Gout Pal Interactive

Yes.

Another reason why people on insufficient allopurinol get into that terrible place where they are in almost constant pain due to crystals partially dissolving and reforming.

Nasty, sadistic thing, that allopurinol underdose.

In your case, the 3.5 to 4.5 gives you good margin. It might not stop the occasional soreness, but it will prevent the partial treatment hell.

As GoutPal said…Yes the numbers can go up as crystals dissolve. You will even feel some twinges as your body reacts.

Crystals come in two forms. The first type are free flowing in your entire bloodstream until they eventually collect loosely in joints or capilairies, but have constant access to regular bloodflow. The secondkind are the compacted ones that make up tophi and/or otherwise dont have regular access to bloodflow.

The first kind will be the first to dissolve. Once your UA numbers start to drop, these will begin rapidly dissolving back into liquid acid and get expelled. Once these are mostly gone, you will see your numbers start to drop again. It takes a long time to dissolve the compacted crystals  – frequently years.

I suggest drinking more water for the next few weeks/months to help eliminate the liquid acid. If your numbers dont go back down, then you are producing new crystals as fast as the old ones dissolve. Eventually you want to stabalize at a lower number.

Post edited 8:06 pm – October 29, 2009 by zip2play

I think that once you have gout you will NEVER get to the point where every crystal has dissolved, NEVER! Once gout develops you have LOTS of urate deposits, probably OUNCES rather than milligrams, many of which are so firmly enshrouded in encapsulating scar tissue and god-knows-what-other-detritus that it is with you forever. And there will always be that certain deposit that is close to breaking out.

Secret, as I see it, is to make surre that when the breakout occurs to make sure it doesn't tip the nearby body parts into a saturated condition.

A  Gout attack is a localized condition and thus when a deposit erupts you don't want it to erupt into an area that is either too close to saturation, too acidic, or too cold.

An awful thought that we must all digest: ONCE WE HAVE GOUT WE WILL ALWAYS HAVE GOUT.

Corollaries are :

1. The faster we lower our serum uric acid the less urate we will deposit, i.e., treat uric acid EARLY before we have too may attacks and lay downn too much UA.

2. THe lower we keep our SUA the less likely a migrating deposit will redeposit

3. The lower we keep SUA the more likely we will NEVER suffer an acute attack, damage our kidneys or develop heart disease.

By this logic, once gout develops, running a 6.0 MAY be okay but running a 4.0 is a LOT better

To the precise question: Yes, when crystals dissolve UA goes up…when they deposit UA goes down!

What is confusing, to me at least, about UA- is where it is.

Joints, tissues, blood or being/been excreted.

The focus usually is on the joints- but the bigger picture is very fundamental to understanding UA management.

I suppose a test kit tells more- but not enough.

A wild card , for sure!

Some excellent points here, and I'll try to avoid clouding the issue.

As zip2play says, you can only easily measure uric acid circulating in your blood stream. At this moment in time, you cannot easily measure, or even estimate the amount of uric acid that is crystallized in joint fluid and other tissues.

Fortunately, you do not need to.

You know from a series of tests that allopurinol is doing it's job. Your body cannot raise uric acid levels by producing more uric acid, so increases are either a bad reading, or old crystals melting.

It doen't really matter which for now, because the main thing is that you are in a good place.

As Tavery suggests, increased water will help flush the free uric acid, and medical authorities also recommend alkalizing the urine to prevent kidney stones.

On a slightly related note, I have just read about some uric acid researchers who found their urine samples had gone cloudy (you wouldn't believe the stuff I read sometimes). They ascertained that the cloudiness was uric acid crystals, and the sample temperature was, from memory, 24 degrees (centigrade). When heated up to body temperature, the crystals dissolved.

Northern hemisphere readers should remember to keep kidney/bladder area warm this winter, as well as the extremities.

No idea, but it is not relevant without the other part of the equation – uric acid concentration.

In practical terms, there is absolutely no way to measure all the variables that affect saturation point.

What we can do is avoid the cold.

I'm keen on this idea ,Zip-

You could charge admmission to make it worth while- or even put it on Utube!

NY 's a wunnerful place

Joking apart, there's no doubt that escaping the effects of high UA ,with or without gout , means keeping consolidation sites warm. mainly the feet. hands and knees can be dealt for, too.

The similarity with Deep Vein Thrombosis  (DVT) comes to mind -where relatively young people have suffered bad effects and even died ( if memory serves) after long, immobilising plane flights.

Warnings about this are common now- but seemed strange in the early days to me, anyway- for other than the elderly.

Gout is increasing, but still not so common. Hopefully sites like this will not only highlight the risks of high SUA and how to treat & manage gout – but also bring this simple fact to the fore.

I shall definitely be watching my foot warmth this winter and ensuring daily exercise for my feet.

Excellent, Utubelite.

What a beacon for other gout patients who are starting, or considering, uric acid lowering therapy.

I believe the uric acid lowering phase needs to run for 6 months, below 6mg/dL, without a gout attack, before you can be satisfied that all uric acid crystals that can dissole will actually do so.

Though 6 months is a lot longer than your 5 weeks, it is very encouraging to see how quickly you are seeing benefits. I put this down to getting uric acid low enough to avoid problems with partially dissolved or reforming uric acid crystals.

When the big toe is down to “uneasiness” rather than screaming pain, life must be good indeed.