I’m developing the sections:

• How food affects gout
• Food as gout treatment
• Medical Food Issues
• Good Gout Food
• Bad Gout Food
• Other Gout Diet Pages

So have I missed anything? Or included something that is not really required?

I often think food is an obsession amongst gout sufferers, and should not have as much importance as it does. But as a gout forum regular commented recently

Personally as someone who is past the nooby stage of understanding Gout. I am more interested in diet related info ie. what food items are good and which are bad for Gout. Info is very lacking on that side everywhere.

Solid research papers/clinical studies on diet + Gout is what I am most interested in as all the hearsay of this food is good that food is bad has not convinced me. For example Cherry and BBQ seems to have cult status but it did absolutely nothing for me. I ate unbelievable amounts of both for months without any improvement. So I am not sure if they actually work or some people are just having placebo effect

I could not agree more (thanks VG). At an early stage of my research, I started looking at diet. What does it really mean?

I found 3 meanings:

1. The usual food and drink of a person or animal.
2. A regulated selection of foods, as for medical reasons or cosmetic weight loss.
3. Something used, enjoyed, or provided regularly.

Meaning 3 strikes a chord with me. If diet is not enjoyed, it will not be sustained, so lists of foods, though useful in some contexts, are just a research and planning tool. What we really need is a sustainable approach to diet planning that sees gout as one of the restrictive parameters, but not as a goal..

My Gout Diet section is certainly not going to be about regulated selection. If you want to be told what to eat, look elsewhere.

I will focus on the first meaning (“usual food and drink of a person”) and return to the original Latin root of the word diet. It comes from diaeta, meaning way of living. So I will advise gout sufferers what will be their usual food and drink for gout. I will also put this into the context of a way of living. Diet is one important aspect of lifestyle. Exercise and metabolism are equally important components.

For me, the third definition is key, except I change the or to and. The GoutPal diet is something used, enjoyed, and provided regularly – a way of living that eases gout pain and gives your best chance for long term health improvement.

I’ll soon be introducing a voting/polling section to measure the importance you attach to gout diet in general, and specific topics within the subject of gouty lifestyle. In the meantime, here is a good place to discuss gout diet. What is important to you?

I review the goods and services and also report the views of other visitors where these are available.

Many of these resources are free. For paid gout resources, I also summarize the most popular in the Gout Store.

I’m delighted to receive gout resource recommendations from you. Please review goods and services that have helped you, and share your opinions and experiences in the Gout Forum. That is also the place to raise questions about gout resources that you have heard about.

You can save a lot of time and money by asking about gout products and services before you buy them, so please check here first, or start a discussion.

Gout Products

Gout treatments, test equipment and other gout products that help you manage gout.

Gout Books

Gout Services

Other Gout Resources

Websites, offline gout resources, and other information that does not fit the main gout resource categories.

Gout Store

Quick links to popular gout resources. The Gout Store is due to be revamped soon to include customer reviews and GoutPal assessments.

I usually offer as much help as I can, then qualify my remarks by advising the gout sufferer to seek medical attention.

But what should I do when your doctor’s advice is advice is clearly wrong?

I know what the leading medical authorities suggest as the best way to manage gout because I research it every day.

I know what typical gout sufferers need to endure, because I am one.

I know when a doctor is giving bad advice. The first comment here is transferred from a separate discussion because it is extremely important. Yes, it refers to allopurinol, but it raises a much larger issue. The writer is clearly unsure about the professional advice given. In this case the advice is clearly wrong. But what should you do when you do not trust medical advice from professionals, and what should I do to give advice that you know you can rely on even though I cannot treat you professionally?

For my specific advice about allopurinol, please see my reply to the first comment. For a discussion on how to handle bad advice, please read on.

On my main gout advice website, I end every page with the disclaimer:

Information on GoutPal.com is to help you understand gout and related issues. It should not be used for diagnosing or treating any health problem or disease. The information is given to help you understand your doctor’s advice and know what questions to ask. It is not a substitute for professional care. If you have an actual or suspected health problem, you should consult your doctor.

On this site, Gout Pal Interactive, I assume visitors will realize it is a gout sufferers discussion arena, and accept the opinions and experiences offered by myself and other contributors are well-meaning amateur views. Maybe I should clarify this with a disclaimer on this site, but my aim is to help gout sufferers, not compound their suffering with meaningless get-out clauses.

The best answer I can come up with at the moment is to carry on giving the best advice that I can, and encourage others to do so. However, I am concerned that doctors who give bad advice need to learn the correct procedures. Perhaps, if you have concerns, you should raise them with the professional bodies in your country in an effort to save other people from potentially harmful practices.

