been trying to consume more protein to aid my recovery with running.

I'm tempted to buy a uric acid portable tester, and start to take weekly readings - then alter things slightly to see if I can alter it (increase water intake, try lemon juice / cherry juice etc)

I do eat beef, chicken, pork etc. Our most common meat is chicken. I eat a little bit of things that can be triggers (tuna, brown bread etc.) I also do things that you would think would trigger it like having a night out (once in a blue moon) and having a good few drinks.

What do you think to the idea of the tester? It's a bit pricey at about £50 with 25 strips but if I'm only testing once a week then it is only £2 a week. Just thinking that way I can see if I can see patterns and see if I can get a gradual downward trend on the level over this next year.

I also don't fully understand the crystals, obviously when I was in excruciating pain, the crystals were in the joint and they were crippling me. My uric acid levels are relatively high at the moment at 517 - does that mean there are crystals somewhere in my body now? Or will there be a uric acid level where my body gets overwhelmed and then starts to create the crystals?

OK - high blood urate (hyperuricemia) is caused in most people by your kidney not getting rid of your uric acid (uric acid is formed by the break down of purines and purines come in DNA of everything - but most in meats fish etc). However.... catabolism (the break down of the dead/old/diseased tissues), is something like a couple of kilos a day of meat in a 80 kg man... now there is no way (I assume) that you are eating anything like that amount of meat in your diet. Your diet will not change your blood urate level, unless you are an alcoholic or doing something else very strange)...I have asked several leading experts on this - why do doctors give advice on diet? They replied that in the past it was believed that diet was a factor, but now, it is given out partly as tradition, but also because patients feel better if they believe that they have some control of their disease. Furthermore, there are some triggers in some patients (eg sardines is well known, and I think mushrooms might be too for some people)... 

Are there store of monosodium urate in your blood? The answer is yes. When the urate crystalises the body attacks it - thinking its a virus (its the right size and shape) - it's this white cell attack that causes the pain and does damage throughout the body. To get rid of the crystals the body "buries" them under a layer of protein all over the body. When you take allopurinol of febuxostat the blood urate falls. The body "realises" low blood urate means that the crystals can be dug up and released into the body. When they are released there is a time before they dissolve (and kidney flushed), and during that time there is a chance of an attack. However, every day that goes past some of this stuff is being flushed out and quite quickly its gone (can take up to 60 months but the vast majority its - I forget - its something like 3-12 months for most of us). 

**** The fact of having one attack is a reason for optimism *** some people never have another attack so, in that case, suck it and see - see if you are one of the lucky ones. However, the chances are against you - unless you had the attack through dehydration during an endurance run for example.  High blood urate will cause damage - long term - over a decade or more - not a year. 

I'm afraid fit and healthy is not a good sign. If you were horribly fat and an unhealthy alcoholic there is perhaps a chance that becoming fit and healthy might help - but you don't have that option.

Good health!  

I've been running since 2015, but did long bike rides for the 5 or so years before that. Rides of up to 100 miles. Before that I played basketball.

So I've been fit and healthy for the last 10 years, and wasn't really unhealthy before that. I was never overweight but didn't do a great deal other than walking between the ages of 20 and 25.

The only thing I can say that I was bad for was getting dehydrated. I've always sweated more than my friend when running out cycling but I'm normally quite good at rehydrating when exercising. However my one bad point was drinking at work. I changed jobs about 6 years ago and now have the kind of job where you are extremely busy. It is very easy to forget to ever have a drink or get chance to go to the toilet. I had the gout attack and that was the main thing I changed. I bought a half gallon water bottle so I could easily track how much I drank throughout the day and space it out evenly. Drinking more forced me to go to the toilet at work and got me into the habit.

I might be lucky and never have another attack again but even so if my uric acid levels remain high then I don't want to be causing other things to happen. So if that is the case even without any more gout attacks I still need to address the uric acid levels. If that can't realistically be done through diet then I don't see that I have much in the way of options other than the pills everyday for the rest of my life.

If it did not start in the classic location, your big toe, then it is entirely possible it is not gout but "pseudo-gout" which is caused by calcium rather than uric acid.  Even with high numbers.  Pseudo-gout does not cause that "hot" feeling, it causes less swelling, and it attacks other joints.  There are neither dietary guidelines nor effective medicines for it, other than NSAIDs and time, and maybe water.  It is possible that the high urates make you more susceptible to the pseudo-variety but it will not respond directly to gout medicines.  Short of biopsy I'm not sure there is any sure way of telling what you really have, but I believe the pseudo-gout is given short shrift by most doctors.  Just thought I'd complicate your life a bit.

It started off without the heat but ended up with lots of heat and lots of swelling. I remember putting ice on, after fifteen minutes you'd take the ice off and it still felt hot.

No history of gout from any known relatives.

I still eat food with high purines. I looked at the list a year ago and decided I didn't eat an excess of any of them so carried on just fixing the hydration issue as that was the only problem I could see. As I had no further attacks I presumed I had fixed the issue. It was only this blood test that led me to realise that the underlying issue is still there. I guess I don't really know but my uric acid levels may have been high like this for my whole life and if I hadn't had that one attack I would be completely unaware that the levels were high now.