GoutPal

The Benefits of Calcium When Living With Gout

Bob Coburn — Sun, 27 May 2012 10:54:54 +0000

Our guest writer, Bob Coburn, returns with an important article about calcium – a vital consideration when planning your gout diet menu.

The Benefits of Calcium When Living With Gout

One particular mineral that has gained some notoriety lately is calcium.

The effects of calcium, which when taken in moderate amounts can have an overall positive effect on the body, are being cited in anecdotal evidence as a way to combat some of the symptoms of gout.

Uric acid is one of the primary contributing factors to the painful symptoms experienced by gout sufferers. Therefore, controlling the production of this substance is key to getting symptoms under control. One of the techniques that are now being used to accomplish this is by changing the pH level of the body in order to manipulate its uric acid production.

pH stands for the power of hydrogen and refers to the acidity level in the body. That is, when the pH levels of the body are raised, it becomes more alkaline, while lowering pH levels makes the body more acidic.
We are surrounded with acidic food everywhere. High purine, high carbohydrate, processed food and carbonated drinks are all acidic. The human body naturally exists in a slightly alkaline state, but after years of consuming acid foods, becomes progressively acidic

So, when the body’s pH does go out of balance (becomes more acidic, less alkaline), it counterbalances the acidity by using whatever calcium is accessible to sustain the proper pH balance. Ordinarily, the next best source of something alkaline is the calcium in your bones. It only makes sense, then, that calcium supplements will help retain bone strength while also maintaining the pH balance of the blood for other issues. If you also frequently consume alkaline drinks, you will start to win the battle against all those acid foods.
Therefore, by raising the pH levels in your body, you are effectively putting into practice a natural gout treatment. By making the body more alkaline, the uric acid levels will be reduced. This is because uric acid can be diluted by drinking water, and the more alkaline the body is, the more water-soluble uric acid becomes. And so, the higher the ratio of alkaline to acid in the body, that is, the higher the pH level of the body (or the number on the pH scale) the more alkaline your body will be, and the more uric acid will be dissolved into the water you drink. Water with a spritz of lemon juice or apple cider vinegar is an alkaline drink often recommended by nutritionists to gout sufferers. Green tea and carrot juice are additional beverages that can keep the body alkaline.

PURIXA™ (www.purixa.com) is one gout cure that benefits from a moderate supply of calcium. In addition to its uricosuric and xanthine oxidase inhibitor mechanisms, PURIXA also contains green tea extract to raise the body’s pH level and extremely high quality milk calcium to help replenish bone calcium that is depleted when the body is in a high acidic state, as is often the case with gout. …

Gout Management: Mind The Gaps

GoutPal — Tue, 22 May 2012 03:07:36 +0000

Following yesterday’s feature on simple gout treatment management, I will now look at the consequences of not following that advice.

I am a great believer in a systematic approach to managing gout. If you follow my simple process, you logically move from a clear starting point to a finished objective. For most gout sufferers, the objective is a permanent pain-free life. If you do not follow my systematic approach, you introduce random risks. These are gaps in your gout management plan. In those gaps hide all manner of nasty surprises. Let’s look at some of those gaps, and the inherent risks.

Please note that this is not a comprehensive review of all potential hazards from poor gout management. I include some of the common ones that keep being discussed in the gout forums. My personal gout management tools, announced in yesterday’s article, will cover the risks associated with all failures to manage, in each of the three main gout management steps: symptoms, treatment, & diet.

Gout Management: Risks Of Bad Diagnosis

In bad gout diagnosis, I also include no diagnosis. What are the risks associated with wrong gout diagnosis?

Gout Exists But Not Diagnosed

Most cases of gout are easy to diagnose, but occasionally gout is interpreted as something else. There are two reasons for this:

Uric acid levels in the blood can fall during, or immediately after, a gout attack, as uric acid moves from blood into the joints in crystal form.
Many doctors use laboratory reference ranges as an indicator of your health. In fact, normal in this context is a statistical average range, which is totally dependent on the reference samples used. It has no medical value, as the samples could easily include gouty subjects. This is why reference ranges vary from lab to lab. The safe medical upper limit is 5mg/dL (0.30mmol/L, 300μmol/L).

Gout Diagnosed But You Have Another Disease

There are other diseases that mimic symptoms of gout. These include pseudogout, bursitis, and septic arthritis. The situation can be complicated by the fact that you can have any of these diseases together. In most cases, diagnosing these conditions as gout will lead to unnecessary suffering as the uric acid lowering medications will not help other conditions. In the worst case, if your “gout” turns out to be septic arthritis, then steroids may cause it to get worse.

Avoid Bad Gout Diagnosis

If you do not have a clear gout diagnosis, you need my personal gout symptoms assessment tool for swollen joint sufferers. This tool guides you through how to work with your doctor to get a good diagnosis of your symptoms. You can only access the tools through the gout forum, so please read yesterday’s article about simple gout treatment, then start using the gout forum.

