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These symptoms are not typical of gout. You could have low-level pain from gout but the symptoms should be on-and-off rather than constant and you would normally also have the intense bouts. Some people are atypical though. Even so, you should have the most gout pain in the coldest parts of the body (feet, hands are typical).
You could try more doctors, scans and so forth but as far as gout is concerned a couple of simple and affordable uric acid blood test would provide a clue. Maybe you could also describe what Naproxen does and doesn’t do for you.If you haven’t seen a rheumatologist in 6 years and you have chronic pain in many joints, I don’t think it would be excessive to consult a specialist again. Perhaps see another one this time.
Since you mentionned a calcium deposit I have to wonder: could this be pseudogout or even calcium oxalate crystals in the joints? I don’t know how one would go about diagnozing that other than by drawing joint fluid which is often not a straightforward procedure. Maybe that’s something you could ask a rheumatologist.Finally! You had me worried with your previous result.
366 isn’t great but it would be sufficiently low… if it wasn’t only one result. As it is just that, I wouldn’t wait 4 weeks for the next test (assuming you have a choice in the matter).You’ve gone slow and safe until now. While the small SUA drop 80mg should provide would be useful,
1) you can’t be confident yet that your hemo would remain stable if you kept taking 60mg and should your hemo start dropping after you start taking 80mg, you will be glad to know for a fact whether 60mg is safe
2) your SUA might keep dropping without a dose increase anyway since this result is consistent with your deposits taking a helluva long time to dissolve
3) lowering SUA slowly seems to cause less attacks (in some cases anyway)Unless this result is a fluke, as I understand it moderate cardio exercises can only help because crystals would dissolve anyway. Increased blood flow will only make them dissolve faster, shortening the attack window for each deposit. But recall that exercise causes an immediate increase in SUA (the general recommendation is to avoid prolonged strenuous exercise).
The notion that symptoms will abate this soon is recklessly optimistic so hang onto your colchicine.
Diclo gel isn’t quite free of the nastiness of pills and isn’t very effective but it might be an acceptable compromise for minor symptoms if you take well to NSAID pills in the first place. Don’t bet on the gel stopping an attack though so keep the pills around!
On the bright side, there’s a good chance that any lingering symptoms might in time go away. You won’t know how much damage is permanent for quite some time.May I remind you of Keith’s advice regarding pain? Some medical professionals are used to dealing with patients in pain and they know what works.
You may now tell them you are undergoing successful therapy according to your last blood test which would make the source of your pain temporary. That changes the risk picture a bit as far as pain management is concerned.Yeah, eating guanine seems to have very little effect on people’s SUA for some reason. But adenine does have an effect and you find that everywhere you find purines. It’s just that the relative amounts vary a bit between foods.
Hypoxanthine seems to be a good bit worse than adenine and you don’t find that purine everywhere. But some plants have significant amounts so avoiding the stuff is unfortunately not quite as simple as avoiding animal flesh.I doubt doctors would recognize gout symptoms in patients with 400 but yeah, even 10% might be enough in some cases.
In practice though, the pill is almost always going to be a better solution whenever people have recognizable symptoms because you ideally want uric acid lower than 360 during the initial phase of ULT.I found numbers for “Vegetable drink powder from Kale”. That contains mostly guanine which is a harmless purine. I don’t know if the same can be said about what you’re eating but the plant doesn’t seem to contain a whole lot of purines in the first place.
Rheuma would be wrong if they put it that categorically. You can get a lot more than 10% out of diet. I did, no thanks to any doctor’s dietary advice. That was still not enough for me in the long run but it would be enough for some people.
Our bodies do work differently (take your persistently high SUA tests for instance). So yes, I do try to discourage you from generalizing from my experience. Maybe that’s unnecessary but better safe than sorry, eh?
Sometimes I’m also trying to avoid needlessly rubbing salt in the wound (so to speak), hence strategic silences. As far as I can tell, you’re already doing the best you can to reduce your SUA.It’s only a forum but it’s still a venue in which we are discussing medical issues. You have the NHS but doctors cost me more than lawyers so it is a rather serious matter as far as I’m concerned. And money aside, some of the drugs discussed here have killed a lot more people than gout.
I don’t know a better way to learn about purines and uric acid than to read the litterature.
Briefly: purines vary between particular foods rather than between convenient categories like animals and plants. Purines are no different from anything else that’s found in food in this regard. But unlike proteins for instance, I’m not aware of a comprehensive database with quality information about the amounts of purines in foods. So it can get complicated quickly… arguably more complicated than it’s worth.
Some plants have next to no purines so they’re safe. And we know replacing meat with dairy and eggs (also next to no purines) works. We also know soy is quite nutritous relative to its purine content and soy eaters seem to have good SUA numbers as well. Other plants though are nowhere as nutritous yet pack a non-negligible amounts of the most potent purines. So you don’t want to rely on any plant for nutrition. It’s always going to come down to the amount you eat so you only have to worry about plants you’re eating in large amounts.
Most people would I think eat rather small amounts of vegetables even if you told them to “just eat more” so that would be good advice for them.My suggestion: don’t worry about this yet. Diet isn’t as effective as drugs.