5 years ago I had severe pain in my hip for over a year (to the point of being disabled to work) and finally convinced my doctor to test my uric acid since gout runs in my family He argued that gout does not happen in the hip. (11.6 was the outcome).

My history is of being a commercial fishing captain where I sit in a chair with my feet propped out the window and my but being to lowest center of gravity.

My questions:

1. How often does gout occur in only the hip?
2. When it lasted as long as it did is there anything to help my hip (I rarely have flareups of gout but have constsnt pain from the prolonged gout)? I can not afford the MIR etc.. my doctor wants me to have.
3. How can I gain weight back?

Thank you very much for your time, I know this has been a long letter,
Terry

Gout. The Lancet. Jan 2010.pdf (781 KB)

GoutPal Note:

This is an excellent summary on the current understanding of gout, and how best to treat it. Towards the end, the authors note:

patient information seems to be an outstanding issue in the management of gout—every patient should be informed about the disease, its curable nature, the targets and practicalities of drug therapy, how to prevent and handle flares, and the importance of lifestyle and dietary factors.

And that, my friends, is the GoutPal raison d’être.

• What is the best colchicine dosage for gout?
• Can I take allopurinol and colchicine at the same time?

Colchicine Dosage For Gout Discussion

Many gout cure discussions on colchicine end up with a proven method from our most prolific contributor:

Have your doctor call in a prescription for 30 or 60 colchicine tabs. Fill it immediately and take 2 tabs. Take an additional one every hour until you have taken 16, the pain stops, or the diarrhea becomes intolerable. It usually works seemingly miraculously well.

This will end your acute attack but NOT your gout…that’s what the Uloric or allopurinol is for.

There are many more colchicine related discussions, both live and waiting to be archived.

Colchicine Dosage For Gout – Next Steps

Read the colchicne reference page for more information about this gout medicine.

Look at related answers about gout cures for pain here and check the Gout Treatment reference pages.

It could be a gout specialist, e.g. a rheumatologist, or it could be your local MD who has given you great gout treatment.

Prompted by a tidying up of old forum discussions, I notice that there are occasional calls for recommendations for a doctor with good gout knowledge. Rarely are these answered, but some of that may be due to the way topics that ask that question are scattered over many forums.

I’ve decided to try and build a list of recommended gout doctors, and I can only do it with your help.

If your doctor is particularly good with gout, please pass on their details, but first contact them to check this is OK. I will start a new list organized by country and region with the details.

Similarly, if you are looking for a gout specialist, please say which area you are prepared to travel to.

To kick things off, the old message that I have just deleted was seeking a gout doctor in London UK, but prepared to travel to the home counties. Nobody was able to respond at the time. Do you know a suitable gout doctor?

Also, a gout specialist was named in a different context, but the writer didn’t actually say he was any good or not. This makes me realize that if you are going to recommend someone, you should say why.

Treatments for gout pain are important, and there are lots of questions about them elsewhere.

On this page, however, we look at questions that have been asked about gout medicines that lower uric acid.

Uric acid lowering has been about allopurinol for many years, with a touch of probenecid and other uricosurics. Lately, new uric acid lowering drugs have been developed, available now, or still waiting testing and approval. There are always lively debates on these medications, and here are some of the old gout cure questions that have been answered in the past.

Archived Gout Cure Questions

How To Remove Tophi

A visitor from Vietnam asked how to remove tophi. I explained that the best way is to get uric acid below 6mg/dL (350mmol/L). After a few months the tophi should shrink considerably, but any that do not may need to be surgically removed.

What Is Febuxostat?

This was a question raised about the time that febuxostat got FDA approval and was released under the brand name Uloric. We learned that it is the same drug released in other parts of the world as Adenuric. We also learned that it is very expensive at $5 per pill compared to $4 for a whole month of allopurinol.

Where there are many other discussions on certain topics, I will create a summary page when I can combine two or three discussions. The questions listed above that do not have a direct link to an archived question summary fall into that category.

Next Gout Cure Steps

Look for similar questions in other areas of this Gout Treatments archive, and study the Gout Treatments reference pages for more details.

• Is Celebrex (celecoxib) a good treatment for Gout?
• What is Celebrex for ?

Celebrex For Gout Discussion

nulima:
I was just given this NSAID instead of the indomethacin I had before. The reason I can’t take the Indomethacin is due to a duodenum ulcer which caused it to be made worse.

Celebrex is an anti-inflamtory drug. Has anyone used it? Like to see your response please. Thanks.

GoutPal:

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) reduce inflamamtion by inhibiting enzymes that trigger inflammation. This enzyme, Cyclooxygenase, has different types – COX-1 and COX-2.