Gout Management: Risks Of Bad Treatment

In bad gout treatment, I also include no treatment. What are the risks associated with poor gout treatment?

These treatment notes assume that you have a confirmed gout diagnosis. If you do not, none of the rest of this applies, so please go to the gout forum now.

Gout Left Untreated

The only effective treatment for gout is to maintain uric acid at a safe level. Failure to do so means that crystals will continue to form in and around your joints. More joints get involved, and lumps called tophi form in tissue throughout the body. This can happen so slowly you do not notice. After several years, these tophi will destroy your joints leaving you crippled, and can damage other organs, especially kidneys.

Gout Treated But Uric Acid Not Checked

If you take gout medicines to lower uric acid, but do not check the results, you are putting yourself into a health lottery. Most gout patients who do not get regular uric acid checks, and even some that do, fail to take a sufficient dose. Insufficient dosing is just the same as no dose at all. You may slow the process, but eventually you will become crippled or worse, if uric acid is not kept at a safe level.

Avoid Bad Gout Treatment

If you do not have a thorough gout treatment management plan, you need my personal gout treatment management tool for gout patients. This tool guides you through setting treatment goals with your doctor, and monitoring your progress towards these goals. You can only access the tools through the gout forum, so please read yesterday’s article about simple gout treatment, then start using the gout forum.

Gout Management: Risks Of Bad Diet

In bad gout diet, I also include no dietary control. What are the risks associated with poor gout diet?

These treatment notes assume that you have a confirmed gout diagnosis, and a thorough gout treatment plan. If you do not, this gout diet information does not apply, so please go to the gout forum now.

Gout Diet Unrestricted

In theory, a correct dose of uric acid lowering treatment, such as allopurinol or febuxostat (sold as Uloric or Adenuric), allows you to eat what you want. Please do not forget that the objective of your gout management plan is to lead a happy pain-free life. It will not be very happy if you fix your gout only to suffer heart disease, stroke, diabetes, or some other disease associated with bad diet.

Gout Diet Over-restricted

There are many lists of foods you should avoid with gout, and most of them are wrong. Unnecessary restriction of foods can lead to poor diet, and this will not help your gout treatment program. A balanced, varied diet is a healthy diet for gout. Unnecessary restrictions cause stress, and often lead to people abandoning a healthy lifestyle, because the effort seems too large. Only consider changes if you cannot achieve your treatment goals, and then make changes slowly.

Avoid Bad Gout Treatment

Gout Management: Next Steps

I have mentioned six common mistakes when managing gout. In practice, there are many more, and in almost all cases, the outcome of bad management is that you suffer unnecessary pain. Do yourself a favor, and develop a simple gout management plan today.

All the knowledge you need to do this is here on GoutPal. In fact, there is so much information here that you may feel overwhelmed. That is why I have provided a support forum. It is also why I will give you tools to help you build a good relationship with your doctor. Go to the forums now, and let us start to develop your personal plan to manage your gout and live a pain-free life. The gout forum is linked at the end of the section links near the top and bottom of every page here. For other relevant links, please see my simple gout treatment article.…

Simple Gout Treatment

GoutPal — Mon, 21 May 2012 07:04:33 +0000

I know gout can be complicated, but let’s try the simple approach to gout treatment before we look for difficulties.

Gout treatment is the heart of finding gout freedom.

Gout treatment must be preceded by a proper medical diagnosis of your gout symptoms.

Gout treatment might be followed by adjustment to your gout diet.

So for all of you making life difficult for yourselves by worrying about food and drink – stop now. Do not even think about diet until you have a good gout management plan.

1. Starting A Gout Treatment Plan

The best gout treatment plan starts with good diagnosis from your doctor(s). If you have a confirmed gout diagnosis then move to step 2.

Gout diagnosis can be difficult for a small minority of gout patients. For most people, it is very simple.

If your gout symptoms are not confirmed, see your doctor or rheumatologist today. If they are confirmed, a more complete analysis of possible causes is useful, but not essential. If you have it, it may give you more options for gout treatment.

I will announce a personal gout symptoms assessment tool soon. In the meantime read the Gout Symptoms section, which is first in the list of sections near the top and bottom of every page. If you still have questions, ask in the Gout Symptoms forum.

2. Your Gout Treatment Plan

With your gout symptoms confirmed, you need to work with your doctor to develop a good gout treatment plan.

There are several stages to your gout recovery, and each stage requires clear goals, appropriate therapy, and meticulous monitoring. My gout treatment section covers the stages of therapy for lowering uric acid. It also covers the pain relief you will need during early weeks or months as you start your recovery.

I will announce a personal gout treatment management tool soon. In the meantime read the Gout Treatment section, which is second in the list of sections near the top and bottom of every page. If you still have questions, ask in the Gout Treatments forum.

