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Hi Chris, welcome to the gout forum. Everyone’s first post gets held for checking, but now that your first post is approved, others should appear immediately. Thank you very much for adding some information to your personal gout profile. That makes it much easier to respond, when I can quickly see some facts about you. When you get blood test results, please add them to your profile, and also add any prescription changes. Test results and medications history are invaluable information that helps everyone give better advice.
I’m really pleased that your doctor understands gout. The “around 300” target sounds about right, though better phrased as “no higher than 300mmol/L.” Of course, I’m guessing the scale used to measure your test results, but mmol/L seems the most likely. For most readers, the equivalent result is 5mg/dL which I always refer to as the upper safe limit. There’s more info about this in the right-hand sidebar below. Look for the multicolored table.
300mmol/L is a good target for maintenance treatment, but for the early stages of uric acid lowering, I would always aim lower, unless there are health complications that prevent this. That is why personal targets for uric acid are so important. They vary from person to person, and from time to time. As well as recording test results in your personal gout profile, it is good to add a note about your current target, and a history of target changes. I find that when you and your doctor agree a target, and review it until you reach stability, then you stand the best chance of getting gout completely under control.
That lays the foundation for a future of gout-free living, but you also have to plan for the early months of uric acid lowering treatment, until your gout is stable, and all gout inflammation has stopped.
A low uric acid target will reduce the period of time you are at risk from gout flares.
Maintaining fluid intake to avoid dehydration remains important.
Healthy eating can improve inflammation, especially if saturated fats are controlled. Unfortunately, there are no clear guidelines on controlling fat intake for gout. The overview is that you need to aim for good balance of unsaturated fats against saturated fats. I’m working on refining this for better specific food advice, but it’s a slow process. The point is that uric acid crystals alone do not cause gout attacks. The inflammation process needs Free Fatty Acids (FFAs) to provide the pain signal pathway. Most of the advice available about improving omega-3/omega-6 balance is relevant to gout sufferers, but might need some specific gout refinement.
All this is general advice, and doesn’t really answer your question about how soon you can get back to judo. As a non-medical website provider, I cannot give professional medical advice. That has to be your doctor’s job, as medical history and physical examination are vital.
In theory, there is no reason to avoid any physical activity with gout. Acute gout pain is an inflammatory response to uric acid crystals. You might not feel like exercise, and swelling might restrict mobility. However, unlike a sprain, resting the affected joint will not improve it, though it might feel better, especially if raised above heart level.
Unfortunately, untreated high uric acid is likely to have a joint weakening affect that is separate from the pain we experience as a gout flare. In your profile, Chris, you refer to “a few years” of gout. Every day of those few years may have contributed to weakened tendons, cartilage, and bone. I must stress that the degree of damage varies enormously from one gout sufferer to the next. You might be perfectly OK now, or you might need to wait for joints to recover with a few months of no uric acid crystals. Only a physical examination can tell, so please let your doctor take a look.
And just to emphasize how complicated it is to use herbal medicines for gout, take a look at http://www.ifrj.upm.edu.my/Article%20in%20Press/IFRJ-2010-271%20Parveen.pdf
This is a series of lab tests to see how various plant extracts inhibit xanthine oxidase. Again, it does not measure effects on gout patients. It only measures the potential for replacing allopurinol and Uloric with natural products. There can be many differences between what happens in a laboratory, and what happens in your body. However, this might serve as a guide if you want to try papaya for your gout.
The essence of this report, which compares various different parts of 5 different plants. Of these 5 plants, papaya was most effective, and the most effective extracts were derived from the leaves or unripe fruit peels.
@girish-kumar it would be great if you could share your experiences with your uric acid meter. It might help other gout sufferers who are thinking of buying a uric acid test kit.
That’s quite unbelievable, nokka. I’m glad they’ve come to their senses and arranged for your blood test. I hope the results are everything you want them to be.
