Latest gout attack - after effects

Thanks.

I'm hoping that my milder but more general joint pain is also because of uric acid. In which case (fingers crossed) it is related to my gout and medication may help.

Thanks. Very helpful.

Is the allopurinol medication permanent or do you come off it at some point?

My recent gout flare up subsided as usual, but this time left me with random milder joint pain. I say random because the pain seems to depend on what I've been doing. For example I went for a longer walk than usual yesterday, and now the bottom of my foot is painful.

I'm trying to keep my diet in check until I can see my doctor (I'm away at present).

Gout is caused by high  blood urate in turn caused in most casss  by the kidney not removing enough purines. This mainly happens in men over the age of 40, other classic victims tend to be overweight to obese and dont exercise enough. Of course there are the occasional 25 year old fit slim woman with gout, but she is an exception.

Gout is caused at the bottom level by too much purines. The allopurinol breaks down the purines  into a form which is more easily removed by the intestines and kidney. It is for life.

Diet is only 15% of the purines in most people. The exception would be if you only eat red meat in which case it might be 20%. The purines are caused by your body breaking down your own tissues as happens 24/7 as old cells are replaced. For a 75 kg person this breakdown is about 1.5 kg of our own flesh being replaced. This leads to purines, so as you can see your body makes the purines of 1.5kg of meat and you eat say only 200 Grammes. Even vegetarians get gout. 

Once on allopurinol the gout will recede but allopurinol as it clears out the stores of urate crystal in yourtissues it may trigger gout itself. It takes 3-33 months for most people to complete this process - the majority in the first year. You should be given colchicine as prophylaxis but many doctors are very poorly informed on gout and don’t bother to read the advice given them by the NICE. 

If you don’t get your blood urate down in the long term a host of disease risk are increased -  heart kidney intestines blood vessels all get problems. The allopurinol or other urate reduction therapy stop that long term degeneration. Be aware you need to get your urate down to 3-4 not under 6 as would be ok for a healthy man.  Many doctors don’t appreciate that.

Diet changes may reduce your urate down to where you don’t get gout, but will not reduce it to the point where these internal long term harms are not occurring. 

The best thing you can do to help your kidneys is

drink water

reduce alcohol

Reduce sugar

Cut out high fructose corn syrup 

Reduce BMI to under 25

Move a bit more than you do now

Drink even more water

Allopurinol is a life sentence but only like a type1 diabetic is sentenced to insulin. For the vast majority allopurinol is no problem at all.  

Again the best advice - drink more water! 

I suggest you stretch and do some warm ups before doing any type of extensive exercise this would include walking. I, too, suffer from mild joint pain but not from walking or jogging, because I do warm up & stretch before hand but because of old age mostly in my hands, a bit of arthritis and repetitive movements my wrists aren't exactly strong enough to handle. Be more gentle with yourself.

rustygecko, that's all good stuff, but I would add that anyone with gout should also learn which foods contain the most purines.  I can certainly cause myself an attack with just a couple of "bad" meals, if I am not also taking my drug of choice - which is celery seed rather than allopurinol.  Fish is my worst food, fresh fish or pickled herring. Canned salmon is apparently much lower in purines, it seems to be safe for me, in modest amounts.  Beer is also supposed to be really bad, but I've never been much of a beer drinker anyway.  And I caused my own first gout attack with - hummus!  Some authors doubt if vegetable-based purines can ever cause an attack, well I'm here to say, it caused one.  Of course I was nearly living on the stuff, but even so.

Yes, I concur, my once favorite food, pickled herring causes immediate accumulation of purines and with 24 hrs. I'm in excruciating pain. As for celery seed I've read some folks here say, it didn't work for them. Is there any medical research to support it works?

That is all very well and dandy. But you are addressing the gout and not the underlying disease. If you have had gout attacks and your blood irate is not very low, you are staring down the barrel of a heart attack 10 years down the road. Now, if you are 84 when you have your first attack that’s not such an issue. If however you get gout in your 40s it is.

The fact that food can trigger gout shows that your hyperuricemia is uncontrolled and you through diet etc are keeping your blood grate just below the level of gout flare, not keeping it at a healthy level.

Either way, good health. 

PS Do you have your blood irate tested regularly? What was the result?

There is some research on celery and celery seed, the active ingredient is the one that gives it the taste and smell, the short name is 3NB, it blocks the conversion of purines to uric acid, you can probably google for more.  Seems to be working for me taken in capsules, and it's also a nice spice for soups and other dishes, or you can eat about five stalks of celery if you prefer.

 

irate, is that the uric acid number?  I had my semi-annual blood test a few weeks ago and the doctor seemed happy, I have the papers around here some place.

