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Hi,
Sure, attacks sometimes last a long time. But I obviously can’t tell if what you’re suffering from right now is gout as you suspect or something else.
The longer you have untreated gout, the more likely you are to get constant attacks or very long attacks. If your gout is untreated as I suspect, consider seeking treatment!Hi,
Most of the pain specific to a gout flareup is directly or indirectly attributable to an autoimmune process which we might also call inflammation.
This may be triggered by crystal formation but I would instead expect the typical flareup to trigger crystal formation rather than the other way around. Note that a flareup might not have anything to do with crystal formation, for instance when it takes place during the early phase of an effective UA-lowering treatment.
In any case crystal formation as such isn’t painful and people who have UA crystals typically do not experience pain at any given time.The reason why the immune system seems to suddenly decide to make a painful fuss about crystals which had been laying around for a while are as mysterious to me as the reason it stops doing so. But note that this isn’t peculiar to gout but a feature of many autoimmune diseases (or even sometimes of allergies or harmful overreations to an infection).
That said, if the crystals were entierly dissolved the flareup would naturally stop but I don’t think that is how a flareup typically concludes. I expect the immune system has ways both to bury (so to speak) the crystals as well as to down-regulate autonomously.I don’t understand what you’re after if not advice about a medical issue but the time to find the right dosage as well as the time during which people still suffer from attacks varies wildly. The experience of a couple of random people will therefore not be of much help unless these people have a decent theoretical understanding of the issue are only refering to their own experience in order to illustrate a point.
Again, there’s no way I can give you a more useful answer as long as you do not provide any of the relevant information. But you could of course provide your own answer by reading the relevant literature yourself.In order for AP to cure gout, the dosage must be right. Else it’s going to help but will not stop attacks completely.
And how long it takes depends largely on how bad your gout was: how long it was untreated, the average amount of uric acid in your blood before treatment, and how efficiently your body excretes uric acid (which implies it might also depend a bit on other factors such as your consumption of other drugs).
It is not unusual to experience an attack a year after starting AP but since you have provided none of the above information, I can not say whether something seems wrong with your treatment or not.There is as I’m sure you’re aware a possibility that your ankle problem has nothing to do with gout so perhaps you should see a doctor (depending on how bad it is, how long it lasts and so forth and so forth).
If you don’t take something to stop a gout episode (like a large enough dose of naproxen), it can last longer than 48 hours. Even with the maximum safe dose, it can sometimes last much longer!
The first time I had pain there, I thought I’d hurt myself jumping wrong with the wrong shoes. The pain came fairly slowly and lasted a few days. The second time was much worse… which is not to say that there’ll be a second time for you. I obviously can’t tell the cause of your trouble. And for all I know, my “first time” wasn’t actually gout but simply an accident! All I’m saying is that gout can show up in different ways and that what you describe is consistent with gout.Hi,
This sounds like it could be an early stage of gout which would in many cases not be recognized as such. Gout can get much worse than this but if it’s gout and you treat it early, you could not only avoid the worst of the pain but also the attendant irreversible damage.
The thing is, most doctors are unable to diagnose gout based on a single episode. So it could easily be something else, no matter how adamant the doctor is.
What I recommend is that you make it a point of getting another uric acid test done in a few weeks even if the pain has gone away and you would rather forget all about it. Results are sometimes off for no apparent reason but it seems they are commonly off during an episode. 377 is a borderline result (high enough for gout but low enough that it could easily be something else) so you badly need more data.
There are specific tests you can have done to diagnose gout properly but it would probably be best at this point to do no more than monitor your uric acid (that’s cheap) and laying the groundwork for such tests while waiting for another episode. You could for instance look for a rheumatologist or an imagery person (ultrasound or MRI) willing to receive you on short notice whenever you experience severe pain again. You should also plan how you’re going to get there if you can’t walk normally (I used to keep canes at home for instance, and I needed a driver).I’m very impressed by how quickly you were able to see a specialist. In that situation, I do think it was crazy to give you allo.