Most NSAIDs, like Indomethacin (becoming increasingly known as indometacin) affect COX-1 and COX-2, but COX-1 is also good at protecting the stomach, so ihibiting it can cause, or exacerbate, ulcers. This is a short summary of a very complicated subject.

Generally speaking, COX-1 inhibition is seen as a bad thing, yet many people can cope with this class of NSAIDs without showing problems. Significantly, most experts believe that the risk increases the longer NSAIDs are taken.

Celebrex (a brand name for celecoxib) is the only COX-2 inhibitor currently available in the US. Vioxx and Bextra have been withdrawn, whilst Arcoxia (Etoricoxib) and Prexige (Lumiracoxib have been refused approval. There are fears of increased risk of heart attack and strokes.

The most important thing for any gout sufferer is to see pain relief in general, and NSAIDs in particular as short term measures. They should only be used to support uric acid lowering therapy. Quite frankly, I believe any doctor who prescribes long term pain relief outside a uric acid lowering treatment program is putting health at risk. (I accept there may be individual circumstances where this is the only resort, but it should be exceptional)

There is even less excuse for avoiding uric acid lowering treatment now that the new alternative to allopurinol – febuxostat – is available.

Celebrex For Gout – Next Steps

Similar to etoricoxib, celecoxib is definitely short term only. As such, it might be a useful choice for the occasional acute gout flare, but you must seek other choices for longer than a week.

Look at related answers about gout cures for pain here and check the Gout Treatment reference pages.

Hello, i run into web site after helplessly trying to get some info about gout. My dad is visiting me here, and he is having one of his attacks. He is 72.

I guess he was never diagnosed properly, and last 15 years he was given some non-steroid, anti-inflammatory medication. At the end he ended up in a hospital for a bleeding ulcer, and that was first time he was diagnosed with gout. That was last year in September.

His gout was so bad, that he couldn’t walk. He was given injections for pain and inflammation. They put him on allopurinol 100 mg. he got better, but never 100%. When he came here, I looked through his lab tests. Back in September his uric acid was 516 umol/l. Average should be 182-403. In November it was 400umol/l, and in December was 474umol/l. All this time he was taking 100mg allopurinol.

I was trying to contact his doctor and ask, and comment, that 100mg is not working for him, but no luck getting right answer. Right now he is having another attack, his elbow is swollen, hot ,red. His foot ankle has same problem. He is cold all the time, not a happy camper. I increased his allopurinol to 200mg one week ago.

Today we had his blood drawn, and I will know his uric acid measurements tomorrow. His diet is very healthy, no alcohol, lots of water. I am not giving him any ibuprofens because of his stomach ulcers.

Please advise about mg of allopurinol/ uric acid levels, or any other medication that might work. Do you know how long it takes for allopurinol to have an affect on uric acid? Thanks a lot. Nina

• Is Arcoxia (etoricoxib) safe for gout pain?
• What alternatives to etoricoxib (Arcoxia ) for gout?

Gout and Etoricoxib Discussion

Dkr:
As a European, I have access to the new drug extoricoxib, marketed as Arcoxia. Medicine is taken once a day one 120mg tablet for acute pain and effect for me has been as good as with Indomethacin, except Arcoxia is much easier for stomach. I can take it on an empty stomach, and have not had any problems.

Arcoxia is not yet approved in US (“On April 27, 2007, the Food and Drug Administration issued Merck a ‘non-approvable letter’ for Arcoxia. The letter said Merck needs to provide more test results showing that Arcoxia’s benefits outweigh its risks before it has another chance of getting approved.” – wikipedia )

GoutPal:

The fact that the FDA refused to approve this drug speaks volumes to me. On the approval refusal, there was a great deal of news about Arcoxia/Etoricoxib, including some harsh criticism for the manufacturers, Merck.

Medically, Etoricoxib belongs to a group of drugs called Cox-2 inhibitors. This group is part of the Non-Steroidal Anti-Inflammatory Drugs class (NSAIDs).

Unlike traditional NSAIDs (ibuprofen, indomethacin, etc), Cox-2 inhibitors do not inhibit Cox-1 enzymes which are prevalent in the stomach, so are much less likely to cause ulcers and stomach bleeding.

Unfortunately, Cox-2 inhibitors appear to be linked with higher risks of heart disease. FDA approval has been withheld from Arcoxia because Merck have not shown that the increased risk of heart disease outweighs any significant benefit of etoricoxib. In the wake of Vioxx (another Cox-2 inhibitor) controversy, Merck appear to have been criticized for failure to present data in a suitable way. Type FDA Arcoxia into the search box on the GoutPal Worldwide Search page for more information.