Let this be a warning to other gout patients – you really must take control of your own gout treatment. Your health is too precious to risk poor treatment for any reason.
I agree with you, Girish. Though price is a factor, health is more important. It seems bad to me that your doctor prefers a medicine with no long track record. Also Uloric has a small risk of liver problems, which is why it is important to get Liver Function test at the same time as uric acid test.
I think you should ask your doctor to switch to allopurinol, and I would love to know why he did not suggest it in the first place.
Hi @nokka
It’s very good to hear from you again. I’m glad your gout is well under control.
I’m amazed at your doctor’s response. These days, medical management id focussed on prevention, which is a good thing. I thought all doctors encouraged annual checks. I certainly cannot imagine why a gout sufferer would go for longer than a year without a uric acid check. For anyone on allopurinol, febuxostat, or other uric acid lowering treatment, I believe Kidney Function and Liver Function tests are also important.
This is the best way to ensure that uric acid stays safe. In the unlikely event of an adverse reaction, the other tests will pickup any signs at an early stage.
This is so ingrained in my health beliefs that I can’t even remember where the recommendations for annual checks came from. Both UK practices that I have attended have made annual checks a routine where you go for blood tests, have a telephone interview, and only consult the GP in person if there are any issues. For the life of me, I cannot imagine why a period longer than a year would be suitable for anybody on daily medication – unless it’s cost-cutting at the risk of optimal healthcare.
I’d be interested to know why your doctor thinks it’s OK to go beyond a year. Does he think you should wait until serious ill health strikes before you bother him?
1. I do not think it is right to prescribe Uloric before allopurinol, unless there is some specific reason. It begs the question: why prescribe an expensive licensed drug before cheap generics. The ethics are widely debated on many drugs, not just these 2. In the end, I think your doctor has to justify his choice to avoid the accusation of profiteering.
2. I hope someone local can answer this.
3. Both types of cherries have helped, but neither have been shown to lower uric acid from 9.6 to 5.6. Ideally, you need to get down to 5, so I would recommend cherry juice with uric acid lowering medication, not instead of it. A generally healthy diet is always good for gout, and specific improvements, besides a higher than average cherry intake, include alkaline diet, skim milk, and plenty of fluids.
Hi @girish-kumar welcome to the gout forum. As this is your first response here, this question about a uric acid test meter was delayed for moderation. Your future messages should get posted immediately.
I have only used the UASure meter, and I found it to be accurate. I have not used the EasyTouch meter, but I have no reason to believe that it is not as useful. If I were planning on buying a meter today, I would look at availability and price of the test strips. Strips cannot be re-used, so you need to be certain you have access to however many you need.
Whichever meter you choose, you need to be prepared for a period of getting used to it. This means establishing a fixed routine for testing that you always follow.
I know this is not a clear recommendation, but I do not really think the brand matters that much. I know several visitors here have bought the EasyTouch brand, so I’d be very interested to see their comments.
OK, so the last result was 0.37 mmol/L. Now, I have a real ‘bee in my bonnet’ attitude to anything around the 0.40 range. Let’s say 0.36 to 0.44 for the sake of this, though a few points either side might be included. I don’t have an adequate name for this range, but for now, I’ll call it Gout Hell.
The danger of ‘forum medics’ is that anything I say here could easily be denounced by a specialist examination. I’m not offering medical advice, but I’m suggesting a situation that can and does happen. Your pain might be something else, so I have to recommend that you see your doctor if you are worried.
Back to Gout Hell. It happens in the range I mentioned. Every gout sufferer is different, so the Gout Hell range for uric acid will differ from person to person. The principles are:
1) Uric acid fluctuates naturally from day to day, and during the day.
2) At a certain point, crystals will form when uric acid gets too high. Again, the crystallization point varies from one person to the next.
3) Crystallization point is affected by uric acid concentration, temperature, and some other factors that scientists are still trying to isolate.
