I've had 'gout' for a year now - advice needed regarding medication
Posted , 7 users are following.
Quick bit of history...
One year ago I had a gout attack in my left ankle - came on in the middle of the night. Initially it was extremely painful (couldn't walk without crutches), but there was no redness or heat from the area so the doctor dismissed gout and sent me for an x-ray as they thought I'd broken it. X-ray came back clear and by this point my ankle was hot so they sent me for blood tests. Gout was confirmed by high levels of Uric acid.
I was given a dose of Naproxen, within a day or so it got better and I could walk again. I finished the dose which was perhaps 2 weeks and by this point there was just a bit of pain in my ankle when rotating it round but I could walk again. I lasted about a day or so without the tablets before it came back in the night, I got a repeat prescription quickly and took them the next day and it went pretty much straight away. I took the dose which again was 2 weeks and went back to the doctors. They prescribed me another dose but asked me to not take them until it started again. 1 year later I still have the unopened packet of Naproxen as it never came back again.
They have just sent me for blood tests again and have phoned to say that I still have high levels and they'd like to put me on Allopurinol to lower it - they want to start at 100mg and then increase it after a couple of weeks. They told me the limit for Uric acid was 360 and mine was 517.
I eat healthily and exercise regularly - I run at least 50 miles a month and do quite a few half marathons.
Since I had gout I only normally drink water - I drink over 2L of water every day. The only time I drink anything else is when out for a meal etc. I do drink alcohol but it is very infrequent, I might have 5 or 6 drinks perhaps 4 times a year - I don't drink at home (unless we have a party) (boring I know!) To make a good guess I reckon all but 1 day a month, all I drink is water. In the last few weeks I've been training hard for a run that is coming up so I have also been drinking protein recovery shakes which I have found have helped with recovery for my calf muscles. I have drunk one of these after a hard run (600ml) in addition to the at least 2L of water I drink every day.
I have declined the Allopurinol for now, partly due to the fact that I have this run coming up in a few weeks and don't want the risk of the tablets upsetting things. And partly as I wanted to research it more first.
The Doctor gave me the impression that given my diet and the fact that I drink plenty of water, that they don't think that I could lower my levels through a change of diet.
I also mentioned that during the past year I've had moments where if it was diet, then I would have thought I'd have triggered it (All inclusive holiday for a week - where I ate far too much and drank alcohol every day).
So they don't think it is diet related but said that it could push it over the edge. Before I had gout, I often didn't drink enough during the day at work and didn't go to the toilet at work. So that has been my biggest change since having the attack.
I'd more or less forgotten about it given that I've not even had a twinge since (the ankle continued to hurt when running for a couple of months but I put that down to damage the crystals had done) - but that has all gone now and I get no pain from it. I kind of hoped the blood test would say the levels were normal now and I could forget about it.
I don't really want to go on to the tablets and the doctors have given me the option to leave it for a year and see what happens over this year. I'm down for annual blood tests for life now. However I'm just concerned about whether or not the high uric acid levels will cause any long term damage?
If it helps I'm Male and 35. Otherwise fit and healthy.
Has anyone got any advice regarding the medication given that I have only had one attack? Most people seem to have had multiple attacks when I've read up about it.
0 likes, 36 replies
matt16522
Posted
Unfortunately a relatively small family makes it difficult as it gives me a small sample size. I can fairly comprehensively say that nobody in the previous 3 generations before me on my mother's side and 2 generations before me on my father's side has ever had gout or related symptoms.
No heart problems either from the above generations, everyone living into their 80s, 90s and even 100s. Only one relative who only made it into her 70s but she died of cancer.
rustygecko matt16522
Posted
bruce13593 matt16522
Posted
I am not a physician, nor do I have a "Dog In This Fight" other than I suffer from gout 1 or 2 times a year. I have read on other forums that baking soda helps, but I have found that barley grass pills or powder give almost immediate relief. I think it has something to do with balancing the acidity levels in your body. I have the traditional big toe type. Upon the first symptoms I take 2 Advil and 6-8 Barley Green pills. I have used the powder as well, but it doesn't taste that great. I usually mix the powder with V8 to tolerate the dry taste. I think barley grass is harmless, but again I am not a physician. The only reason I am writing is because I suffered a bout this morning and I went on the web to see if this was a common treatment. I believe it is simple and safe and I have had no problems. Good Luck!
matt16522
Posted
Going to leave any decision until after the run I am training for in a few weeks.
Will probably end up giving the medication a try.
matt16522
Posted
Sorry but one more question!
I've switched my research to reading about hyperuricemia instead as that is the underlying cause of why I got gout. However that has led me to more confusion.