It took such a long time for me to get to see a specialist (for instance I had to go to the ER and pay for it out of pocket even though that was useless, perhaps in order to document the seriousness of my case) that giving me allo right away without a real diagnosis would have made sense.One last bit of advice: make it a point to get another UA test. There’s no rush to do it so maybe it could for instance wait for your next regularly scheduled test. But understand single results are sometimes off, especially when people actually have gout. And the test is dirt cheap whenever you are already going to have another blood test.
Writing an allo script is taking the disease seriously. The trouble is that it’s not clear you have it! And I’m not your doctor (or anyone else’s) but depending on your background, history and other tests results, allo could be low-risk. The social cost is also very low compared to many routine drugs. That said, it’s certainly not zero risk and not doing a blood test before increasing the dose beyond 100mg/day in particular is irresponsible considering your only test result suggests 100mg may already be more than you need…
Typically, allo is a lifetime drug but that’s in part because most users have a much more serious gout than yours (assuming you do have it) and also in part because doctors are typically reluctant to prescribe it early enough, when it could stop the disease from progressing to a stage at which gentler ways to control it become ineffective. Taking allopurinol early makes tons of sense so your GP’s approach isn’t totally crazy but on the other hand it’s a slow disease so waiting for a second opinion shouldn’t make much difference (unless you have to deal with crazy waiting lists or something).Hi!
No, one UA test returning 7mg/dl (are you sure you got the value right? check the unit as well if you can) doesn’t even come close to establishing a diagnosis of gout. The real issue isn’t the test but: is this GP skilled and experienced enough to reliably recognize gout at first sight? I doubt it. In any case, gout doesn’t always mean meds for life.
The relevant specialist you could consult is called a rheumatologist.If you do start allopurinol (or have already started it), standard procedure is to get another blood test before increasing the dose. There are two main points: it may show that the dose you started with is strong enough for you and it is also improtant to make sure your liver and kidney function are not badly affected by the drug.
You don’t have to take allopurinol for life if you start it. I don’t recommend trying it for no good reason because it is a dangerous drug but it can work as a gout test. If you took it every day without fail (unless of course you get a bad reaction) for a couple years, it should cleanse you thoroughly of any gout you might have. And if your symptoms don’t stop, you’ll know for sure they aren’t caused by gout.
A warning: people who have some East Asian ancestries are especially at risk of getting serious reactions to allopurinol and should take a genetic test before trying allopurinol or simply use an alternative.You don’t have to take colchicine even if you have gout. If you don’t get serious swelling or pain, there’s not much benefit. If you do end up getting these symptoms, you’ll regret not having taken it earlier but that’s not the end of the world (in such a situation, treat such symptoms with a drug such as irfen if you tolerate this class of drug).
That sounds like a seriously gout-unfriendly diet, as one might have guessed. How unfriendly depends on the amounts you eat but in any case there is significant room for improvement. And as you probably guessed by now, quitting grains and fruits to make your diet ketogenic must have made worsened your uric acid problem (though that of course depends on what other foods you ate in larger amounts to compensate).
The trouble is that the reason people so often find it hard to quit allopurinol and the like isn’t that you get addicted somehow but as I hinted at above that once you’ve allowed your gout to fester, recovery will likely take a very long time and you may never get back to the situation you were in when your gout started. In other words, even if the right diet would have prevented your gout or fixed it if you adopted it right away (which is by no means a given!), chances are it’s now too late for that.
But let’s see what story the numbers tell because they might be surprising…Indo isn’t for pain management by the way. It prevents damage so if a dose you tolerate stops your pain, great: you’re actually perventing damage (the pain was merely an alarm bell of sorts). But you can also use it to deal with painless swelling as well as to prevent flares. Normally you’d use colchicine for that (especially if, like me, you tolerate it better than indo) but if you are luckly enough to tolerate indo well, you could stop colchicine for a while and rely only on indo. Indo is also a dangerous drug but has different side effects than colchicine. Ideally, you would avoid prolonged use of either drug but if you need to take at least one every day, not taking the same one for too long might be prudent.