4) When crystals form, they are recognized as intruders, and attacked by the immune system, resulting in painful inflammation. The immune system creates a coating around the crystals, so they are no longer an immediate threat, and inflammation subsides naturally.
5) When crystals form, soluble uric acid levels fall. The mirror of this is uric acid levels rising as old crystals dissolve.
6) When crystals start to dissolve, the immune system coating tends to shed, so partially dissolved crystals are exposed to the immune system. This is the reaction we often hear about from people who start allopurinol or other uric acid lowering treatment. It is important to note that it is not a side-effect of any particular treatment. It is part of lowering uric acid, and it can happen in response to natural fluctuation, or diet improvement, as well as uric acid lowering medicine.Taking all these principles together, in the Gout Hell zone, you find a constant fluctuation of uric acid levels around the crystallization point. This means crystals are constantly dissolving and reforming, so you get continuous inflammation, and prolonged gout flares. These days, we are learning that this inflammation is made worse in the presence of certain fatty acids, but we do not yet have any clear guidance on how to reduce fatty acid related problems.
I’m not sure if any of this really helps, Mark, but it might explain what is happening to you. It might end tomorrow, or it might continue until you get uric acid under control. I don’t think anyone can predict. I certainly wouldn’t know what is the best thing to do now. It would be very easy to say: Start the allopurinol now, and get uric acid to 0.30mmol/L. Only you know if that is right for you.
“The more I move it during the day, the better it seems to get” That is exactly my experience also.
“this is the way it?s going to be from now until forever” I’d be optimistic and say this is the way it’s going to be until I get uric acid down to 0.30mmol/L (might be a few weeks after that, but I don’t want to suppress the optimism.
Exactly what is happening with the allopurinol? If you’ve started it, you are on the road to recovery. However, the first few weeks are the worst, as you have to start slowly increasing from 100mg/day. It’s a wonderful turning point after a few weeks at safe uric acid levels when you start to forget what gout pain feels like (poetic license – I know you never really forget)
You haven’t given us much information Joseph, so it’s hard to know what to say for the best.
Can I suggest you login and add some basic information to your profile. If you don’t know what to write, ask by replying to this. Essentially, it’s basic facts. When did you first have a gout attack? How many attacks have you had? If it’s more than you can count, then how many per year? What about uric acid? When were you last tested, and what are some recent results?
Also think if you injured your foot. Sometimes we think everything is down to gout, but it might be something else.
Most importantly, what does your doctor say? did he prescribe naproxen, or are you getting it Over The Counter?
There are lots of ways to get rid of gout pain quickly, but I need more information before I can help properly. Generally speaking, you will get better gout pain relief with a combination of pain relief medication. For more general information, see http://www.goutpal.com/gout-treatment/how-do-i-stop-gout-pain/
@melanie-nitto I wonder how your husband’s gout is progressing.
Can you persuade him to join here? He will get great advice on managing his gout in the best way that suits him. It seems a shame to wait for it to get worse before dealing with it. I did that to myself, and I regret the permanent joint damage that I could have avoided if I’d got gout under control sooner.
A lot of publicity is being generated by a recent gout study: Switching from allopurinol to febuxostat for the treatment of hyperuricemia and renal function in patients with chronic kidney disease
Febuxostat is the generic name for the Uloric brand. It’s sold around the world under various brand names, and it is an excellent second choice alternative to allopurinol. Let me describe the results, then I’ll explain why it is second choice, and when it is better.
The key findings from this gout and kidney disease study are:
The serum Uric Acid levels significantly decreased from 6.1 ? 1.0 to 5.7 ? 1.2 mg/dl in the febuxostat group and significantly increased from 6.2 ? 1.1 to 6.6 ? 1.1 mg/dl in the allopurinol group. […] Febuxostat reduced the serum Uric Acid levels and slowed the progression of renal [kidney] disease in our Chronic Kidney Disease cohort in comparison with allopurinol.
So does this mean that Uloric is better than allopurinol?