When reading about hyperuricemia, it appears that normal uric acid levels for a male are between 3.4 and 7 mg/dL. One site I was looking at said that crystals start to form when the uric acid rises above 7mg/dL.
I might be making an error in my conversion but converting 7mg/dL to µmol gives me 533µmol. Now presuming I'm converting to the correct units as I was only told my level was 517. Then wouldn't I actually be within the normal level? Albeit close to the upper limit?
Or have I missed something vital in this? Or is the information I'm reading about hyperuricemia not valid?
matt16522
Posted
Ok another conversion tool gives me 416 for the conversion from 7.
Another site is more specific and states the upper limit at 6.8 which works out at more or less the 400 I've seen. So my values are high.
rustygecko matt16522
Posted
BUT.... was the test taken while you had gout symptoms or within a few weeks of an attack? If yes - that result is very high.
The upper limit should be 6.9 I think because at that point crystals start to form (depending on body temperature).
Second, European Guidelines suggest serum uric acid levels ≤ 6 mg/dL in people having chronic hyperuricemia with urate deposition. You are above that level.
Reading about hyperuricemia is the way to go in my opinion; gout is a symptom.
matt16522 rustygecko
Posted
I have no idea what the readings were the rest of the time.
rustygecko matt16522
Posted
8.7 = 518
IMO too High.
You seem to have hyperuricemia. To be diagnosed as having gout in the UK you have to have two attacks in 12 months. Hyperuricemia (as I m sure you have read) causes generalised inflammation with all the *long-term* complications. You will have to make up your mind whether you can control it by diet or whether you are prepared to take a drug for the rest of your life. You have time though to think about it and see how it pans out over the next year or so.
matt16522
Posted
So technically I don't have gout yet? Unless they counted the fact that as soon as I stopped taking the tablets to start with it flared back up again but stopped again with extra tablets. Anyway that is irrelevant, you mention generalised inflammation, is that something I should be showing signs of now? As I say I'm not showing any symptoms other than the high uric acid reading in my blood.
rustygecko matt16522
Posted
Inflammation is not something we'd be aware of - it's happening in our arteries in particular but also other organs - we'd never know.
According to the *UK* definition - you don't have gout that they would recommend treating (it is probably different elsewhere). Here they require 2 attacks in 1 year.
As I said, with you, you are young and you have time to watch and see. Probably gout will come back, but you have to make the decision if you d like to cut the high blood urate or not, but at 35 you have time.
matt16522
Posted
I'm in the UK, interestingly so far the doctors have only called it gout and they've never mentioned hyperuricemia. Obviously they did say that I had high uric acid levels though.
rustygecko matt16522
Posted
They don’t talk about hyperuricemia because they think the great unwashed don’t understand them. In fact, using that kind of vocabulary helps your relationship with your doctor because they appreciate you using their argot and tend to see you more as one of them.
The second reason is that until very recently hyperuricemia wasn’t seen as clinically significant per se.
As to why your GP has prescribed Febuxostat instead of allopurinol - a mystery, but it is one of the problems of the NHS. The NICE exists to look at the latest research and keep GPs up to date. They are also there to stop drug company reps from “influencing” doctors into prescribing expensive but unnecessary drugs. As for allopurinol not being to lower blood urate - I guess a drug company rep has got to the pharmacist too.
If you go to NICE gout management online you can see their recommendations and the reasons. They instruct doctors that only consider gout after second attack; use allopurinol for long term management (reason allopurinol is very well understood and stupidly cheap, Febuxostat is new, ridiculously expensive and no better). Febuxostat is to be used for second level management for the under 2% who cannot tolerate allopurinol. It’s people like your GP that bankrupt the NHS: every time he prescribes Febuxostat instead of allopurinol it costs the taxpayer £2,000 for nothing.
As I said the recommendations of NICE are online for anyone to see.
matt16522 rustygecko
Posted
My doctor hasn't prescribed anything yet. I was on naproxen to get rid of the gout but since then I've not had anything. Febuxostat wasn't mentioned. The doctor wants to prescribe allopurinol.
I got my home tester today and just have it a quick try 8.8 is my current reading which I think works out slightly higher than 517 but in a similar region. Will now so if I can reduce it at all.
marat01648 rustygecko
Posted
You seem to be very knowledgeable about gout. My brother and I have been suffering from gout attacks for about 15 years. I’m currently 47 years of age. My uric acid levels range between 7-10. I’ve made a commitment to try to reduce my uric acid levels by a strict diet. In case that does not work and I have to start medication, what are your thoughts about Allopurinol vs Urolic? If you had to take one, which one would you take? Also, in your opinion, do you believe that uric acid levels can be reduced to a normal level through a very strict diet?