3. Help Your Gout Treatment Plan With Diet

Though many gout sufferers, and some healthcare professionals, become obsessed with food and drink, diet has little effect on gout in most people. Clearly, if your diet is bad by recognized nutritional standards, then it may have a bad effect on gout. Obesity, and excess animal protein, consumption can make gout worse. But frankly, you should worry more about the potential risks of heart disease, stroke, and diabetes.

If you have a good gout treatment plan, then you might help it by assessing your diet. You might be able to improve diet to assist both uric acid and pain relief aspects of your gout treatment plan. However, without the monitoring that is vital to a good treatment plan, any diet changes are pointless. As you will see in my Gout Diet section, food and drink can have small changes on uric acid and on inflammation.

In the context of a good treatment plan, some gout patients can manage their gout with diet changes alone. But it is very easy to get it hopelessly wrong, so if you are considering gout diet improvements as a treatment option, please ensure you arrange regular uric acid tests with your doctor, or spend a few dollars on a home uric acid test kit.

I will announce a personal gout diet planning tool soon. In the meantime read the Gout Diet section, which is third in the list of sections near the top and bottom of every page. If you still have questions, ask in the Gout Diet forum.

2012 Gout Treatment Plan

Thousands of the 2million+ visitors to GoutPal have followed my free advice. They have worked with their doctors and other healthcare professionals to lead a pain-free life. Many millions more need my help, so 2012 is my year for gout freedom evangelism.

I am introducing personal monitoring programs so that gout patients can plan and manage their own gout treatment plan online. With instant access to hundreds of fellow gout sufferers, GoutPal members can help you work with your doctor to produce a personal treatment plan that works for you.

All I ask in return is that you join in, help spread the word, or both.

Gout Treatment Plan: Next Steps

Stay Updated	Spread The Word	Join In
Stay updated, so you do not miss the announcement of my rewards schemes and gout treatment planning tools. Subscription is free at: Enter your email address: Or subscribe by clicking this badge: Subscription is free and your email address is safe – I will never share it with anyone else. Thank you for getting my subscriber number over 1000. Now I’m seeking 10,000, so please invite anyone you know who suffers from gout, or who has an interest in it. If you mention gout in conversation, you may be surprised how many people know someone who suffers from this painful disease – ask them to start their recovery by subscribing here. Also ask your doctor and other healthcare professionals. Many a doctor finds GoutPal useful for definitive, independent gout facts – make sure yours is among them.	Gout is a uric acid imbalance. It is not an eating disorder or a social disease. Yet, I need your social skills to help me spread the word. Please tell your friends on Facebook & Google+: Please click the Facebook Like button. GoutPal On Google+ Please click the Follow button. I will soon be adding a points reward scheme on Facebook that will give you access to your personal gout treatment planning tools	Register for the gout forums, then earn points. You can earn points by voting on questions and answers. Tell the world what you like and what interests you, or simply thank contributors who write good gout questions and answers. You can earn more points by asking questions and by giving answers. Points will give you access to your personal gout treatment planning tools. There is no need to wait until the tools are available – I’m not even going to release them until there are 100 gouty people with at least 1000 points. Start earning your points by registering for the gout forum.

Stay Updated

Spread The Word

Join In

Stay updated, so you do not miss the announcement of my rewards schemes and gout treatment planning tools. Subscription is free at:

Thank you for getting my subscriber number over 1000. Now I’m seeking 10,000, so please invite anyone you know who suffers from gout, or who has an interest in it. If you mention gout in conversation, you may be surprised how many people know someone who suffers from this painful disease – ask them to start their recovery by subscribing here. Also ask your doctor and other healthcare professionals. Many a doctor finds GoutPal useful for definitive, independent gout facts – make sure yours is among them.

Gout is a uric acid imbalance. It is not an eating disorder or a social disease. Yet, I need your social skills to help me spread the word. Please tell your friends on Facebook & Google+:

Please click the Facebook Like button.

GoutPal On Google+

Please click the Follow button.

I will soon be adding a points reward scheme on Facebook that will give you access to your personal gout treatment planning tools

Register for the gout forums, then earn points.
You can earn points by voting on questions and answers. Tell the world what you like and what interests you, or simply thank contributors who write good gout questions and answers.
You can earn more points by asking questions and by giving answers.
Points will give you access to your personal gout treatment planning tools. There is no need to wait until the tools are available – I’m not even going to release them until there are 100 gouty people with at least 1000 points. Start earning your points by registering for the gout forum.

The rise above 1000 subscribers has prompted me to start the gout treatment planning tool process. Get the forum users, Facebook Likes, and Google+ followers to 100, and I will open the tools to selected testers. Get them to 1000, and I’ll open the tools to everyone who qualifies. As with all GoutPal support services, these tools are free of charge.…

Best Tophi Picture

GoutPal — Tue, 08 May 2012 03:37:25 +0000

Regular readers will have noticed an upsurge in the number of tophi pictures here.