<!–more Continue reading Is Uloric better than allopurinol?–>
Given the stark choice of two crates of pills and a room full of gout patients, the answer is yes. In that artificial situation, I would have to recommend Uloric. But this does not account for:
- Cost – Allopurinol Wins
- Length of safety record – Allopurinol wins where genetic screening is done properly
- Patient profile
Patient profile is key to deciding if Uloric or allopurinol is best. This gout study deals exclusively with kidney disease sufferers with gout. This is a notoriously difficult group of patients to treat. The advantages that Uloric bring to this group are not necessarily representative of all gout patients.
Nonetheless, the study does give some important pointers to us. Actually, the pointers are there for rheumatologists. I believe that any gout patient who has complications such as chronic kidney disease should consult a rheumatologist. That rheumatologist can try allopurinol and Uloric at different times. He can assess uric acid, glomerular filtration rate, and other kidney and liver function test results. Then doctor and patient can make the right personal choice based on all factors.
Results of gout studies like this are good for giving us pointers to the best treatment options. But, there is never a best treatment for gout. What matters is the best treatment for each individual gout patient based on personal history and test results.
Do you have hidden gout?
I’ve just found more evidence of the dangers of high uric acid. The main danger being that high uric acid is not treated as a problem until gout attacks occur.
But modern advanced imaging techniques show that uric acid crystals start attacking joints long before we notice gout attacks. Browsing through my Gout Support Circles, I found a link to “Hidden gout- Ultrasound findings in patients with musculo-skeletal problems and hyperuricemia.” That gout study tells us:
Ultrasonographic gout-specific signs are not only found in joints affected by gout attacks, but often also in the corresponding contralateral, asymptomatic joint. Patients with asymptomatic hyperuricemia already showed sonographic features implicating an as yet ‘silent’ precipitation of urate crystals.
Ultrasound is one imaging technology that is easily accessible for most gout patients. If you have experience of ultrasound for your gout diagnosis or treatment, please share your story here.
“Also, I?m one of those people who simply cannot go to sleep on their back unfortunately!”
I think you are very fortunate with that. Sleep apnea is very complicated, but for me, I stopped it by training myself to sleep on my front or side. That was in my early days with GoutPal when someone (Burt?) brought up the subject in relation to gout. I hadn’t realised until then, and I still don’t know if there is a link between sleep apnea and gout, but I sure do feel safer sleeping and breathing.
I’m glad the co-codamol is helping, Mark. Gout itself is bad enough, but gout and no sleep is worse.
Good news on the doctor front, Mark. Looks like you’ve found a good one there, and have a good chance of controlling your gout.
The pain at night thing is tricky. I have a couple of half-baked theories, but I can’t find any solid explanations. Though pain at night is emphasized in many gout studies, I have only found one that offers explanation. Hart’s “Pain patterns in the rheumatic disorders” suggests that one reason may be lack of distraction. That ties in with one of my theories. During the day, I am always busy. Before I got my gout under control, If I woke with gout pain, I found I didn’t notice it so much if I read for a while.
The other thing I found was the keeping warm that I mentioned earlier. Not heat, but an emphasis on lack of cold. Gout in the foot – wear thick socks. Gout in the knee – get the long-johns on. I never did any score keeping with or without these interventions. I’m a great believer in scientific research, but I have my limits when it come to the tedium of record keeping.
To @kipper it sounds like you may have had episodes of gout, but it appears to be under control. In that case, blood tests at leas once a year to monitor uric acid are a great idea. I look forward to your update in 2 months.
@donkeyfumbler I’ve been thinking about your statement: “I?m not sure why it suddenly flared up again after a pain-free night the night before, though I suspect that the hot bath I had before bed was the cause ? like the warm wheat bag before, I suspect that suddenly warming up my foot is not a good idea.”