Allopurinol is the only drug you mention, John. But it’s not the only drug you should be taking.
People normally take colchicine and/or common anti-inflammatory drugs during the first months of allopurinol treatmeant. There are lots of drugs which can bring inflammation down but allopurinol isn’t one of them. Maybe there’s a reason for you not to take any other drug (all drugs are dangerous) so that’s something to discuss with your doctor. Your doctor will also be able to make sure nothing is wrong with your foot other than gout (it’s unlikely but you never know). If your doctor isn’t helping, maybe see another one?
You can also take actual painkillers but the way you describe your foot, your priority ought to be to bring that inflammation down.
@Keith: the data from the studies you referenced so far doesn’t show that there’s much if any benefit in lowering the amount uric acid in the blood more than John Kelly already has. On the contrary, it suggests diminshing returns.Clearly, when I said “low-grade” I meant something different than you do because what you’re talking about is more than a minor nuisance. Maybe I should have said “very-low-grade”.
Crystals take a long time to go away even with very low blood tests.
I’m not going to talk about painkillers Keith doesn’t talk about. None of us wants to be extradited on terrorism charges or something.1. When I started Febuxostat, doctors insisted I take too much. I had pretty bad blood tests, little appetite and obviously lost some weight (not a lot).
2. I have no beliefs about purines but I believe already asked you: what is there to prove? Purines are molecules, not life forms. Like Keith says, the amount of febuxostat you’re taking is supposed to dramatically lower the amount of uric acid made from the purines in your body anyway.
3. I wouldn’t worry about where the stuff is in the pill. But surely you haven’t thrown away pill fragments. Taxpayers are paying for them even if you’re not.
If you mostly cured your gout through your diet, it’s only to be expected that the remaining symptoms would be very difficult to diagnose. An immune reaction to something inside a joint would need to be quite strong before redness and swelling become apparent. Full-on gout is very strong.
Gout is a slow disease. You might need to eat meat for years before you get full-on symptoms. And it would likewise take a long time to make them go away after that. So you don’t want to develop typical gout symptoms!
Since you did take allopurinol in the past and your uric acid tests at 361 even though you are on a “very restricted vegetarian diet”, as long as you haven’t eliminated gout as a culprit for your symptoms I think it would be prudent to remain careful about your diet and to keep monitoring your uric acid.
You can of course eat roast beef and stuff once in a while, whether it be as a test or for a social occasion. It takes a lot more than one meal for uric acid to do much damage.And in case you weren’t aware: people who have had gout in the past develop osteoarthritis more often than people who never had gout.
Like you said, no answers (or at least not yet)…
I’m not doing regular blood tests anymore but subjectively, I’m good.
I’m still getting a little abdominal pain as well as occasional low-level gout-like symptoms but that’s no big deal. I’m not sure I’m out of the woods yet but I haven’t used the painkillers the benighted folks across the pond are so afraid of for about 6 months now, nevermind the stuff which is actually harmful (AKA anti-inflammatories).I had constipation on only 40mg. Just take your pharamacist’s or GP’s recommendation. Problem solved. It may also help with abdominal pain. But I recommend you start with a lower dose than generally recommended.
Hopefully your system will get used to that side effect and you will in time be able to discontinue the product that helps with transit.361 is a touch higher than recommended. No big deal. I wouldn’t call that “high” but unlike 4.6, it’s high enough for concern. Once you develop gout, you’re far from safe if you test at 400.
If you had many tests done since you quit allopurinol and the highest was 361, that would be one thing. As things stand, your uric acid could conceivably be slowly increasing or simply chronically too high and we wouldn’t know. Your uric acid definitely not scary high and won’t kill you but in my opinion, a little gout is too much.4.6 isn’t “high normal”. It’s low. Your uric acid on the other hand isn’t low. You had one low test while taking a drug that lowers uric acid. All that number tells us is that the drug works on you.
If some people in Canada find uric acid numbers too complicated to bother with, that’s their problem. We all understand that “you can have high levels with no gout, low levels with gout” but that’s no reason not to make use of the data we’ve got. Likewise, smoking isn’t recommended even though you can smoke without getting cancer and get cancer without smoking.@Luke:
Based on your old diary, my guess is that you have a good shot at keeping gout at bay without recourse to allopurinol if that’s what you want. As your doctor said, your uric acid was never very high in the first place. You’ll need to keep monitoring it however and you may need to go back to allopurinol as you get older.
In the meantime, if your highest test result since your stopped having attacks has indeed been 6.5, while you should be OK you should also be aware you might have a very small safety margin. A diet which lowers uric acid and/or weight loss might turn your borderline test results into reassuring ones.
If you allow gout symptoms to come back, you may not be able to get rid of them as easily as you could have prevented them.4.6 is pretty low. Gout is unlikely (but not impossible) at that level. I need to take a drug which lowers uric acid in order to get test results that low.
It’d be worth re-testing your uric acid in a few months if the symptoms persist. And if the second test is low as well, you may want to consult a rheumatologist (that’s the appropriate medical specialty) instead of simply assuming you have gout.
Joint pain can have other causes besides autoimmune diseases by the way.