Most are quite horrendous, but I make no apologies for warning of the dangers of untreated gout. If you are in the unlucky position of having gout, you have all my sympathies. Until you experience that agony of a gout flare, you never truly understand gout. Yet we often bury our heads, and leave gout untreated for years.

Is it fear of daily meds? Is it lack of understanding? Is it simply that we cannot tolerate a cure?

Despite the advances in science that mean we can now control gout, there is a tiny minority who cannot tolerate common uric acid lowering treatment. If you do not get uric acid to safe concentration, you are doomed to continuous growth of tophi. You might treat the pain, but can you control the gout?

Pain relief without uric acid control means more and more uric acid crystals that will eventually show themselves as gouty tophi.

I have shown many terrible tophi photographs here. I want you to realize that untreated gout is serious.

Gout treatment, however, has it’s limitations. What do you do if you are in that tiny minority who cannot tolerate mainstream uric acid lowering treatment?

The good news is: help is at hand.

Rather than trying to expel more uric acid with uricosurics like probenecid, or inhibit uric acid production with xanthine oxidase inhibitors like allopurinol or febuxostat (Uloric/Adenuric), why not simply convert uric acid to something less harmful?

During my years of gout, and my search for gout freedom, I have been fascinated by the development of what is now known as Krystexxa. The easiest way for you to track that development is to search for puricase, PEG-uricase, pegloticase, or Krystexxa, in the search box above. Those are the labels for a remarkable gout medication during various stages of development.

Like any scientific research, the studies of the development of Krystexxa can be tedious at times. What makes it really interesting are these before and after photographs of tophi in a gout patient treated with pegloticase.

Here, we have a situation where uric acid has a difficult time. In other gout treatments it is encouraged to leave the body, or discouraged from being produced. With Krystexxa, uric acid disappears. It is converted to other harmless compounds, so the treatment gives remarkably low levels of uric acid in the blood. At those levels, tophi cease to be a long-term threat. As the pictures show, they simply melt.

Later, I will review the report on Krystexxa that contains these photographs of shrinking tophi. but for today, I simply want to share with you, the clear knowledge that a low level of uric acid will cause tophi to shrink. It may take longer with allopurinol or Uloric, but those gouty lumps will go. Just make sure you get your uric acid concentration low enough. The upper limit is 5mg/dL (0.30mmol/L), but going lower for a year or so will shrink those tophi faster.

Don’t miss out on the Krystexxa report, or other news about gout. Subscribe to my free update service, and ensure you stay in-touch with the latest developments in gout treatment.

Leave this Tophi Picture to browse more information on Tophaceous Gout…

Thank You Team For Resolving Gout

GoutPal — Wed, 25 Apr 2012 05:22:58 +0000

Today is a great day for passing on the thanks from many gout patients who have resolved their gout.

I speak of resolving gout, as it cannot really be cured. Medics speak of controlling gout. I often speak of fixing gout, or finding gout freedom. There are a few cases of secondary gout, i.e. gout caused by another health condition or it’s treatment. In these cases, curing the underlying condition may well cure the gout, but for most of us we cannot expect a cure.

I do not think that matters. What matters to me is that, with a simple treatment program (or occasionally a complex treatment program), we can live an active life, free from pain, and free from the fear of pain.

When I started GoutPal.com, it was mainly to find my understanding of gout, and ways to cope with it. Seven years on, I have found my gout freedom. The help, encouragement, and support from members of the gout forum community has been invaluable to me, as they have to many others.

With current reorganization of the gout forum, many messages of thanks will be lost. I will try to preserve some of these messages here. If you want to add new messages of thanks for resolving your gout, the new gout forums are open. I am busy adding new features to these, but even now, they offer all the support of the old forums in an easy-to-use question and answer format. The ‘Please Tell Me’ buttons near the top and bottom of every page give you a quick way to share your feelings, opinions, experiences or questions about resolving your gout.

At the risk of blowing my own trumpet, I will admit to a large amount of pride in the following messages. Some of this is personal pride, but mostly it is because I am proud to be a member of this friendly, supportive, gout community. Only today, I have seen one selfless gout patient offering unneeded colchicine free to people struggling to afford the Colcrys brand. The team spirit is humbling, but there is a more important back story.

The gout sufferer has donated his unneeded colchicine because he has resolved his gout. If you are in pain now, can you imagine how good it must feel to be so certain of your treatment, that you can give the gout pain meds away? The contributions from people who had fixed their gout kept me going when I needed it. The following messages will prove that you can resolve your gout and live a pain-free, worry-free, life. You do not need to spend 100s of dollars on foolish reports or snake-oil remedies. Just work with your doctor to find an inexpensive treatment program. The gout forum members will help you find a treatment program that is right for you. They will support you through every stage of it. Great gout friends, not greedy gout profiteers.

Resolving Gout Messages

From gout hater, March 2012

Thank You

Thank you to everyone here who has shared their story about gout. [...] The gout is now gone from left foot and both knees, but not from right foot hopefully it will be gone soon.