I’ve seen other references to heat being bad for inflammation, and I’m going to investigate this further. I’m thinking that it is probably best to simply keep joints at normal body temperature. I.e avoid cold where possible, but not artificially raise temperature. There is an argument about applying ice. It should definitely reduce swelling and therefor ease pain. Personally, I’m against icing because it creates an environment where uric acid crystals are more likely to form. People must make there own choice on this, as pain relief in this situation might be more important than a temporary increase in uric acid crystals. That temporary increase is unlikely to make pain worse, so it definitely a personal choice.
Sorry if anything I’ve written earlier is confusing on the heat v cold issue. I think I need to review my guidelines and make sure they are fair.
We’re all learning!
Hey @kipper – thank you for posting. I can see a bit of potential confusion there, so I hope I can clarify.
USA scales for uric acid tests are in mg/dL. This is the scale I use most because most of my visitors are from America. If I’m in the middle of a conversation, I often omit the scale, but the scale is vital. In this conversation, I am mainly using mmol/L, which is the common scale in Britain and Australia. There is a factor to use to convert between the different scales which is roughly 0.6 when going from mg/dL to mmol/L. The most important number is 5 mg/dL which is 0.30 mmol/L.
0.30 mmol/L is the safe upper limit for a gout patient. Because I keep emphasising 5 mg/dL as the upper limit, occasionally people confuse this with 0.50 mmol/L. They see their results similar to your earlier results, ie less than 0.5 and think it’s OK, but it is actually very bad.
The situation is made worse by labs that issue reference ranges. Doctors who don’t know gout, don’t understand that these reference ranges are statistical *not* medical. Hence my rant aimed at Mark’s doctor who thinks that only values over 0.42 are serious. In many ways, around 0.40 mmol/L (around 7mg/dL) is just about the worst uric acid level anyone can have. It is at that sort of level where you get a constant barrage of new crystals forming and old crystals partially dissolving. Your immune system is in a constant state of alert, and painful inflammation can last for weeks.
0.30 mmol/L is now accepted as the safe upper limit because it gives a safety margin before the crystallisation point is reached. The way that uric acid crystals form is the result of many factors. In the lab it is 0.40 mmol/L, but in the wild, it is very easy for crystals to form below that.
Many use the midway point as a cutoff, but this is more down to historic practice rather than current scientific knowledge. I think that little gout calculator would make more sense if it used the lower limit of 0.30 rather than 0.35. The main point to understand is there is not really a fixed cut-off point for uric acid crystals to form. Some people can have very high blood levels, and no trace of crystals, but these are exceptions.
I think it is best to play safe, and assume anything over 0.3 mmol/L (5mg/dL) is gout. This is an effective level for diagnosis and for treatment. The only thing I would add is, if uric acid is between 0.3 and 0.4 mmol/L at diagnosis stage, I would recommend lifestyle changes before medication. That is in addition to a review of other medicines, which is always important before starting uric acid lowering treatment.
Wow, I love your positive response, Mark.
I have to admit to a certain amount of pride in my previous reply. It prompted me to write Doctor, do I have gout?
I’m obviously worried about how this will turn out for you, but I also worry about the thousands of other people in similar situations. You’ve doubled my resolve to work harder to get the message out. Professional rheumatologists have most of the answers for tackling the gout epidemic. We just need to make sure everyone looks in the right place and asks the right questions.
I guess we also need to make sure they get the right answers.
Mark, I’m absolutely gutted for you. You have one of the doctors who does not understand gout. I’ll refrain from ranting about the idiocy of a doctor who thinks like this. Does he have similar outdated cut-offs that declare lack of interest for other patients? Does he say come back in 6 months because you are only a little bit pregnant, or only have a little bit of cancer? Oops, I didn’t refrain from ranting, did I?
I am certain that you have gout. I believe your attacks were triggered by the trauma of hockey field incidents. I believe you have had a slow buildup of uric acid crystals over many years. I believe your gout will get worse unless something is done to get your uric acid down to 0.30. If this is in doubt, the next stage is a joint fluid analysis at a rheumatologist who has immediate access to polarizing microscopy. Immediate access is important because uric acid crystals dissolve if there is any delay between sample draw and analysis.