On the other hand, The European Medicines Agency Committee for Medicinal Products for Human Use (CHMP), have approved 120mg once a day for gout. Amongst other recommendations they warn against taking etoricoxib if blood pressure is above 140/90. See the complete report, Questions and Answers on the Review of Etoricoxib-Containing Medicines.

So, Americans have no choice – you can’t have it. [We had no response from other countries]

Current medical opinion is, if you do have access to Arcoxia (or other etoricoxib containing drugs – Algix, Auxib, Etoricoxib MSD, Exxiv, Ranacox, Tauxib and Turox) you should take the precaution of regular blood pressure and heart checks.

Also, never forget that this is simply pain relief. It will do nothing to lower excess uric acid, which is the real gout danger.

Dkr:
Arcoxia 120mg is currently prescribed only for seven days in Finland for people who don’t have any heart related problems. For me it is much better alternative than indomethacin, since the latter one makes my stomach “hard” and timid. Like GoutPal mentioned, it is only for gout attacks.

Keiran:
I have been taking Arcoxia (etoricoxib) for a couple of years now. I have only developed gout in my late 30s and other prescribed medicines just didn`t work. I am now a visiting professor in China and am afraid I have no access to this drug. My gout is now playing up again and I fear it will be an uncomfortable 9 months unless I find a source.

Etoricoxib & Gout – Next Steps

More than most gout pain relievers, etoricoxib is definitely short term only. As such, it might be a useful choice for the occasional acute gout flare, but you must seek other choices for longer than a week.

Look at related answers about gout cures for pain here and check the Gout Treatment reference pages.

Over the years, we have investigated hundreds of pain relieving gout cures. See which work and which do not.

Though uric acid lowering is most important, we all need relief from gout pain until the uric acid is low enough to keep us free from gout. But there are so many different pain killers, it is often difficult to know how to choose them, and which is best at different phases in our gout treatment plan. Here I list the archived questions about gout pain relief.

Archived Gout Cures Questions

What is the best colchicine dosage for gout?

The best colchicine dosage for gout is the one that gets rid of your pain – fast. See how much you need, when to take it, and how long you need to take it for.

Is Celebrex (celecoxib) A Good Treatment For Gout?

Celecoxib (brand name Celebrex) is the only COX-2 inhibitor available in USA. Celecoxib, compared to other NSAIDs is much easier on the stomach, but heart risks remain with longterm use.

Is Arcoxia (Etoricoxib) safe for gout pain?

Lots of interest in etoricoxib (brand name Arcoxia) which is available in Europe and elsewhere, but deemed unsafe in USA due to heart disease risks. If it is available to you, please be sure to read the European review on risks and benefits of etoricoxib in acute gout and other conditions.

Gout Cures – Next Steps

Look for similar questions in other areas of this Gout Treatments archive, and study the Gout Treatments reference pages for more details.

• Is orange good or bad for gout?
• Can orange juice make gout worse?
• Does orange juice cause gout?

Gout and Orange Juice Discussion

Don:
there are so many conflicting reports on three beverages: coffee, tea, and orange juice.

Certain sites say these (or some of them) are excellent, others say they are the worst. What are your feelings/experiences?

GoutPal:

The hydration effects of these, and most other drinks, are far more important for gout than anything else.

Ignore any claims that caffeine in drinks may worsen gout throughout it’s diuretic effect. You will never get enough caffeine from these drinks to cause dehydration problems.

Coffee has been shown to be beneficial for gout.

The same study showed that tea consumption is not associated with a risk of gout – i.e. it is unlikely to have either positive or negative effect. [Please note that there are recent studies showing a positive gout benefit for tea. Links soon, or use the search box near the foot of the page.]

I’ve only found one relevant study relating orange juice with gout, and, quite frankly, I don’t fully understand it. In “Comparative Value of Orange Juice versus Lemonade in Reducing Stone-Forming Risk”, Odvina shows that orange juice promotes excretion of uric acid. Beyond that, the study is more concerned with formation of kidney stones, so gout risks are not really investigated. The study does state that

Through its alkalizing effect, orange juice also lowered the calculated amount of poorly soluble undissociated uric acid, which could reduce the propensity to form uric acid stones

So, it appears likely that orange juice is beneficial to gout sufferers.

One important point to bear in mind, Don, is that total gout diet is always more important than individual food items. In a good diet, the variety of foods should ensure that no one food dominates to the extent that it has significant influence.

 

Orange Juice & Gout – Next Steps

There are several recent studies on orange juice and other beverages in respect to gout. I will be publishing these in the next GoutCaster Newsletter – get your free subscription now to make sure you learn about this new natural gout remedy.

