First-ever gout patient interested in trauma vs. gout? Advice Myths & confusion.

[stephen q shannon]

The importance or validity of trauma triggering gout. I experienced what I thought was a moderate bicycle spill. Wearing a good helmet. Biggest impact was on the right hand, periodic swelling 5-6 weeks later. Later left hand seemed to have gout-related pain and redness as I then next experienced my first-ever full blown left toe gout attack quickly relieved of pain with $14 RxMethylprednisolone 4mg dosepk and still using it for next 4 days.
Now focusing on diet upgrade. Not obese. Years of sane diet low in alleged purines content. I am 80 as of Feb. Now using less & less sugar and returning to gluten in some foods such as whole wheat bread. We typically don’t eat bread and use little milk, then only low fat. Switched about a year ago to almond milk. Need to know its value if sugar-free? Thoughts & reliable resources? Love what we have found here so far. Thank you!

[Keith Taylor]

Stephen, welcome to the forum, especially the way you have joined. More on that another day, but first I must respond to your immediate questions.

Trauma is well recognized as a trigger of gout attacks. As scientists discover more about the intricacies of the gout-pain pathway, we learn more about how this happens. For myself, I’m struggling to apply sufficient brain time to explain it in simple terms. Let’s put that on the “questions to be answered better” pile, and look at the practical aspects.

It doesn’t really matter in the long-term what triggered a specific gout attack. We know that there are many things that can stimulate the immune system into phagocytosis. That is the inflammatory process that we recognize as the agony of an acute gout flare. We also know that most triggers seem to become more sensitive, the longer we have gout. Irrespective of immediate triggers, which we might be able to avoid, gout cannot happen if we dissolve most uric acid crystals. The only way to do that is to lower uric acid below 6mg/dL. 5 is a good long-term upper limit, but to get rid of crystals quicker, we should aim to reduce uric acid even lower.

These are the reasons I emphasize a personal gout treatment plan. Depending on individual circumstances, people have different priorities between pain control and uric acid control. Both these are easily dealt with in isolation, but in practice people get pain control and uric acid control confused. I get the impression that you are very capable at controlling gout pain, so maybe the priority is for uric acid control. Have I read that right?

Now, moving to diet, I believe that gout diet management should always support the treatment plan. We are not yet at the stage where you have a well defined personal gout treatment plan. In general terms, it is important that what you eat does not raise uric acid. Ideally, you could hope that diet might reduce uric acid. I actually prefer to manage specific diets for an individual, rather than generalizing.

My best general advice is that diet can improve uric acid, but we need to know uric acid numbers. Test results allow us to assess if we can rely on diet alone, or if we need to consider diet combined with uric acid lowering drugs. As well as specific foods affecting uric acid directly, excess iron and excess calories can increase uric acid. The only way I can assess all the factors is to get more data. On the question of almond milk, I need to do some more research.

In summary, I need to:
1) Explain, in laymans terms, why trauma can trigger a gout attack.
2) Investigate and explain how almond milk affects uric acid.
3) Review the member profile information, and related information. I must make sure that personal gout facts are easy to record, and that I respond to them in a timely manner.

Whilst I’m doing that, I’d appreciate your response, Stephen, to:
1) My assumption about your priorities between uric acid control and pain control
2) Do you have any uric acid test result information?

[Author]

Posts