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I have gout. Tested and proven. I’m 66 years old and have had gout for about 5 years. The first several years there was little pain and only during the night. My gout is in all the joints of both feet. I can feel it when I flex my toes. It normally doesn’t hurt to do so. There is no redness or swollen joints that are visible. I can walk, run even when playing tennis, without any pain. Trophi in my fingers on my right hand. No pain, just lumps below the skin on or near the joints. Mobility is excellent. I have a home test kit and my readings are between 4 and 6 constantly. When I eat red meat they go up. When I go vegetarian they go down. Exact same thing happens with the trophi. I only have pain in the middle of the night. Usually a couple of Advil along with an extra strength excedrin kills the pain. I have high blood pressure along with the gout. Taking Losarten, 50 mg once a day. Just started Allopurinol 300 mg once a day. From my readings I see I am going to have to get Colchicine and maybe that will help control the nightly pain. It has gotten worse lately and I’m powering down the pain killers almost nightly. I have had a kidney stone, 13 mm, which was destroyed by Ultrasound. About 7 years ago. No kidney problems since. Highly athletic, playing tournament tennis, and in great shape. I read somewhere, maybe here, that taking Losarten and Allopurinol together is a no-no. The only problem is when I take then separately the Allopurinil gives me a mild headache. Prone to migraines so I have to be careful when a headache starts. I have read that diet usually doesn’t have an immediate effect on the gout. In my case it sure does. A meal of turkey, red meat or any fish sends me to the medicine closet for stronger pain killers before the night is over. Any thoughts?
Understanding of diet and gout is changing.
Until recently, the focus has been on purines, and for the last few decades we have known that only animal purines affect gout significantly. Vegetable purines have little or no effect on gout. Other studies have shown that uric acid crystals grow slowly, so many have believed that diet cannot have an immediate effect on gout.
However, at least one study has shown that gout sufferers do get pain associated with eating certain foods. You have experienced this, and so have most other gout sufferers. Until quite recently, this was a mystery.
Even now, we do not fully understand the processes, but various investigations have proved that uric acid alone does not cause gout attacks. That explains why people can get horrendous tophi without any pain, but we do not know exactly why. The most likely explanation is that Free Fatty Acids (FFAs) cause signals to travel to our immune system and trigger the attack. This is under investigation as the most likely reason for food causing gout attacks. It happens that foods rich in purines are also rich in FFAs, so the purine gets the blame when it is probably the fault of FFAs.
Colchicine is the ideal gout medicine to prevent this type of pain until you get uric acid fully under control, with most old crystal deposits dissolved.
I’m a bit surprised by your meter readings. Do you have the machine set on mg/dL? Do you have comparisons with lab test results from blood drawn at your doctor’s?
Keith,
Thank you very much for the information. Didn’t know about free fatty acids and that explains a lot. Just tested my uric acid level on a UA Sure and it reads 6.2. Initially the readings were up around 7 to 10. They just started going down about a month ago when I switched to a no meat, no fish and no turkey diet. Interestingly enough even though the readings have come down the pain associated with the feet at night hasn’t. Perhaps it’s the Allopurinol? I have been taking 300mg once a day for about 2 weeks now. Any thoughts on the combination of Losarten and Allopurinol taken together. I was just wondering whether they had the same effect taken separately. As a side thought the pain at night the last 2 nights hasn’t been bad enough to make me take any pain medication and the tophi are definitely getting smaller. Most interesting. Have ordered .5mg Colchicine and will start taking it as soon as it arrives. Oh, by the way, I am the doctor. A retired Ophthalmic trauma surgeon who specialized in rebuilding the orbit, so I know almost nothing about gout or it’s associated symptoms. Thanks again for all you do.That combination is interesting, but first let me try explain what I think is happening with the pain.
The fact you have tophi, tells me you have a substantial buildup of uric acid crystals. They will be throughout your body. Even in places where you have never experienced gout flares. Lowering uric acid to 6 should dissolve some of these, but as they dissolve 2 things happen:
- Partially dissolved crystals become exposed to the immune system, and might trigger a gout attack
- Dissolved uric acid raises the blood concentration and might cause the level to rise above the crystallization point, causing new crystals to form.
That’s 2 mights. Nothing is certain, but there are three important considerations:
- Lower temperature lowers the concentration point, so colder parts of the body, such as the feet, are more likely to be at risk, even with uric acid down to 6.
- As old crystals dissolve, the duration, frequency, and intensity of gout flares will fall.
- You can shorten the time you are at risk from gout flares with maximum allopurinol, then reduce to a maintenance dose once you have gone six months without a flare.
Colchine is very useful during the time you are at risk. There are different strategies. Some recommend one tablet daily with a second at the first sign of a gout attack. Others recommend as required, but again take as soon as you feel an attack might be coming on. Under my doctors advice, I adopted the preventative strategy for two weeks every allopurinol dose change, then switched to as required. If 2 colchicine didn’t tackle the pain, I supported with ibuprofen. Occasionally additional support prom paracetamol/Tylenol might be necessary.
Now, the interesting combination of Losartan and allopurinol. Losartan is always the best choice of hypertension med for gout sufferers, as it encourages excretion of uric acid through the kidneys (uricosuric). I’ve learned today, from “Effect of losartan potassium, an angiotensin II receptor antagonist, on renal excretion of oxypurinol and purine bases” that it also encourages excretion of allopurinol, and it’s active by-product oxypurinol. My interpretation of this effect on allopurinol is that it is not significant unless it stops you achieving uric acid of 5 or below. In your case, @doctalmadge, this not significant, as you are nowhere near the maximum allopurinol dose.
The other finding of this investigation is slightly more worrying. The report concludes:
the uricosuric effect of losartan potassium may increase the frequency of calculi in the urinary tract
The 2 ways to reduce the risk of kidney stones are increased water intake and alkalizing the urine. Increasing water intake up to around 3 liters per day is OK, but much more than that creates its own risks. Alakalizing is possible with baking soda (sodium bicarbonate) or potassium citrate supplementation, but the healthier option is alkalizing diet.
Keith,
An update on “A different kind of Gout.”
I have been taking 900 mg daily of Allopurinol for about 2 months now. My reading of Uric Acid are constantly down around 2.5 to 3.5. I still have considerable pain in all digits of my feet. It is much worse at night when all is quiet and I’m in bed. In fact I can’t sleep unless I get up and take some Liquid Advil. I have not tried Colchicine yet but am wondering if the above is normal in your experience. I have been taking Losartan Potassium for high blood pressure in the morning and the Allopurinol with my evening meal. The pain in the feet only occurs after I have gone to bed and all is quiet. then it builds up slowly until I need to do something about it. Thank for your help.Mike Talmadge
Your pain sounds worse than mine, but pain is a very personal, subjective issue. I believe two months might be too early to notice the full benefit of allopurinol, but you should notice some lessening intensity and frequency.
In my experience, gout pain deserves more than an Over The Counter pain med. I had a couple of times in hospital, where they really know about pain relief (nurses can’t stand men moaning all night – well not in pain, anyway 😉 ).
If you can’t sleep for the pain, see a doctor, or pharmacist. If it gets no easier soon, suspect something else, because gout can’t live for long with your uric acid levels.
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