BCX4208, co-developed by New Zealand crown research institute IRL, is a next generation purine nucleoside phosphorylase (PNP) inhibitor, which a recent study shows may have utility in diseases dependent on T-cells, B-cells or uric acid.

The latest trial is designed to determine the effect of different doses of orally administered BCX4208 on uric acid levels in the blood, the build-up of which can lead to the often painful condition known as gout.

BCX4208 differs from existing gout treatments in that it targets an enzyme known as PNP (purine nucleoside phosphorylase). This novel mechanism gives the drug candidate the potential to address unmet medical needs across a broad spectrum of inflammatory diseases in which this enzyme plays a role. It has the potential for once-a day dosing suitable for chronic administration and has been shown to be well tolerated in safety studies. Existing treatments have a range of side effects.

Dr Jacquie Harper, who leads the gout research programme at Malaghan Institute of Medical Research in Wellington, NZ, says: “Gout prevalence is increasing worldwide and is a real problem in New Zealand. A major risk factor for developing gout is excessive uric acid levels in the blood but the choice of uric acid lowering drugs is limited. A new, well-tolerated treatment for controlling uric acid levels would be good news for gout sufferers.”

Dr Richard Furneaux, who heads IRL’s Industrial Biotechnology research, says: “BCX4208 is the second drug candidate we have discovered in collaboration with Professor Vern L Schramm, the Ruth Merns Chair in Biochemistry at the Albert Einstein College of Medicine at Yeshiva University in New York City. Our first is in a pivotal Phase 2b human cancer trial for Cutaneous T-Cell Lymphoma with results expected in 2010.”

The gout trial is recruiting 120 patients at 12 hospitals in the US and is expected to run till September 2010.

There is an interesting video news clip, Relief for gout sufferers thanks to Kiwi company, with some ‘juicy’ gout images.

Over the years, we have investigated hundreds of herbal gout treatments. See which work and which do not.

There are many myths surrounding gout cures derived from natural sources. Here I list the archived questions that consider how effective various supplements and potions are in the search for gout relief.

Herbal Remedies for Gout That Work

What herbal gout treatments are you looking for?

See live discussions in the menu above, or use the search box at the foot of each page.

Herbal remedies That Hinder Gout

What is safe?

Don’t worry about everything under the sun. If you have a good gout management plan, most gout patients should be able to enjoy a normal life.

Herbal Remedies That Have No Effect On Gout

Should I combine Devil Claw with allopurinol and colchicine?

A gout sufferer who started on allopurinol and colchicine after previously trying herbal remedies wondered if he should continue with the herbal gout treatments. The answer was, given that Devil Claw has little or no effect on gout, there was no need to continue.

Gout Remedies – Next Steps

Look for similar questions in other areas of this Gout Treatments archive, and study the Gout Treatments reference pages for more details.

• Can you use a sauna with gout?
• Does a sauna help with gout?
• Does sauna treatment help gout?

Gout and Sauna Discussion

Dkr:
Does anyone have experience how sauna could affect uric acid levels. I am from Finland and since almost every house here have Sauna. Should I go to sauna more?

GoutPal:
I do not believe that sauna will harm gout sufferers, and there may be some benefits. However, you must keep replacing the water that you lose through sweat. My research indicates that sauna will increase uric acid through sweating. Avoid alcohol or any other diuretic before, during and immediately after using the sauna – water, milk, fruit juice (in fact almost any fluid) are all good.

Dkr:
I read the article and it was quite opposite that I was hoping for. I expected that sweat would extract uric acid more. I made this assumption, because nine months every year I live in tropical warmth and three months in Finnish summer that is some what colder. Always when I come back to Finland I get gout attacks, but in tropic I get attacks very rarely.

GoutPal:
Unfortunately, there are many things that can trigger gout attacks – often a combination of more than one change.

I don’t interpret the sauna research as saying that sauna is a risk on it’s own – only when it leads to dehydration. It is very hard to realize when dehydration occurs – you are not aware of the fluid loss, but your body sees it and slows down urine production to compensate. It is very easy to replace this – you just need to remember to take water into the sauna with you.

Gout and Sauna – Next Steps

See the Gout, Sweating & Sauna reference page.

Though drugs and gout diet questions are most frequent, we have many discussions about lifestyle issues, and how they affect gout.

Some of these issues can help gout, some hinder it, and many are not relevant.

Lifestyle Remedies for Gout That Work

What is best natural medicine for uric acid or gout?

Suf from the Phillipines asked this question. My response was that there is no single best natural treatment because you need one medicine to lower uric acid, and one to reduce painful inflammation. Of all the remedies for gout, if I had to choose one single treatment, I would say water is the best natural medicine for uric acid or gout.

