A variety of gout information..
Blood uric acid levels pretty much lost all meaning for me a LONGtime ago..I’ll be SERIOUSLY HAPPY!!! when medical science figuresthis one out.Again and again and again and over and over I seemedical references to this..
IT ALWAYS ends up BACK at the same place..ya get the guy with theuric acid level of like 9..sure a bit over the average of 7..and likealmost all people with high uric acid levels..hyperuricemia..NO GOUT?NEVER!WHY?..this baffling question has been around for too longnow.Then the guy with like a level of 4/5..CRIPPLED with gout.Almostno-one ever puts together the fact that the blood uric acid level canget pretty much as high as it wants..BUT and the big but..HUGE..thatthe uric acid has to somehow..unknown..get into the joint fluid(synovial fluid)..AND reach a high enough concentration in order forit to crystalaize..The argument that gout sufferers cannot eliminateenough uric acid..or not enough fast enough..don’t wash no more. I mean obviouslly..someone like me who has NEVER had even aboveaverage levels is eliminating more and more percenatge wise thansomeone with a raging high level..but somehow..SOMEHOW..ALL of usgout sufferers..have at a certain level..uric acid spilling over intothe joint fluid..and enough of it..and enough of it to staythere..and get in a high enough concentration that it crystalizes..Iknow what my level is..yes I am PAINFULLY aware of that..my ownpersonal uric acid level..if it goes much above the halfway point..3-7..(here they use a different scale)((.180-450))..mine has been atabout 3 for years now..on allopurinol..before allopurinol it wasabout 4..and guess what happens to me at 4?.. That is the role of allopurinol..to reduce YOUR overall averageuric acid level..I crystalize out at 4..meaning at this level ofblood uric acid..even though I have some EXCELLENT blood tests/kidneyfunction..yes I am healthy fit/good diet..for whatver reason..somehowthis uric acid gets from my bloodstream into my joint fluid.. Others blood uric acid levels get to like 10..and are seriousllyunfit/unhealthy.with nowhere near the blood work..nor kidney functionof me..who gets the gout?ME!
Oh well..it takes a while to get an average uric acid levelestablished.If you get gout..it is too high..so you startallopurinol..and it gets lowerred..the dosage may needadjustment..and there you stay.
Diet and uric acid levels This here is another can of worms..it is pretty common knowledgethat diet can influence uric acid levels 5-15%.. Some facts get in the way though..someone with pretty much ashigh a blood uric acid level as can be had is hospitalized..on amedically supervised hospital vegetarian diet..the blood uric acidlevel can only be reduced by .028 umol/L..yup..there is about yourmaximum of 15%..that is providing that the person is almost awaif..and a vegetarian with a blood uric acid level of only180..there is the 15%..what about the other end of the scale?Whatabout in the real world..?eating normally..being of averagehealth..it is pretty much impossible to CONSISTENTLY lower the blooduric acid level average by even 2-3 %. Has anyone else here actually experimented/played around withthis?Just curious..I have..seriouslly.We have government healthcare..plus I was literally crippled with gout.No cost to me.Andjustified by all the Dr’s I saw..they were pretty baffled.And I wasVERY interested/concerned..the Dr’s wanted “average” uric acidlevels..a lot of them..as in real world/real life..exactly how Ilived..not this fasting..being a good boy stuff.I was after allpretty sick and wanted this gout nonsense over.Of course everyone isdifferent..my results..were that the blood uric acid levels hadalmost no change no matter what I did.The clinic was open from 7am to10 pm..and I had so many stinkin’blood tests..that the clinic saidthat they would just fax them to me.This is strictly an absoluteno/no where I live..I had these samples taken at all hours..underpretty much all condtions..hard exercise..and..various timesafter..drinking a few beers..eating a few cheeseburgers..There wasalmost no difference in the few months of this..all around 450umol/l..nothing worked..and I tried I think everything for thisgout..I VERY RELUCTANTLY went on allopurinol..almost immediately..andI mean it was like days..the uric acid level dropped to around 3..ithas stayed there for years.
Uric acid crystals.. It used to be “known” that when there were gout crystals therewas gout/an attack..such was it that in some medical literature evennow Dr.’s still rely on it.I mean it was almost never done as afollowup..it was just assumed no gout attack=no crystals.Well so muchfor that theory..so much in fact that a lot..more and more Dr.s don’teven bother with the crystal thing.And along the way..more and morecrystals were seen in the joint/fluid and no attack.. It used to be thought that when the attack ended..the crystalsdissolved/dissipated..that was untill followup studies/researchinvolving actual fluid samples showed very clearly that the crystalswere still there.There is scientific debate as to how long itactually takes to make the crystals..some theorize that it takessince puberty..when gout actually starts..20-30 years..it does indeedtake on average of about 30/40 years for the first attack. Patients that went on allopurinol..showed a drastic reduction inactual crystals..no-one else.
Gout attack triggers.. It used to be thought that it was a massive amount of purines/oralcohol that drastically raised the uric acid level..more andmore..it is known that it can be a very slight increase..notmeasuresble by blood tests..or even a decrease. Other factors..chemicals..that can interfere with the white bloodcell attack on the crystals..or the chemical coating on the crystalsthemselves. There are simply too many people..many of them here..that haveattacks set off for..no good reason.
Shock wave therapy for gout(crystals) This is close..it is pretty common for kidney stones to be brokenup by sound waves(lithotripsy)..however..gout sufferers that haveuric acid stones..these stones cannot be seen on x-ray..hence verydifficult to sight the equipment.There is a clinic nearby thatadvertises sound wave therapy..of course I called them..they saidthey didn’t know if it would work..they weren’t sure if the crystalswould get broken up small enough..if I ever get another attack..IWILL BE THERE!