Again THANK YOU to everyone that shared their journey and knowledge, without this I would not have been able to ask to right questions

From vegetarianGuy, September 2010

Update and thank you message

So as I am busy living my life you might not see many posts from me in the future. Instead of just disappearing I wanted to say a proper goodbye to you all and a big thank you.

From davidk, October 2010

Gout sucks! GoutPal rocks! THANK YOU! THANK YOU! THANK YOU!

Did I mention thank you!? I think I am finally over the hump of gout suffering. Thank you GoutPal for creating and maintaining this site. [...] We have a tablecloth we use for Thanksgiving and on it, we write what we are grateful for. This year I’m going to write “being able to walk without a cane and able to play with my kids.”

Resolving Gout: Next Steps

I’m going to take a break now, before the tears of joy damage the keyboard. I will return with more thanks for resolving gout, later.

If you are not resolving your gout, the next step is pretty obvious – join the gout forum and get the help you need.

There are a few rough edges as I move things, change formats, and improve features, but as I said on Facebook earlier today: the great gouty helpful spirit lingers on.…

Is Gout Massage A Bad Treatment Of Gout?

GoutPal — Sun, 22 Apr 2012 04:17:20 +0000

One of the most popular topics on the gout forum is about massage and gout.

It started with a forum member asking:

A couple times I have massaged the toe joint and it felt like perhaps I was able to break up the crystals a bit. Not sure if that can really happen or if I imagined it. So, my questions are: 1) can you really break down the crystals by manually massaging the joint? 2) if so, should you? Would that help break it down and assist in the process or is it doing more harm than good?

Inevitably, as forum discussions tend to do, there is talk of supporting the gout massage with hot baths, which in turn leads to discussion of what to put in the bathwater. But this misses the fundamental question: does massage help gout, or will massaging gout cause more problems?

Firstly, as with any aspect of gout treatment, your first call should be to your doctor. Your doctor is the only person qualified to assess your individual medical status, and likely response to massage.

Following that, I would like to move on to general advice about gout and massage, backed up by references to scientific studies. Unfortunately, there are none. Of course, if you know of something I have missed, click the ‘Please Tell Me’ button, and let me know. I have seen some general advice about massage and inflammation, but before I explain that, let me explore one aspect of gout that is commonly misleading – sharp uric acid crystals.

Gout Massage & Uric Acid Crystals

A point was raised that massaging a gouty joint could cause damage from sharp uric acid crystals. Uric acid crystals, when seen through a microscope, are appropriately described as pointed, needle-like, or sharp. Whilst this is true, shape is irrelevant. Gout is caused by an immune system response to invading uric acid crystals, in a similar way to the response to invading viruses or bacteria. You can see this in action if you use the box above to search for white blood cells. There you will see that, at this microscopic level, shape does not matter. Cells are not punctured by sharp crystals. Cells will engulf invaders of any shape, but can only deal with one (maybe two). If they meet more, they call for reinforcements, and that triggers the inflammation and pain that we feel.

Now it might be that massage is a bad treatment of gout due to this inflammation process, but it has absolutely nothing to do with the shape of the uric acid crystal.

Gout Massage & Inflammation

Every professional massage guideline that I have seen says that massage should be avoided completely if there is any inflammation anywhere in the body. Beyond that, areas that have been subject to inflammation in the past should not be massaged.

That seems pretty clear to me. Unless your doctor advises specific medical reasons why your individual case history warrants an override, stick to the best general advice and avoid massaging gouty joints.

Gout Massage: Next Steps

You can see that, until the scientists investigate specific effects of massage on gout, we are probably better playing safe, and stick to gout treatments that have been proved to be effective and safe.

If you have questions about gout and massage, enter your question into the search box to see if we are already discussing a similar massage topic. Alternatively, click the Please Tell Me button.…

Feet Tophi

GoutPal — Sat, 21 Apr 2012 10:28:18 +0000

The feet tophi pictures relate to gout crystals showing in various parts of the feet, except the toes, which I put on a separate page.

Tophi In The Right Foot

An article titled “An Unusual Soft Tissue Tumor”^[1] grabbed my attention. Tumor has terrible connotations and I was worried what I might find.

As it turns out, not as bad as I imagined, but still quite horrific. First, the definition of tumor:

A swelling of a part of the body, generally without inflammation, caused by an abnormal growth of tissue, whether benign or malignant.

A swelling of any kind.

Apart from the “generally without inflammation” that is a fair description of tophaceous gout. In this respect, inflammation is a tricky aspect. Sometimes tophi are accompanied by inflammation, but often they are not. The report notes:

Tophaceous uric acid deposits are an important differential diagnosis when evaluating benign soft tissue masses, even in the absence of a history of inflammatory arthritis

It is quite common, due to the way uric acid deposits form, for people to experience tophi without ever getting typical acute gout flares in the joints. Please see tophaceous gout for explanations.