Lifestyle Issues That Hinder Gout

Is sauna good for gout?

Answers similar questions like “Can you use a sauna with gout?”, “Does a sauna help with gout?” and “Does sauna treatment help gout?”. This discussion about gout and sauna warns about the risks of dehydration. Also see the gout reference page on gout, sauna and sweating.

Lifestyle Issues Not Relevant To Gout

What is safe?

Don’t worry about everything under the sun. If you have a good gout management plan, most gout patients should be able to enjoy a normal life.

Remedies For Gout – Next Steps

Look for similar questions in other areas of this Gout Treatments archive, and study the Gout Treatments reference pages for more details.

I visited the doctor last Tuesday and he was ready to put me on an Rx treatment. I told him about what I had been reading up online (mostly from GoutPal) and wanted to try some dietary changes first – much to my suprise,he agreed!

As the site suggests, a gout diet is as much about balance as what we eat. I also see alot of talk about pH balance. I have been drinking distilled water for 30+ years. After reading about the balance of foods and pH, I decided to check the pH of the distilled water and found it to be 6.4! What is the chance of all of the acidic foods + beer, topped off with acidic water are increasing my attacks?

If so, does anyone have any knowledge of how to best turn water alkaline? There is a ton of information on this on the web but it is very contradictory.

Thanks for the help, great site!

Despite the fact that food plays a much smaller part in gout than most people think, there are some food choices that you can make that are better than others.

Definite Gout Remedy From Food

Can orange juice make gout worse?

Worried about orange juice and gout? Ignore the people who warn against it – they do not know what they are talking about. Orange juice is good for gout.

Potential Gout Remedy From Food

Are figs good for gout?

Morin, a compound found in figs and other fruit, has been shown to reduce uric acid in rats.

Not A Gout Remedy From Food

Can i get uricase from foods for gout?

No. Uricase is an enzyme that breaks down uric acid. Some animals have it, but not humans. Rasburicase (sold as Elitek) is only available to patients at risk of gout due to chemotherapy. Efforts are being made to produce a form that will be better tolerated (PEG-uricase).

Natural Gout Remedy – Next Steps

Look for similar questions in other areas of this Gout Treatments archive, and study the Gout Treatments reference pages for more details.

Xanthine Oxide Reducing Insect

This is really bugging me! But, could bugs be the answer?

Quercetin is a member of the flavonoid group of compounds. These compounds occur naturally in plants, and have been shown to have properties that are beneficial to health.

Quercetin has been studied in several recent investigations to assess it’s ability to inhibit xanthine oxidase (XO). Both allopurinol and febuxostat work by XO inhibition.

Unfortunately, the quercetin studies are largely confined to laboratory experiments with occasional animal tests. Animal tests so far have not shown success, and this appears to be down to solubility of quercetin.

Just as I thought I had finished reviewing relevant research, I spotted a mention of quercetin buried deep in a study of large cabbage white caterpillars. So deep, that I cannot assess if quercetin is actually relevant, but it does not matter – the abstract is fascinating.

A comparison of extracts from the tronchuda cabbage (Portuguese kale) with extracts from caterpillers feeding off it reveals some startling chemistry. The caterpillar extract is far more effective than extracts from the plant on which it feeds. The authors of “Pieris brassicae Inhibits Xanthine Oxidase” conclude:-

This is the first time that an insect has been tested for its xanthine oxidase inhibitory capacity, which proved to be very high. These findings are interesting considering that they can be used by food or pharmaceutical industries to prevent the oxidation of their products, to increase the dietary supply of antioxidants, or for prevention of free radical-mediated diseases, namely, gout.

Grub up!

It should work fine, but some features may not be fully completed yet.

These are the current discussions on gout treatment. This includes all aspects of gout cures and remedies for both medicine and alternatives . If you want to discuss a different aspect of gout, please choose a different page from the Gout Help Discussion List.

New (unanswered) topics are listed first, followed by live discussions. Please join in any discussion you are interested in.

If you have a question about gout treatment, please check the current discussions, and raise your question in a related topic. If there are no current topics that match your question, please start a new discussion using the form at the end of the lists.

New Gout Treatment Topic

If none of the topics above suit what you want to discuss, please start a new gout treatment discussion here.

It includes closed gout treatment discussions that are waiting to be summarized in the archive.

The Gout Treatment Section at GoutPal.com is a fuller reference to all gout treatment issues. These archive pages support that with personal views and experiences. Please note that almost all the experiences quoted here are based on personal accounts from fellow gout sufferers and their carers. They are not medical opinions, but they may help you understand what your doctor tells you, and help you know what questions to ask your doctor.

