GOUT aka GOUTY ARTHRITIS

[flowergirl2day]

Lenin,

What an informative post! Many thanks for taking the time to share.

The more I read about this condition, the more confused I get. I did some research about how uric acid and aspirin relate to kidney disease. Among other things, I learned the following:

Apparently, gout can exist in an individual without an elevated uric acid level. (Great!) This holds true for an acute attack of gouty arthritis as well. A single change in uric acid level, UP or DOWN, can bring on an acute attack of gout. Worse yet, one can get an attack WITHOUT ANY change in the uric acid level. What gives?

It seems to me that one can have this condition and not be aware of it at all, until there's an acute attack. It also looks as if there are no measurable indicators...why bother with the serum ua tests? There seems to be very little anyone can do to prevent getting this disease. I've been lucky enough to have lived without chronic pain thus far. I consider the lack of symptoms in this disease and its poor detection through testing ominous.

Am I wrong? (I'd love to be!)
Flowergirl

[Phlox]

Youre right flowergirl, something I learned during my last AWFUL attack of Gouty Arthritis, is there seems to be a large amount of conflicting information. Worse, Gout still seems to be thought by most people (even by some in the medical community) as a condition caused by the old stereotypes: Overweight Alchoholics who eat crap all day. What a joke! I dont fit that mold, and Im finding alot of people who dont, so why that still persists is beyond me.

Before my last attack, I had a couple Gout attacks that were bad but only lasted a few days and, looking back, were NOTHING compared to what my last attack did to me. I was, as Lenin said, literally CRAWLING across the floor so my foot didnt touch anything, and couldnt do anything to get rid of it. The Indocin & Colchicine didnt get rid of it, and not only did it last for weeks---after about the third week it moved over into the OTHER foot and stayed another almost 2 weeks. During this time, my heart would go into sudden episodes where it raced like I was going to pass out, and I now think of Gout as something more than a painful condition that lasts a few days...its something that I think can take you out, in more ways than one.

Considering all of that, I was shocked to find such a vast amount of conflicting information, and a lack of definitive answers for things we can do in the future. I started itching when I tried to take the Allopurinol, and I also have NEVER shown a high uric acid level in even ONE bloodtest, so I am really in a quandry over this. I also have a white "lump" under my wrist now that doesnt go away, and I think it could be the tophi that I had on my feet during my bad attack. There were several of them, but just the one remains. Even this, though, seems to be lacking in definitive answers. Even the diet when you go digging, is conflicted about many foods. There were also many sites that said alot of the people who are diagnosed with Carpal Tunnel are actually suffering from Gouty Arthritis, but since it is still so hard to lock down, it is under-reported.

I recently asked a doctor about the lump on my wrist, who looked clueless and just shrugged his shoulders. That shrugging of his shoulders, is what the entire catalog of information about Gout seems to be like---sort of a "Well....we kinda know some things about it, but...." I would think that Gouty Arthritis should be as important and well researched as the other forms of Arthritis, since it is a documented killer (especially before Allopurinol entered the scene).

[Lenin]

Part of the problem with diagnosing based on uric acid levels in the blood deals with some people's ability to have a supersaturated condition without crystallization. The other is that the solublitity is remarkable dependent on temperature and thus while solubility is pretty high at 98.6 F it is LOWER at 80F and VERY low at 60F.
People measure body temperature in the mouth...or some other indiscreet cavity. BUT where does gout typically strike, the big toe, the ankle, the last finger joints, the wrists...the COLDEST parts of the body. NOBODY gets a gout attack in the mouth...or the indiscreet cavity.

Thus an upraised toe all night with slow blood circulation in a cool room easily can become 20 degrees colder than the rest of the body...that's why the typical attack of big toe PODAGRA is at 5 AM.

(I read a case history of a homeless guy who was bedevilled with what seemed to be merciless gout but constant uric acid below 4...it took a while for one of the doctors to realize his leg circulation was rotten and the temperature of his feet often went below 60 degrees F. They gave him colchicine and the pain went POOF!)

Too bad though, once crystals form any chance of avoiding attacks with supersaturation disappear because that first crystal serves as an easy starting point for more.

All those dietary recommendations are just so much hooey from days of yore...when there's no cure, doctors WILL devise a way to get paid and the no-sweetbreads, no anchovies diet was just suuch nonsense. I'm sure Henry VIII's doctors were well respected and WELL paid...at least until they killed Henry with dietary recommendation for his gout.

I think to get rid of tophi once formed, it takes more than just allopurinol...it take allopurinol PLUS an agent to dump the uric acid; something like sulfinpyrazole. Those uricosurics are hard to take though, lots; of side effects.
I've been takig allopurinol for a zillion years and the tophus on my thumb won't abate.(I've got a story about that thumb for later.)

My favorite gout line, and it was really an epiphany when I read it:
The humorist Calvin Trillin was asked what was the ONE most important thing he learned in his long life. His reply:

"If you have a lump on your thumb, you have GOUT."

(That single short phrase made me realize what a cosmic JO my doctor was.)

Attacks while uric acid seems low: the joint may disengorge part of the tophus into the bloodsteam and cause crystalliztion elsewhere. That's why people often get an attack when first starting allopurinol.

[flowergirl2day]

During this time, my heart would go into sudden episodes where it raced like I was going to pass out, and I now think of Gout as something more than a painful condition that lasts a few days...its something that I think can take you out, in more ways than one.

What a frightening thought! I guess uric acid (or, most likely, the inflammation) can cause tachycardia during an acute gout or a gouty arthritis attack. Is there a slightest chance that the uric acid crystals can be carried to the heart muscle via the blood vessels from another location? Has there ever been a documented case of an uric acid crystal formation in the heart?
I've just read two books about inflammation. Very informative. The two diets, (two authors) which were guaranteed to reduce the inflammation to almost normal levels, have been proven to work. In my opinion, the diets are doable for people with no other health problems and with an EXTREME committment to the cause.

flowergirl

[flowergirl2day]

Hello,

I looked into the urate crystal deposition in human tissues topic. I cannot find any information on whether or not it can localize in the heart.
It seems that the monosodium urate deposits can form in many tissues of human body. These include joints, skin, bursae, ligaments, eyes, face and kidneys. The tophi rarely form on the face, somewhat more often in the eyes. There was a photo of one next to an eye, so I have an idea of what they look like.

Besides being responsible for formation of uric acid stones in 20% of people with gout, hyperuricema may cause an impairment of renal autoregulation. This can lead to hypertension, microalbuminuria and progressive kidney disease. There are three forms of kidney disease attributed to excess uric acid.

A fact: uric acid levels can vary EVERY DAY and throughout the year in the same patient. In my mind, this makes timely detection of gout impossible. I think that just about does it for me! My frustration is complete.

Flowergirl