Anyway, the good news is that I’ve been in exactly the same situation, so I have a way out of this. To set the scene, I should point out that I attend a group practice with online appointment booking. It allows me to avoid doctors who behave like this. Other people on the forum have reported that they just educate their doctor until they get what they want. I’ll tell you my story, and hope that others who have faced this will join in with their experiences. I’m going to talk British for a while, then switch to American at the end.
When I first got a similar response, I was half expecting it, but not fully prepared with the correct references. I was a little flustered, but I pointed out that .42 is a only lab statistic. It is based on sampling from all blood tests processed by the lab in the period it set it’s reference ranges. Those samples include people with gout, so the value is meaningless. I’ve since refined this to also point out that the crystallisation point of uric acid at normal body temperature is 0.4 mmol/L, but joints are usually lower temperature, especially at the extremities (feet and hands).
I then went on to point out that the upper limit according to British Rheumatology Guidelines is 0.30 mmol/L. In my situation, I was determined to start allopurinol treatment, and I got my way with the 100mg starter dose.
Allopurinol has to be started at 100mg as a safety check, then increased until target uric acid level is reached. I had to make a follow-up appointment for dosage review, but I chose a different doctor. According to him, dose was probably OK as I was “not too high.” I repeated my explanation and was told to go to 200mg allopurinol daily. I had a similar situation with my next follow-up, again with a different doctor. I was fearing a real challenge with my fourth doctor, but he actually listened and agreed with me. Dr Chambers is a superstar amongst doctors.
Mark, I really feel sorry that you’ve been let down like this. I know how I felt when my confidence in my doctors was broken. I console myself with the knowledge that doctors have to deal with thousands of diseases, and can’t be expected to be up-to-date on all of them. My experience that 3 out of 4 doctors do not understand gout is borne out in several studies.
It’s now up to you how you want to deal with this. Most doctors are very opposed to patients telling them what they have read on the Internet. I avoided any mention of the word, and just said that the upper limit from British Rheumatology guidelines is 0.30, that the lab statistic was meaningless, and that I wanted my allopurinol. Maybe 1 of the 3 wrong doctors took trouble to check the guidelines and update their procedures. Maybe they left notes on my record. I don’t know that, but I got what I wanted.
In my case, I’d already allowed years of gout to damage me, so I knew I had to take allopurinol immediately. The highest target is the aforementioned 0.30 mmol/L, but I wanted to go lower for at least a year to get rid of old uric acid crystals faster.
Your case, Mark, is obviously very different. If you want links to the facts about uric acid levels, I can give you them. If you want to explore lifestyle adjustments, I can give you help with that. If you want a better explanation of anything I’ve written here, I can try to do that also. Let me know how you want to prepare for your doctor’s appointment, and I’ll try to give you all the help I can.
I’ll finish with a note to my American friends who are reading this. Gout is the same in UK or USA. USA has a uric acid crystallization point at normal body temperature of 6.8 mg/dL. That means anything over 6 is dangerous, and your upper limit for safety is 5. The American Rheumatology guidelines match the British in most respects. The numbers are a different scale, but the principles are the same. 3 out of 4 of you will not get the right advice from your doctor, so you either control it yourself, or allow your joints and organs to be slowly destroyed.
One of my reservations about the calculator was ‘Onset within 1 day’ as it does not appear to change anything. Looki9ng at the code, it is only makes a fraction of a percent difference. As the result is rounded to whole percentage points, you do not see the difference. There might be some combination of factors that cause the result to change by 1%, but this is not a factor to worry about.
OK, I didn’t check the ‘Joint redness’ so that accounts from the increase from 40% to 50%. All that means is that on current knowledge, there is a 50:50 chance that you have gout. I think the only sensible signal that generates is to get a certain figure so we know if your real risk is 86% or 50%.