Recently Closed Gout Treatment Topics

I summarize and add these topics to the Gout Treatment Answer Archives. More topics are added here as current gout treatment discussions are closed.

Gout Treatment Answers Archive

Old gout treatment discussions are archived in the following groups:

Herbal Gout Remedies

Answering questions like “Do herbal remedies for gout really work?” and “Where can I find gout remedies?”, this archive includes summaries of all the discussions relating to herbal gout treatments.

Natural Gout Remedy

Answering questions like “Are bottled maraschino cherries a good gout remedy?” and “Is lemon juice a remedy for gout?”, this archive includes summaries of all the discussions relating to food and drink based gout treatments.

Other Natural Remedies For Gout

Answering questions about non-medical gout treatments that do not fit into the above two groups.

Gout Cure To Lower Uric Acid

Answering questions like “Any new gout cure?” and “What is the cure for gout?”, this archive includes summaries of all the discussions relating to medical gout treatments that reduce uric acid.

Gout Cures For Pain

Answering questions like “What cures gout pain?” and “What are the best gout pain cures?”, this archive includes summaries of all the discussions relating to medical pain reliving gout treatments.

Other Gout Relief

Answering questions about medical gout treatments that do not fit into the above two groups.

If you have any questions about gout treatment, or opinions and experiences to share, you can join a suitable discussion, or start a new topic in the Gout Treatment Help section.

Other Gout Answers sections are listed in the Gout Answers Index.

It includes closed gout diet discussions that are waiting to be summarized in the archive.

The Gout Diet Section at GoutPal.com is a fuller reference to all gout diet issues. These archive pages support that with personal views and experiences. Please note that almost all the experiences quoted here are based on personal accounts from fellow gout sufferers and their carers. They are not medical opinions, but they may help you understand what your doctor tells you, and help you know what questions to ask your doctor.

Recently Closed Gout Diet Topics

I summarize and add these topics to the Gout Diet Answer Archives. More topics are added here as current gout diet discussions are closed.

Gout Diet Answers Archive

Gout Diet archives will appear here soon.

If you have any questions about gout diet, or opinions and experiences to share, you can join a suitable discussion, or start a new topic in the Gout Diet Help section.

Other Gout Answers sections are listed in the Gout Answers Index.

Please feel free to browse, but do not be surprised if something does not work yet.

These are the current discussions on gout diet. This includes all aspects of gout food and drink, and also related topics such as exercise and other lifestyle issues. If you want to discuss a different aspect of gout, please choose a different page from the Gout Help Discussion List.

New (unanswered) topics are listed first, followed by live discussions. Please join in any discussion you are interested in.

If you have a question about gout diet, please check the current discussions, and raise your question in a related topic. If there are no current topics that match your question, please start a new discussion using the form at the end of the lists.

New Gout Diet Topic
Form will go here. Please use Gout Forum until this page is completed.

This section is where you can add your gout questions, or share your gouty views and experiences.

Gout Help Forum

Please read the gout forum guidelines before posting.

Please note that I have introduced this discussion area to replace the Gout Forum and it is not complete. You can use it, but some features are not enabled yet. Use the Gout Forum if you wish, or try the new features here. See the Gout Forum Replacement Progress Notes for more details.

I have organized these gout discussions in similar sections to the gout help pages on GoutPal.com. These are:

• Gout Highlights
• Gout Treatments
• Gout Diet Help
• Gout Symptoms
• Gout Related
• Understanding Uric Acid & Gout
• Non-gout topics

Do not worry if you have an urgent question, and do not know which section is most appropriate – just use the Please Help My Gout section.

Gout Question Archives

I have summarized old gout discussions in the gout archives. This is a great source of gout information. You will find it useful to look at these old questions, to see if they answer your questions.

Gout Forum Replacement Progress Notes

During December 2009, I am replacing the Gout Forum. The new forum will combine the forum and commenting features in this new Gout Help section. The features include:

Consistent input

Old system was confusing with some questions in the forum, and some in comments

Question Archives

To remove clutter, and provide a quick reference point for previously answered questions

Speed

Saving questions and answers is now quicker

Autosave

Lost contributions are a thing of the past

Better Tracking

Topics show as new until you read them. You can still, optionally, track additions to topics by email or on-screen highlights.

I will add a new discussion topic in the Non-Gout section soon, but please feel free to discuss changes in the old forum.

You can also share your gouty views and experiences with other gout sufferers.

Please note that I have introduced this discussion area to replace the Gout Forum and it is not complete. You can use it, but some features are not enabled yet. Use the Gout Forum if you wish, or try the new features here.