Quality of life.. It/this is almost sad..I mean at some point..I hear/read ofpeople giving up this..cutting back on this..not doing that.Ok fairenough..we want to avoid the DREADED attacks..VERY sad is when somuch has been given up for so long..THEN the attacks come backanyway..worse.
I do not know..if I gave up alcohol,coffee,meat,chili,..ETC.,I donot know personally how far I would go..I do know that I have indeedtried this..and fortunately..very,very fortunately forme..nothing..nothing at all worked..so I never had to make thatchoice..had I discoverred that somehing caused it/triggered it..wouldI have given that up..OR would I have said..”Forget it”..I’ll go onallopurinol instead..
Personally I just knew..knew..that my skiing..extremelyhard..screaming heart rate,burning thighs and the pounding on my feetwas what caused my gout.All that uric acid being dumped into mybloodstream..blasting out hot air from my lungs in cold weather isjust a great for the dehydration.I communicated with someone who gotattacks after weightlifting..his passion..so he finally quit.Did hego on allopurinol?No..but he did tell me to quit skiing.All the Dr’sI saw said no..skiing/exercise was not a factor for me..I didn’t havea great deal of choice I was crippled..it was allopurinol.. In the words of my rheumatologist..”Let’s say Arnold that I toldyou to quit skiing or face gout..I know that you have skiiedin/around gout attacks..you wouldn’t quit would you.I know that youwouldn’t quit..so if the choice is now..ya wanna go skiing?..then eatthese mudpies..let alone allopurinol”
Cherries.. Yes I have done that.the different kinds/extracts etc.No it didnot work YES! it was EXPENSIVE!..YIKES!Does it work?A lot of peoplesay so.Some recent research..cherries and a few other berries areEXCELLENT sources of flavinoids..that are extremely good athealing/and getting nutrition to damaged tissue..it is theorized thatthe irritation/damage caused by the crystals to the tissue in thearea is healed by the flavonoids.Idno..
BE WELL!..gotta go now and have my 100 lb dog TOW me around theneighbourhood..sheesh..3 times a day of that for 1/2 an hour each..15years of this..2 dogs later..NO WONDER I HAVE GOUT!
Allie Belletto on June 26th, 2007
There are some very interesting points in there. First thing I note is that allopurinol is a solid answer. I recently read that not only does it work for gout, it improves your arterial function (blood vessels that have been hardened are softened and made more flexible again by allopurinol - reducing heart and stroke risk). Second item, this is the first time I have seen the same scale used in this forum that my doc uses (even though the links to uric acid level appear to be tenuous in your note). Since I am not a math whiz, is there a table somewhere that equates the scales or a calculation that can be done to see equivalencies between the two (i.e. 7mg/dl = 450umol/L)? Third point, your skiing, your friend’s weightlifting, my golf (carrying clubs) and others’ exercises seem to be a common theme. Anecdotally, I know I was not a big water drinker before I began taking allopurinol, and I am thinking that dehydration may play a huge part in the triggering of crystallization - just a hypothesis. While the dehydration may have something to do with onset, allopurinol enables all these activities again, so I am a big believer in this remedy.
Sabina Shamel on June 27th, 2007
The molecular weight of uric acid is 168. To convert grams tomolarity devide by the moluculer weight.7/168 = 416 plus or minus a few decimal places here and there toaccount for the units.7 correlates pretty well with the 450 listed and is probably withinthe accuracy of the measurements.
A word about serum levels of sodium urate. I have posted on thisbefore. It is very important. I’ll keep harping on it thoughbecause it is critical that we get our arms and brains around anunderstanding of what this means to each of us.
Sodium urate in solution is in equillibrium with the crystals ofsodium urate in our foot and these crystals hurt. So far so good.Moreover, it is iimportant to bring down the level of sodium urate inthe blood and this is also true and important. However, you, andyour body must also account for the excess uric acid that is in yourbody that is stored there as uric acid, usually in your fatty tissue,but sometimes as trophi deposits near your joints.
When your body dumps out some of the urate that was in your bloodthrough your kidneys, this stored uric acid can immediately go tosodium urate, replentishing the level in the blood therebymaintaining the balance. In order to lower your overall serum sodiumurate level, you must first deplete the uric acid level in yoursystem. If you take allopurinol long enough, your body will excretethe residual uric acid, it will fail to make more because theallopurinol will stop your body from making more and eventually, youruric acid level in your body will be low enough that the uric acidlevel in your blood will not be replentished after you excrete someof it in urine.
Thus as long as your body has excess uric acid in it, usually storedin your fat tissue, you will have a hard time lowering the level ofurate in your blood because as that urate is excreted, more issupplied via the stored uric acid. Yes indeed, when you go onallopurinol, and are able to stop the production of new uric acid, itis only a matter of time until your overall level of sodium uratewill be reduced and this will happen as fast as you can excrete it.
Earlier a poster suggested that since their urate level was low andthey still got gout, they must be excreting urate normally. This isnot necessarily true. Unless you have had your 24 hour urate level inurine tested, you do not know whether your excretion process isnormal or not. You could have a low blood level of urate, because theconcentration at which crystallization starts could be low for thatperson. That level, that is saturation, is an individual thing ineach of us and is affected strongly by what else is in the bloodaffecting solubility.
The only thing you can say is that if allopurinol eventually allowsthat person to achieve an overall reduction in the urate in theblood, then the kidneys are functioning enough to allow that processto happen. It does not imply that their kidney activity is anywherenear normal and in most gout patients, they do have a measurablyreduced ability to excrete uric acid through renal activity. The lowlevel of urate in the blood is just an indicator that their systemmaintains a low level of urate for equillibrium and that the personwill in all likelyhood get a gout when their system gets to theirsaturation level, it could be 4 or it could be 9.