Comments on: Uric Acid Levels and Gout

By: Linda O'Connor

Linda O'Connor — Sun, 12 Sep 2010 17:21:36 +0000

do you know about the uric acid/glucose meters available in the UK? Would this be a good way to keep your acid levels monitored? Also, do you know any associations between gout and peripheral neuropathy? I have recently started with both and the allopurinol and colchicine make the neuropathy pain worse. Help!

By: Rob Ladd

Rob Ladd — Fri, 20 Aug 2010 14:42:45 +0000

I have suffered from gout for 10 years. When the first sign of a gout flare was felt, I would immediately start Indomethicin to reduce the potential pain. I would then take that med as perscribed every 8 hours including at least 8 hours after the swelling had disappeared. After all this time I finally approached my physician with the concept of lowering Uric acid levels. I was perscribed Uloric one month ago. 3 or 4 days after commencing this regimen, I had a gout attack in the left elbow. This lasted 10 days. I expected gout flares from the information include with the Uloric. Immediately following the firs gout attack, my left ankle was attacked with migration of attacks then moving to my toes and side opposite of the initial attack on my ankle. Before this combined attack was complete, my right elbow suddenly developed a huge (baseball sized) fluid filled growth. This started two days ago with continual growth until aspirated yesterday. The aspirated fluid was full of Tophi crystals. All of this took place over thirty days use of Uloric. I was then advised by my physician to immediatly stop using Uloric and was perscribed Colchicine to be used alongside Indomethicin to help control the inflamation. I am nearly at my wits end while suffering still from multiple gout flares. I stopped drinking alcohol last November and have stopped consuming shell fish and lowered consumption of purine rich meats. I don’t miss alcohol but sure do miss beef which is now down to once a week. The Uloric regimen was frightening as I had never before suffered from multiple simultaneous attacks. I try to convince myself to embrace the pain in a meditative sense. That doesn’t always work.

Thought I’d pass all this on. Regards, Rob Ladd

By: Brad

Brad — Wed, 04 Aug 2010 20:09:31 +0000

I have personally had gout for 20+ years. I was diagnosed in my 30′s with two different kidney diseases. The worst gout flares I’ve experienced in my life, I had to go to the ER for the pain. (Doctors don’t really try to address the pain, only the underlying uric acid levels.) Anyway, both times my blood uric acid levels were normal or lower than 6mg/dl. Both times I was released and told to make an appt. with an orthopedic surgeon, because I must have injured myself and not been aware of it. I remind you, these were acute attacks where I was crying like a baby and my knee was as large as a cantaloupe. Waited the required week to get into an appt. without any pain medication. The ortho did needle aspirations because he actually believed me when I said I had not injured myself. Low and behold, Lab test concluded my fluid aspirations were indeed gout, very bad gout. Aspirated 2 times in 3 days and it looked like buttermilk. I’m told normal fluid should look like very light straw colored urine. The ortho stated he hates blood uric acid level because they are so inaccurate at showing a true attack of gout. You are doing a disservice by carrying on about the importance of blood uric acid levels!

By: john bailley

john bailley — Wed, 30 Jun 2010 15:40:55 +0000

what is sleep apnea?

By: Victor Konshin

Victor Konshin — Fri, 15 May 2009 18:54:43 +0000

Burton, Very good points. I agree that standards need to be developed on how properly measure uric acid levels. This is definitely a problem. I also agree with your comments on uric acid crystal dissolution. Starting uric acid lowering medication at very low doses and increasing slowly are key to preventing attacks during this time. And, of course, being screened for sleep apnea is important.

-Victor

By: Burton Abrams

Burton Abrams — Sat, 09 May 2009 11:38:35 +0000

Hi Vic,

I am repeating here my criticism of medical practice that I have told you about privately regarding the measurement of blood uric acid levels. There is no standardization in current practice for the conditions under which serum uric acid is measured – the amount of time elapsed since last eating, what was eaten, the amount of time elapsed since awakening from sleep.

Contrast this helter-skelter approach to the procedures used for measuring blood sugar. These results are interpreted based on whether or not the patient has fasted overnight, or even with the more controlled glucose tolerance test. At present, knowing your serum uric acid levels has much less meaning than than knowing your blood sugar levels.

There is a way that a gout flare can develop even at a time when serum uric acid concentration is below 6 mg/dl. High serum uric acid concentration is required to form the urate crystals in a joint that are the direct cause of gout. But once formed, these crystals dissolve extremely slowly – over many months. But a gout flare lasts typically 3-10 days. Why doesn’t it last until the crystals are dissolved? Because the immune system coats the crystals with a protein sheath so that their presence is no longer detected by the gout inflammasomes. If that sheath is somehow ruptured, a new gout flare will occur until after the breach is repaired, even though the serum uric acid level may be below 6 mg/dl. The rupture can occur from physical injury, as has happened to me at least twice. The rupture can occur chemically, as often happens when an uricosic drug such as allopurinol is started at too high a dosage. In these cases, the gout flare often starts during waking hours. In the case of gout flares that develop during sleep, my claim is that they are usually the result of a flare in serum uric acid above 6 mg/dl resulting from the hypoxia of sleep apnea.