?I eat a few mushrooms, a little hummus, a little red meat, virtually no fresh fish or pickled herring or beer.  And I still had an attack of what I took to be pseudo-gout, that seemed clearly unimpressed with the celery seed ... and got me to find this group.  I'd be curious how many other people have pseudo-gout attacks even while still on allopurinol, but there just doesn't seem to be a lot of real science available on it, at least not real cause or treatment.

Pseudo-gout, is just another form of arthritis. Could be related to rheumatoid arthritis too. What i found helps is glucosamine chondroitin, how or why it works I have no idea but when I feel it, I take the pills a day or 2 the pain is gone.

I picked up a bottle of glucosamine chondroitin after my last attack, if there's a next attack will be trying it.

RESULTS: Disease flare was seen in 28 (42%) of 66 placebo patients and 32 (45%) of 71 glucosamine patients (difference -3%; 95% confidence interval [95% CI] -19, 14; P = 0.76). In the Cox regression analysis, after adjustment for sex, study site, and OA radiographic severity, time to disease flare was not significantly different in the glucosamine compared with placebo group (hazard ratio of flare = 0.8; 95% CI 0.5, 1.4; P = 0.45). At final study visit, acetaminophen was used in 27% and 21% of placebo and glucosamine patients, respectively (P = 0.40), nonsteroidal antiinflammatory drugs were used in 29% and 30% (P = 0.92), and both were used in 20% and 21% (P = 0.84). No differences were found in severity of disease flare or other secondary outcomes between placebo and glucosamine patients.

This shows that patients when given the real glucosamine v placebo no difference.

rustygecko, thanks.  Is that for gout or pseudo-gout?  Well it probably doesn't matter, probably the same for both, and if it were that great a treatment you'd think it would already be well-known ... and yet I decided to fork out $10 to give it a shot, I just love being a one-man medical trial.  I have found enough alternative treatments that clearly work, within their limits, and yet are little known, that if something seems low-risk and low-cost enough, I often want to see it up close.  Still, what I'd really like is to leave the bottle unopened because I never again have an attack to experiment on!

Placebo works (strangely) even if you know the product is a placebo. So give it a go - it may reduce the pain even if it’s not really doing anything. The animal body is very strange.

How often do you get an attack?

Then maybe what I have is something unknown, because clearly when I take glucosamine for 2 days my aches and pains go away and I mean gout pain, arthritis pain, stiffness, inflammation and whatever else you can think of. We also all heal differently, good genes and good cells seem to heal faster.  If I take turmeric my inflammation goes down, if i take bromelain same thing, if i take a probiotic same thing and glucosamine, the best. Of course, quality makes a huge difference, I buy the best because when I used to buy the cheap or middle of the road stuff it doesn't work, its as if I barely took anything. They probably used the cheap stuff. 

Sorry

I meant urate not irate. The autocorrect changed it.

If someone is taking allopurinol they will still get gout attacks if they aren’t taking enough. The maximum dosage is 800mg. The experts are criticising GPS for not taking the bi annual checks seriously enough, not increasing the dose to stop attacks, and not appreciating the consequences. (At 17 years after being diagnosed heart problems increase by 60% in men; no change at all in women). 

To reiterate though - getting the urate down to say 5.9 is ok for a never-had-gout person. But for a gout victim it needs to be more like 4.0 (the level we were on in our 20s).

And it is well established that more expensive placebo treatments work better than cheap ones. 

hahahahha 

Don't even get me going on placebo readings in medical testing.  Heck, I even suspect that when I was a kid, a pediatrician gave me a placebo prescription for antihistamines.  A one-sample test is bad enough without worrying about placebo effects, I'm not about to double-blind myself!

I've had attacks about every two or three years since 1999, however since just a few weeks ago recognizing pseudo-gout as a separate condition, I have to go back in time and analyze which were real gout and which were probably pseudo-gout - or if they might just occur together or in close sequence.  In retrospect I think I have not had a real gout attack now in about five years, which I triggered with a couple of mistaken meals of fresh trout within a two-week period.  Since then I've watched my diet more and started taking celery seed, at first sporadically and now regularly.  I had what was probably a modest pseudo-gout attack a few months ago, and then this crazy neck thing a few weeks ago.  

Will have to get my last urate number, looks like it was not even on this latest blood test.  But as you point out most of the urate is metabolic, not diet, so I infer that the benefit from the 3NB is also wider than just affecting diet.  Of course I'd rather seen this worked out in detail on lab rats, but we just have to do what we can.

 

So how much do I have to pay for a placebo to get a full and permanent cure?