It might be advisable to take a PPI if you take a lot of indo which is one of the reasons I wanted you to check with your doctor before going down that road but if your doctor has already approved regular indo use…At the stage of the disease described, I’d say 8 warrants the same short-term strategy as 9. It’s a shame doctors allow gout to get so bad. They delay UA-lowering dugs because they’re “lifetime” when in many cases it’s that very delay which makes them lifetime.
But yeah, if Kurtis averaged 7 in spite of a gout-unfriendly diet there would be alternatives…The first thing you need to do is to call your doctor’s office and get the actual values for the past levels of uric acid in your blood. “Normal” is useless. If you’ve had several doctors or have stayed in a hospital, you might want to call all these places.
I don’t know of any good home testing kit. That’s not to say there’s no such thing but I wouldn’t bother if you can get several lab values.
What you may not realize is that advanced gout would make it difficult and more importantly very slow to tell how what you’re eating and doing affects the amount of uric acid in your body. Even if you had a precise and reliable way to measure the amount in your blood, that value would be quite noisy on account of all the uric acid elsewhere in your body.Finding the root cause is most likely going to be the same task as ascertaining the diagnosis is correct: if your problem really is gout (it sounds like it is considering you’re describing a typical development of the disease but I don’t know that you have proof), the cause is probably a metabolic issue that will be impractical to solve without lifelong medication now that the disease has progressed so much and that you’ve become older. Dietary tweaks can make a big difference in some cases, but rarely enough to actually fix the problem. So your best bet to avoid lifetime medication is probably to take the same drug a few years and try to replace it with lifestyle modifications once your gout is cured. But I must warn you that the chances of a successful lifestyle fix would be higher if you moved to Japan or were allowed to join a hunter-gatherer tribe in the jungle… so sticking to the daily pill might well seem like a much more reasonable option once you’ve got used to it.
That’s all premature speculation anyway because your actual uric acid numbers would be necessary to make an informed guess as to the causes of and potential solutions to your troubles.You could research the facts about how what you eat affects uric acid but a much quicker alternative would be for you to post your diet. We’d tell you how gout-unfriendly it is (though we’d probably disagree to some extent).
I have also found a little colchicine every day helps keep the symptoms mild (though a bit more colchicine worked better for me). But I don’t think I’ve ever taken colchicine daily for more than 2 months (it was probably a good bit less than that, actually).
You can also take colchicine after symptoms appear in order to give your body breaks from its effects but in that case, I would recommend combining colchicine with a fast-acting anti-inflammatory. But that’s something your doctor should approve beforehand.The most important thing in your post is that you say don’t know how to get gout under control.
Does that mean you aren’t controlling your uric acid? Or that you don’t know how to tell whether it’s controlled well enough? That ought to be your priority!
Sure, reduing sugar and so forth might help some people. Reducing alcohol in particular should help most people. But in most cases, that’s basically window-dressing because that’s not going to fix most cases of gout.
In most cases, inflammation isn’t reduced through fad diets but by addressing the root cause. Sure, if you are allergic to gluten then quitting gluten would be the sanest way to address that. But that’s a rare cause of noticeable inflammation… and that’s certainly not a cause of ankle inflammation! If you’ve got a bacterial infection for instance, you might need antibiotics. And if you’ve got gout, you need to control uric acid well enough that it dissolves and doesn’t come back out of solution.Gout starting in the feet and then moving on to the ankle is a pretty typical development regardless of diet. And it typically doesn’t stop there. This disease gets worse if you don’t treat it properly.
Keto isn’t a magic word. The impact on gout will depend on the actual diet. Obviously we can make assumptions about what a typical keto diet would look like… and that wouldn’t be a good diet for a gout sufferers. But you’re not other keto dieters so what is YOUR diet like?