If it’s 50%, you have to see a rheumatologist, in my opinion. The treatment for gout would be to lower uric acid to below that limit, so it would not apply. By the way, my recommendation is because gout is really all I know about medically. A qualified doctor might be able to suggest a better specialist. This decision might be tempered if your uric acid is only just below that level. A cheaper alternative to referral to a specialist might be another blood test in 2 weeks if there are doubts.
If it’s 86%, I would treat it as gout. Get uric acid down to .3mmol/L and assume the problem is fixed, unless it recurs.
There are nuances to uric acid levels that make treatment very personal. It’s easy for me to imagine many different possible scenarios. The only thing that makes sense is to consider the possibilities when we know the exact uric acid figure now, and also what it was from previous tests.
The onset within one day seems to have no effect. I can’t understand why it is included if it makes no difference, but I haven’t had chance to check the calculation yet. Because it is just pulled from the authors website, it is difficult for me to match the calculation to the original report. All it means is did the pain go from nothing to extreme within one day. What you describe in step 3 of your original post indicates this is the case. It’s certainly a common factor in gout, but I don’t know the profile of the other types of arthritis that it could be.
(update: do not worry about onset within 1 day: https://gout-pal.com/gout-pal-forum/please-help-my-gout/gout-calculator/#post-17476 )
This is where a rheumatologist is useful. As they can test for pseudogout and septic arthritis, they can rule on some of the other possibilities. I know nothing about psoriatic arthritis, which is another possibility, except that it is usually accompanied by scaly skin.
The data that was used to generate that calculator has been published in various journals and scientific meetings. The most high profile is Rheumatology journal in August 2014 titled: The validation of a diagnostic rule for gout without joint fluid analysis.
The abstract is widely available, but the full report is expensive. If anyone has a full version of the report, I’d love to see the exact values on which the calculations have been based. Also, there might be explanations about my reservations about the calculator. Does the report consider menopause? Also, there is the emphasis on big toe involvement, but this can be lifestyle specific. The big toe is the coldest large joint for most people, but lifestyle, environment, or work factors make other joints more important risk factors for some people.
This post prompted me to find the gout calculator, I just described at https://gout-pal.com/gout-pal-forum/please-help-my-gout/gout-calculator/
From the facts I could muster from this case, it gives a 40% chance of gout. It will be interesting to see how actual uric acid test values affect that calculation.
Cool diagnostic tool for gout. I am a male, and checked all factors except for big toe (MTP1 involvement). My calculated risk for gout with those symptoms is 79%.
I don?t think the warm wheat bag would make pain worse. They?ve always had the opposite effect in my experience. Keeping exposed joints warm is particularly important for gout sufferers. I used to rely on bed socks. As the weather gets colder, avoiding temperature drops, particularly in feet and hands is important.
I’m looking forward to seeing your uric acid blood test results.
The needles are very fine. I actually said something along the lines of “When will you start” and the response was “It’s done, you can go now and I’ll see you with the results soon”
Your thoughts about trauma causing gout are similar to mine. It’s certainly plausible. [pause while I look for more info]
It’s difficult to find information about the time between injury and gout attack. There is an interesting diagram that I’ve tried to attach here. It’s from “Revisiting the pathogenesis of podagra: why does gout target the foot?” at http://www.jfootankleres.com/content/4/1/13
If you already have uric acid crystal in your joints, trauma can activate them, but I would imagine that would be within a few hours. The other factors that the report cites may well take a few days. Of course, none of these situations are possible if uric acid has never been above 0.30 mmol/L
What really bugs you, also really bugs me. I guess this is not an appropriate time to joke, but when did that stop me. What your doc should really be asking is “When are you going to learn to play hockey properly?”
Sorry.
I look forward to reading your results. Please ask for all your uric acid test results history. 3 out of 4 doctors cannot interpret those results properly.