Right Foot Tophi

A 63-year-old man presented with a slow-growing tumor on the front of the sole of the right foot. The mass was firm, painless, and attached directly by it’s base. There was no history of trauma or previous arthritis.

Dual Energy Computed Tomography (DECT) of the right foot was performed on a dual-source CT scanner at 140 kVp and 80 kVp tube potential.

Feet Tophi: Next Steps

There are other tophi images within this Gout Symptoms section, and you can find them quickly by searching for gout crystals in the box above. If you have photographs of tophi or other gout-related images, please share your gout pictures.

To learn when I add new gout crystals images, please subscribe to my free update service:

Leave Feet Tophi to browse the Gout Symptoms pages

Feet Tophi References

Title: An unusual soft tissue tumor. Authors: Akkara Veetil BM, Bongartz T. Published: J Rheumatol. 2010 Jun;37(6):1269-70.

Tophaceous Gout

GoutPal — Sat, 21 Apr 2012 08:08:43 +0000

Tophaceous gout is the name applied to a stage of gout where uric acid crystals form jelly-like clumps under the skin. Without treatment, the crystals, together with dead white blood cells, will continue to grow and harden.

Tophaceous Gout: Causes

Uric acid crystals tend to form slowly. In many people, this means that they do not get the excruciating painful gout flare that results from the immune system being overwhelmed by an invasion of crystals. Instead, the isolated crystals are engulfed by white blood cells, and are no longer seen as a threat. This is similar to the process used by our immune system to defeat invading bacteria and viruses. In those cases, the invaders disintegrate after attack by white blood cells, and the resulting debris is absorbed or excreted.

As uric acid crystals are not living cells, they cannot die, but the coating from white blood cells renders them invisible to the immune system. They are no longer a threat, but they have to go somewhere. They either eat into your cartilage, tendons, and bone, destroying joints, or they form lumps in soft tissue giving tophaceous gout.

Tophaceous Gout: Symptoms

The lumps are collectively called tophi, with a single lump being a tophus. As well as the disfiguring appearance, tophi can restrict movement, and may burst through the skin causing pain and risking infection in the resulting wound. If lumps are opened, either by accidental trauma, or deliberate lancing, they usually exude a chalky substance that looks like toothpaste.

As uric acid crystals form more readily at colder temperatures, tophi are usually found in the extremities, particularly the ears, fingers and toes. However, they can grow anywhere, so it is important to get unknown growths checked by your doctor as soon as possible.

Tophaceous Gout: Diagnosis

Diagnosis is straightforward, and reflects the standard for diagnosing gout in general. The test is to analyze a sample from a tophus under polarizing microscope which will reveal uric acid crystals if gout is present.

There are new imaging technologies that can reveal uric acid crystals in the body without the invasive sampling processes. DECT is the best of these, but availability is very limited. Ultrasound techniques are improving to recognize patterns from uric acid deposits, but again, access to advanced techniques is limited. For most patients, the analysis of samples is the only practical option, but this is painless if managed by a competent, experienced health professional.

Tophaceous Gout: Next Steps

Now you know what tophaceous gout is, your next step is to get it treated. Many people shy away from seeking treatment because they fear the tophaceous tumors. You should not fear them, but you should fear the likelihood of similar growths hidden within the joints where they cause permanent damage. See a doctor immediately. Maximum doses of the uric acid lowering medications described in the Gout Treatment sections are usually very effective at shrinking tophi. You should also discuss pain relief with your doctor for the early stages of that treatment, as lowering uric acid can cause gout flares from dissolving crystals.

Left untreated, existing tophi will grow larger, and will spread to more places in your body. I collect photographs and images of tophaceous gout, which you can find by searching for gout crystals in the search box at the top of each page.

Leave Tophaceous Gout to browse other Gout Symptoms pages…

What Is The Best Alcoholic Beverage To Drink With Gout?

GoutPal — Wed, 18 Apr 2012 12:39:29 +0000

Many people worry about gout and alcohol. Daily gout diet forum topics include questions similar to “What Is The Best Alcoholic Beverage To Drink With Gout?”

The first thing I have to know is, “Why are you asking?”

Do you think alcohol is causing your gout, making it worse, or affecting your treatment, and why do you think one form of alcohol is different from another?

Before I begin, this is not one of my explanation articles. It is more a quest to clarify how you think about alcohol related to gout. As such, I will not be referring to specific gout research, though I may mention some facts or views in general terms. Once the issues are clarified through better forum discussions, I may publish specific guidelines based on medically acceptable evidence.

I have started reviewing the gout forum discussions about alcohol related to gout, and the situation is not good. Everybody seems to want to jump on the bandwagon and express their own feelings about alcohol. Often these bear no relationship to gout.

The biggest danger is from people with an alcohol fixation, or even a dependency. This is quite outside the scope of a gout support service. If you have health issues with alcohol, these need to be dealt with in conjunction with your doctor or a suitably qualified clinic.