Likewise, you can in principle do keto safely even if most dieters are reckless. But the practice is dangerous enough that I think the obligatory warning is in order: unless you have a compelling reason (such as some forms of diabetes) to do keto, don’t. And don’t do it without medical supervision.Colchicine is also dangerous. I wouldn’t do that for many months on end. How dangerous obviously depends on the dose but how much do we know about the effects of constant use? Have you seen any studies? If you don’t understand the effects of a drug and there’s no compelling reason to keep doing it, don’t!
Asking about speicifc foods would be fine if it didn’t distract from the work of avoiding more hospital visits and worse.
Gout is typically easily cured, but not with tomatoes.Grape tomatoes are just another kind of tomato. Unless you have diabetes or some kind of rare allergy, the only differences between varieties of tomatoes you need to be concerned about is how they keep and how they taste.
Hi,
Tomatoes redux: some minerals, a little fructose, basically no proteins.
In order to make your life easier, I would suggest the following approach when it comes to purines: roots, seeds and seed packaging (fruits and such) are all fine except for legumes.More generally, looking at every single thing you might eat in order to explain gout attacks or prevent them is a fool’s errand. Diets need to be assessed as a whole, not by judging the parts on arbitrary crietria.
The most important part of gout management is typically not what you eat anyway. How many times have you got the amount of uric acid in your blood measured and what was the latest result?A single good test isn’t enough to establish that the dose is sufficient but yes: your prior should now be that 200mg/day is more than enough for you.
Keep in mind that lots of factors influence uric acid so major changes in weight, lifestyle, diet and so forth might require a dose adjustment. It seems that people such as ourselves who take a relatively low dose remain more sensitive to such changes. I might for instance take a slightly larger dose depending on the weather or what I eat.
But perhaps you’d find you would do well on a slightly lower dose and with a somewhat higher average amount of uric acid in your blood. You’ll have to fine-tune by ear because, while test results are of course much better than having no data, they are only a rough guide (or at least that was my rheumatologist’s opinion).
For the next few months however, if you indeed have gout, you’ll probably get pretty random symptoms and test results will probably be your only reliable guide. 296 mmol/l is fine for this stage. Best wait until symptoms are gone for good before experimenting with higher values.I’ve never used Voltaren but I’ve used liberal amounts of generic topical dicolfenac more like every 5-6 hours. Not that I expect it would do much good for a big toe joint… I found it only works acceptably well for smaller joints (but it might for better on others than on me).
You’d know if you had serious gallbladder issues, as they are rather painful. Without such issues and with normal liver numbers, I guess there’s no reason of suspecting malabsorption of a number of other vitamins or to recommend a bunch more tests. The combination of being overweight and living at a high latitude is more than enough to explain a D deficiency.
And regular D supplementation probably reduces the risk of developing NAFLD anyway (and perhaps of developing gallbladder issues as well).If I understand correctly, you have only two uric acid values: one before taking allopurinol and one while on 200mg/day allopurinol. If so, there is no need for another explanation for the first “elevated” value. People who have gout typically only get good numbers while on a medication which lowers uric acid. That’s why they take the medication!
Getting the amount of uric acid in your blood right doesn’t fix gout right away because abnormal amounts of old uric acid can remain in the rest of your body for months or even years after the starting the therapy.I’d say tophaceous gout is unlikely in your situation but it’s the rheumatologist’s opinion which matters, not mine
In the meantime, the X-ray may show something if it is not gout.An ongoing gout attack sometimes behave as you describe: few symptoms as long as you take anti-inflammatories but they progessively come back if you quit taking the pills. I’d give colchicine a try in your situation because it’s slow acting but can put gouty inflammation to rest or at least keep it at a low level without having the same side effects as regular anti-inflammatories.
Alternatively, try a higher anti-inflammatory dose before stopping because you want the inflammation to stop completely rather than being merely moderated or there’s a good chance it’ll come back.
Something else you could try while the symptoms are very mild (but this works for some joints and not others) is a topical anti-inflammatory instead of a pill.D deficiency is common in overweight people. Do you have a gallbladder issue as well? Are your liver function numbers good? Both obesity and D deficiency are associated with NAFLD.