By the way, Mark, as you are probably in the UK I should clarify “A very quick and painless joint fluid test revealed the gout.”
The joint fluid test was definitely painless. Though it’s true that the test itself was also quick, the 4 day wait in an NHS hospital was not!
Welcome to the gout forum @donkeyfumbler
Your situation matches similar experiences from many other gout forum members over the years. Gout diagnosis is very simple for many people, but when it isn’t, it is often really difficult to get the right answers.
The best option, when either diagnosis or treatment is complicated, is to see a rheumatologist. In my situation, at least my doctor had the sense to send me for x-rays to check for physical joint damage. When radiologists found nothing, they put me under the care of the rheumatology team. A very quick and painless joint fluid test revealed the gout.
If your suspicions are correct, x-ray or ultrasound would probably reveal the damage. So, the first question for your doctor on Friday is “Why didn’t you send me for an x-ray?”
You’ve made some references to your uric acid as “not high” and “low.” These descriptions are not very useful, though some doctors insist on using them. The actual number is vital. Anything over 0.35mmol/L is bad, but bear in mind that uric acid in the blood often falls during a gout attack. I don’t know what an acceptable value is during an attack. If gout is suspected, it is best to get tested as often as your doctor feels is necessary, and at least once a year.
The second question for your doctor on Friday is “What is my uric acid test result number and scale?” You can compare this to the multicolored table “Stop Gout With Safe Uric Acid Levels” below in the right sidebar. That also shows the different scales used by different labs, and links out to more information about uric acid levels.
I agree with you that it seems unlikely that this is gout, but I’d have more confidence if I knew your exact results. Trauma can trigger gout attacks, but I really can’t understand why you haven’t been sent for x-rays.
Please let us know what happens on Friday.
Gout never really goes away. The uric acid crystals that cause gout attacks build up slowly over many months and years.
These cause gout attacks at random intervals, often triggered by saturated fats. Attacks get worse as uric acid crystals spread into more joints. This must be stopped because uric acid crystals will destroy joints and spread into soft tissues if uric acid is not made safe. When allopurinol, or other treatment lowers uric acid in the blood, old crystals start to dissolve, and this can lead to a gout attack.
Treatment is in two halves – allopurinol for lowering uric acid and pain control to beat the inflammation.
Allopurinol is only any good if it lowers uric acid to 5mg/dL or below. Your husband should have a blood test booked for around Monday 13th October for first follow-up blood test. Increase allopurinol if safe target not reached. Repeat the test and dose adjustment every 2 weeks until uric acid is stable below 5. If your husband has had gout for several years, I highly recommend aiming as low as possible for one year to get rid of old crystals as fast as possible. Once most of the old crystals have dissolved, gout will not return.
Whilst crystals exist, there is a risk of a gout attack. There are lots of things you can do to avoid this.
Pain relief
Colcrys (colchicine) is only worth taking before an attack, or at the very first sign. It does nothing for pain, but it does slow the spread of inflammation. When starting allopurinol, or changing dose, my doctor advised daily colchicine as a preventative for two weeks.Where Colcrys is too late, or insufficient, anti-inflammatory meds are required. This must be prescribed at gout strength for severe attacks. OTC dose is only good for mild/medium gout attacks.
In the worst cases, seek medical advice on alternating anti-inflammatory with a compatible pain blocker. Your doctor or pharmacist can say what will work with your chosen anti-inflammatory.
Other actions:
Keep hydrated – fluid intake should be sufficient to maintain pale straw colored urine. Skim milk may help reduce exposure to attacks.
Concentrated cherry juice helps some people. Others swear by black bean broth http://www.goutpal.com/1700/natural-remedy-for-gout/
Avoid cold – keep affected joints warm.
Avoid saturated fats
@melanie-nitto I really hope this helps. If you or your husband need clarification, please reply. Future replies should get posted immediately, now that your first post is approved. And sorry for my garbled Facebook message. My keyboard kept going haywire – very frustrating.
