Gout Pal Interactive

Though the pain of a gout attack is often localized in one or two joints, uric acid affects all joints, and other body tissues. It is only when you get an immune system reaction to these urate deposits that uric acid causes gout pain. All gout sufferers have an abundance of uric acid crystals all over the body, but not all are causing pain (yet).

Uric acid is carried all around the body, and will crystallize where it can. Hence tophi in the ears are common. New technology shows us how crystals, though concentrated in joints, are spread throughout the body (use the search box above to find DECT images here, or “dect gout images” in the blue Internet search box at the foot of each page).

So to stop new crystals forming and dissolve old ones, the only answer is to lower blood uric acid levels and treat the whole body via the bloodstream. Allopurinol is one drug that can be administered by injection. The new genetically engineered uricase treatments must be delivered by injection. However, none of these are site specific, because they do not need to be. They also involve trips to medical facilities that pills do not.

As for neutralizing uric acid, the chemistry is somewhat beyond me. My basic knowledge suggests to me that even if a specific agent could be found to react with uric acid alone, this would inevitably produce deposits of the resulting salts. I can only assume that such a reaction would be fatal. Maybe someone with a better grasp of chemistry will be along soon to comment.

Finally, if you are only peeing a small amount of uric acid, is probenecid the right treatment? It is not a good choice for under excreters. Have you had a 24 hour urine test? Are your uric acid levels measured regularly?

Urate lowering therapies are currently the best they have ever been, with recent new drugs, and more under development. However, they are only any use if uric acid levels are properly monitored and managed. Not much point in looking for new treatments, if the existing ones are not applied correctly.

Post edited 5:09 pm – November 8, 2009 by roosterwes

I have a result from a 24 hr urine i took some years ago.  How would i determine if I am an under excreter or over producer from the results?  I can post them.  I just want to get complete understanding before I start getting all the tests through the Rheumy, plus a little backgroiungd wouldn't hurt.  I'm also going to get a UA blood test tomorrow, but I can't get a 24hr urine until Dec 10.  It is very hard to get an appointment with a rheumatologist even close to where I live.  I live in a very rural area, and must travel an hour and a half to see a doc.

Should I start a new post?

ok got it.  I did some more research and I found an article explaining that probencid lasts like 8 hours in the body at effective dose; so I was taking 1 every 12 hours at 500mg; so it was in these 4 hour gaps where the uric acid was building up in my body or so it felt like it.  I switched to 500mg every 8 hours and now I have mild pain in many joints but not the intense burning I had before.  I will go in at the end of next week to check my levels to see where I am at.  I hoping it is close to 3mg/dl. 

Like all in this group I have seen the gnarly looking gout pics on the web; are you telling me that these guys can clear out in a couple months?  I read a study online done by New England Journal of medicine that based on test studies stated it would take 3 years for all the crystals to be gone from people who suffered from chronic type gout with gout symtoms for 15 years or more. I tried to find the study again so I could link it but could not.

Goutpal,

So, my uric acid tests came back at 3.05mg/dl, after bumping to 1.5g of probencid a day; plus up another 500mg.  Right on the money. Uric acid measured after a meal and about 4 hours after my meds.

Post edited 8:16 pm – December 13, 2009 by zip2play

Dr. Buff,

Re those horrific tophaceous pix on the web (and in medical books), no they will not resolve in a couple months…maybe a couple years. Big enough tophi that are mangling the function of a joint must/should/may be removed surgically.

At a SUA of 3.05 (talk about medical personnel not knowing what significant figures  mean??? maybe it was 3.05127932? ROFL) I think you are doing as well as you can and should see significant tophi reduction without too much pain in several months. Keep measuring your uric acid, and to 1 decimal point is MORE than close enough. Yes, that is as good as medical treatment gets so try to stay there. As GP says, EXCEPTIONAL.

You will not remove all your tophi with meds nor can you restore any erosion that has occurred becasue your doctors were incapable of diagnosing the oldest disease in time…I'm sure they were busy measuring your blood pressure, which is what they do best.

Remember, we remove uric acid by a few hundred milligrams and tophi weigh in at ounces or 30 grams per ounce  or 30,000 mg. per ounce. Add to the fact that the deposits are walled off by fattly deposits, pus and, scar tissue so drug treatment may not reach them. That's whay it's so important to prevent their formation. So the net is that some tophi you will have to live with unless you want to resort to surgery. Caution: I doubt that many surgeons are good at this anymore…too busy with brain and heart surgery that pays better.

(I am beginning to think that more of us should be on probenecid…but I have no experience with it.)

ps…If you are getting UA levles of 3 with probenecid, do not worry about under or over excretion becasue it is obviously the right drug for you.

one more thing, probencid does not make me feel tired and crappy like the allipourinol did.  I took it for 3 months and saw more improvement on probencid in 3 weeks.