January 29, 2009 at 2:49 pm #2785zip2playParticipant
We often see a figure tossed out indication that uric acid/urate are soluble if they are kept diluted in blood serum to about 6.5 or 7.0 mg/dL. This makes the rather gross assumption that the body is at 98.6 degreed F. (or 37 C.)
I read an article several years ago in a med journal entitled “GOUT WITHOUT HYPERURICEMIA.” It was a case study of a homeless man who would regularly present at an emergeny room with extreme foot and hand pain, inflammation and even tophi. So the logical assumption was gout but his uric acid leves were always normal to low-normal. He responded very well to colchine and was usually treated for a few days and released, pain free,
A doctor began to start putting one and one together and when the man next presented (in the dead of winter) the temperature of his feet were measured (god knos how) and they were 40 degrees colder than “body temperature.) Eureka! Monosodium urate becomes vastly less soluble as temperature drops and the poor old homeless gent with decreased circulation being exposed to the great outdoors in Winter precipitated uric acid at “normal” concentrations.
This isn't isolated. When you feel you hands and they feel icy cold from shoveling snow, they ARE icy cold and the uric acid that travels very slowly though the capillaries of the fingers and toes can readily crystallize out.
Here's a blurb I dug up:
Effect of Temperature and pH on Uric Acid Solubility
The solubility of monosodium urate is a function of temperature. At normal body temperature, 37°C (98.6°F), the maximum solubility of urate in physiologic saline is 6.8 mg per 100 ml, but at 30°C (86°F) it is only 4.5 mg per 100 ml. Several studies have shown that gout attacks are more frequent in springtime.[12, 13] This may be due to the accumulation of monosodium urate crystals in the extremities during the cold winter months.
That huge difference in solubility is with only a 10 degree drop in temperapure…I KNOW my hands get colder than that, and so does the tophus on my pinky. Any coincidence that gout attacks at dawn when our circulation is down and our feet might be cold.
So, what can this mean for us…wear good gloves, wear two pair of socks and consider staying inside by the fireplace on the coldest days. If you have a nice sauna…all the better (my gym downstairs has steam and sauna and I try for everyday…I imagine my little tophi just MELTING away.)
January 30, 2009 at 8:04 am #4062Keith Taylor (GoutPal Admin)Participant
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Thank you, zip2play.April 23, 2009 at 1:14 am #4435ScottoParticipant
I agree with temperature being a factor in gout attacks. I have a spa that i use regularly but put it off for a while because when i felt the tingle it would seem to bring on an attack. Now being a bit wiser i feel this was from dissolving crystals as it seemed to come and go as i was having a spa.
What are the figures for the ua levels for forming and dissolving of the crystals?
I got my uasure to day and i am at 5.2mg/dl at 0900 and i had breakfast before. Should you fast before test as it states in the instructions and for how long? Zip mention not testing first thing in the morning, Why is this?
It will be interesting my levels after the weekend as i am going away water sking and drinking from today till sunday. Do you take more allpuranol when you have a binge?
So many questions
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