Assuming you simply want to enjoy the social pleasures of alcohol, but worry about the effect on your gout, then you must be clear if you are worried about your symptoms, treatment, or diet.

Gout Symptoms, Causes And Alcohol

Many people believe that gout can be caused by excess alcohol. Some studies implicate alcohol as a contributory factor. If you feel this may be the case, then the easy way to find out is to stop drinking alcohol. If you suffer less gout, then you have an answer, but only a partial one. You should be more concerned with keeping uric acid in the blood at a safe level. If you have had a confirmed gout diagnosis, then the safe level is 5mg/dL (0.30 mmol/L). You cannot judge your alcohol abstinence by lack of pain alone, because uric acid crystals can form very slowly if the concentration in your blood is above the safe level. This will lead to gout attacks in future, and joint damage, so be certain that you check uric acid before and during alcohol abstinence.

There are also concerns that continuous high intake of alcohol can influence gout via kidney impairment, but this is moving into the realms of alcoholism, and certainly beyond the scope of a gout website.

Alcohol And Gout Diet

My guidelines for judging gout diet apply to alcohol. You cannot assess if a single food item or beverage is good or bad for gout. You must assess total diet with regard to purines, calories, iron, and good eating habits, as described in the Gout Diet pages. Once you do that, if the contribution of alcohol in your diet makes your diet poor, then correct it by replacing alcoholic beverages along with improving other weaknesses.

Alcohol And Gout Treatment

The best approach to alcohol and your gout treatment is to start by reading the labels. If alcohol restrictions are included in the medicine instructions, then follow them. If in doubt, consult your doctor or pharmacist.

We have a specific debate about allopurinol and alcohol, but any gout treatment should prompt a look at alcohol. It seems that the percentage of gout-specific drugs affected by alcohol is quite small. However the biggest problem is that excess alcohol is a very common reason for non-compliance. In the afterglow of a drinks session, it seems that many gout patients simply forget to take their gout medications. As a one-off, this is not serious, but constantly missing meds leads to under-dosing, and this can be very serious.

Best Alcohol For Gout

Because of the lack of clarity, we get a lot of discussions about the best choice of alcohol for gout patients. In my opinion, this is nonsense, but given the high profile of this issue, even within the medical profession, I feel I should explain.

In terms of alcohol consumption, it is ridiculous to ask if beer is better than cider, liqueur better than wine, or vodka better than whiskey. We even get questions about mead! For alcohol consumption, the important values are the strength of the drink, and the daily consumption. If alcohol affects uric acid processing in the kidneys, then the rate and strength are most likely to be the biggest influence on gout. Therefore you should think about the strength of the drinks you take, and if you are concerned about alcohol, lower the strength of the drink by adding mixers, or choose a lower strength alternative. The issues become clouded when you consider other properties of alcoholic beverages. For instance, beers contain purines that might be bad, and red wine contains micro-nutrients that may be good. But this simply brings us back to my advice in alcohol and the causes of gout.

The only way to determine if one drink is better than another is to test your uric acid. Stick to one drink for at least two weeks, test your uric acid, then switch to a different drink. Retest after at least 2 weeks, then repeat as often as it takes to get reliable results. If you do this, please share your results in the gout forum, where you can also get advice on establishing test procedures that will produce the best results.

Gout And Alcohol: Next Steps

As you can see, we need to be clear about which aspect of gout we are concerned about when addressing gout issues. You can join the gout and alcohol debate, or ask specific questions in the gout forum. The easiest way is to click the ‘Please Tell Me button,’ but be sure to be clear if you are referring to alcohol relating to gout symptoms, gout treatment, gout diet, or something else. There is no specific link between alcohol and gout, so explain your personal circumstances and the aspect of your gout that concerns you. That way, we can discuss gout in a meaningful way – and get some meaningful answers.…

Coffee And Gout

GoutPal — Mon, 16 Apr 2012 13:01:03 +0000

This is a review of a study Coffee And Gout. It is one of the articles relating to Gout Diet Foods To Eat.

About This Coffee And Gout Report

I have extracted the main ideas from the published gout investigation to present these in a more readable format suitable for unqualified gout sufferers. Inevitably, such scientific reporting will still include technical references. I will refer to my gout glossary for further explanation. If you encounter a term you do not understand, you should search for it using the search box above. If that does not provide an adequate explanation, then please ask in the gout forums, preferably by clicking the “Please tell me” button at the top or bottom of this page.

Coffee And Gout Report Abstract

This is a layman’s summary of:

Title: Coffee Consumption and Risk of Incident Gout in Men
Authors: Choi HK, Willett W, Curhan G.
Published: Arthritis Rheum. 2007 Jun;56(6):2049-55.

Objective

Coffee is one of the most widely consumed beverages in the world and may affect the risk of gout via various mechanisms. We prospectively evaluated the relationship between coffee intake and the risk of incident gout in a large cohort of men.

Methods

Over a 12-year period, we studied 45,869 men with no history of gout at baseline. Intake of coffee, decaffeinated coffee, tea, and total caffeine was assessed every 4 years through validated questionnaires. We used a supplementary questionnaire to ascertain whether participants met the American College of Rheumatology survey criteria for gout.

Results

We documented 757 confirmed incident cases of gout. Increasing coffee intake was associated with a decreasing risk of gout. The relative risks for gout were compared in multiple coffee consumption categories:

Cups per day	0	0-1	1-3	4-5	6 or more
Coffee	1.00	0.97	0.92	0.60	0.41
Decaffeinated coffee	1.00	0.83	0.67	0.73 (4 or more)

Total caffeine from all sources and tea intake were not associated with the risk of gout.

Conclusion

These prospective data suggest that long-term coffee consumption is associated with a lower risk of incident gout.

Coffee And Gout Report

Background

The report starts with explanation of the prevalence of gout^[1-5], and the suggestion that coffee may be associated with uric acid in the blood^[6], and insulin resistance^[7-14]. Given the prevalence of coffee consumption, around 2 cups per day on average for American citizens^[14-15], this is an important issue.

The report includes several references to possible reasons why coffee may be associated with gout^[16-29]. It highlights other studies that report associations between coffee and gout^[6][30].

Study Design

The study uses data from a health professionals survey giving over forty-five thousand respondents who did not have gout at the start of the process. Various aspects of diet were monitored^[31-34], and participants reporting incidences of gout^[35] were extracted.

The report describes details of statistical analysis techniques used, referring to several studies, including two statistical dietary analyses^[36-37].

Results

The full report includes more details about results and data obtained, but the key figures are summarized neatly in the chart, which uses the same data as shown in the abstract above.

Discussion

The report closes with a review of related studies^[38-56],and concludes:

Our study was observational; thus, we cannot rule out the possibility that unmeasured factors might contribute to the observed associations. Overall, however, our findings provide prospective evidence that long-term coffee consumption is associated with a lower risk of gout.

Coffee And Gout: Next Steps

You can now see that coffee consumption seems to be good for gout. What we really need is actual case studies on gout patients with acccurate comparisons on different fluids. One glaring omission from this report is any comparison with plain water. The other possibility is the effect of milk, which is often taken in coffee – search for milk in the box near the top of the page if you have not yet discovered the uric acid lowering potential in dairy proteins.

Leave Coffee And Gout to browse Gout Diet Foods To Eat

Coffee And Gout References

…

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Purine-rich foods, dairy and protein intake, and the risk of gout in men.	Choi HK, Atkinson K, Karlson EW, Willett WC, Curhan G.	New Engl J Med 2004; 350: 1093–103.	Purine Dairy Protein Diet & Gout
Alcohol intake and risk of incident gout in men: a prospective study.	Choi HK, Atkinson K, Karlson EW, Willett WC, Curhan G.	Lancet 2004; 363: 1277–81.
Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study.	Choi HK, Atkinson K, Karlson EW, Curhan G.	Arch Intern Med 2005; 165: 742–8.	Obesity And Gout
Pathogenesis of gout.	Choi HK, Mount DB, Reginato AM.	Ann Intern Med 2005; 143: 499–516.	The Manner Of Development Of Gout
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Caffeine ingestion increases the insulin response to an oral-glucose-tolerance test in obese men before and after weight loss.	Petrie HJ, Chown SE, Belfie LM, Duncan AM, McLaren DH, Conquer JA, et al.	Am J Clin Nutr 2004; 80: 22–8.
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Effects of caffeine on energy metabolism, heart rate, and methylxanthine metabolism in lean and obese women.	Bracco D, Ferrarra JM, Arnaud MJ, Jequier E, Schutz Y.	Am J Physiol 1995; 269: 671–8.
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Racial differences in the incidence of gout: the role of hypertension.	Hochberg MC, Thomas J, Thomas DJ, Mead L, Levine DM, Klag MJ.	Arthritis Rheum 1995; 38: 628–32.
A case-control study of alcohol consumption and drinking behaviour in patients with acute gout.	Sharpe CR.	Can Med Assoc J 1984; 131: 563–7.
A controlled study of diet in patients with gout.	Gibson T, Rodgers AV, Simmonds HA, Court-Brown F, Todd E, Meilton V.	Ann Rheum Dis 1983; 42: 123–7.
Effect of oestrogen therapy on plasma and urinary levels of uric acid.	Nicholls A, Snaith ML, Scott JT.	Br Med J 1973; 1: 449–51.
The effect of acid loading on renal excretion of uric acid and ammonium in gout.	Gibson T, Hannan SF, Hatfield PJ, Simmonds HA, Cameron JS, Potter CS, et al.	Adv Exp Med Biol 1977; 76B: 46–56.