This section summarizes old gout discussions so that you can easily find topics that interest you. Those topics might answer your gout question immediately. If not, you can ask your questions and share your views and experiences in the gout forum.

To help you find your gouty topics of interest, I have organized this section to match the Gout Help sections on GoutPal.com.

I’m happy to provide more, for the usual price of free, but I cannot promise all the answers.

First, I should point out that the offending article was referring to the 2005 report “Serum uric acid and cardiovascular disease: Recent developments, and where do they leave us?” by Joshua F Baker and colleagues. The full report costs an arm and a leg aorta and ventricle, but the free abstract reads:

The relationship between serum uric acid (SUA) and cardiovascular disease has been controversial.

Here we review recent literature assessing whether hyperuricemia is an independent risk factor for adverse cardiovascular outcomes.

Studies from the past 6 years evaluating the association of SUA with cardiovascular disease were identified through MEDLINE, EMBASE, and Cochrane library searches, bibliography cross-referencing, and review articles. Twenty-one cohort studies in healthy and high-risk patients with cardiovascular disease were identified and reviewed.

In studies of high-risk patients, in which more overall events were recorded, 10 of 11 studies were supportive of an independent association. In 10 studies of healthy patients, 6 suggested an independent association of SUA with adverse cardiovascular outcomes.

Increasing SUA is likely an independent risk factor for cardiovascular disease in high-risk individuals. However, the magnitude of excess risk attributable to high SUA is likely to be small in healthy individuals.

Trials of SUA-lowering therapy in hyperuricemic patients evaluating the effect on cardiovascular outcomes are justified in high-risk patients.

So, if you are at high risk of heart disease, high uric acid will increase your risk, but probably not if you are healthy. Further trials are justified, which brings us to the offending article that is giving us some insight on subsequent trials.

The article is actually a letter from Joel A Simon MD, titled “Clinical Trials of Uric Acid Lowering for Coronary Heart Disease Risk Reduction”. (My bold is simply to refer back to the sentence that started all this)

To the Editor:

Baker et al. reviewed the scientific literature on the relation of serum uric acid to cardiovascular disease published since 1998.¹ In concluding, they note that “there is sufficient evidence … to justify a large-scale controlled trial (of uric acid lowering) in high-risk individuals.”

Three secondary coronary heart disease (CHD) prevention trials have been published in which patients were randomly allocated to uric acid-lowering treatment. The Anturane Reinfarction Trial ^{2, 3} and the Anturan Reinfarction Italian Study4 both reported large statistically significant decreases in the risk for sudden cardiac death among patients with myocardial infarction who were treated with sulfinpyrazone, an antiplatelet uricosuric agent. Although serum uric acid levels were measured, they were not reported in the Anturane Reinfarction Trial except to note that participants taking sulfinpyrazone had consistent lowering of serum uric acid levels.² The results of the Anturane Reinfarction Trial were questioned but were subsequently affirmed by an independent committee of adjudicators.⁵ The Anturan Reinfarction Italian Study, another secondary CHD prevention trial, reported that treatment with sulfinpyrazone resulted in a marked reduction in fatal and nonfatal myocardial infarctions.⁴ Serum uric acid levels were measured as a means of assessing pill compliance, and on-study serum uric acid levels were reported as 2.8 mg/dL in the sulfinpyrazone group, compared with 5.5 mg/dL in the placebo group. In contrast with these 2 positive studies, a Canadian trial using sulfinpyrazone in patients hospitalized for unstable angina reported no benefit on the risk for cardiac death and nonfatal myocardial infarction.⁶ Although each of these studies examined sulfinpyrazone as an antiplatelet agent, they effectively tested whether lowering serum uric acid levels with a uricosuric agent decreases CHD events.

References :
1. Baker JF , Krishnan E , Chen L , Schumacher HR . Serum uric acid and cardiovascular disease (recent developments, where do they leave us?) . Am J Med . 2005;118:816–826 .

2. Sulfinpyrazone in the prevention of cardiac death after myocardial infarction. The Anturane Reinfarction Study . N Engl J Med M . 1978;298:289–295 .

3. The Anturane Trial Research Group . Sulfinpyrazone in the prevention of sudden death after myocardial infarction . N Engl J Med . 1980;302:250–256 .

4. Sulphinpyrazone in post-myocardial infarction. Report from the Anturan Reinfarction Italian Study . Lancet . 1982;1(8266):237–242 .

5. The Anturane Reinfarction Trial. reevaluation of outcome . N Engl J Med . 1982;306:1005–1008 .

6. Cairns JA , Gent M , Singer J , et al. Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial . N Engl J Med . 1985;313:1369–1375

So, this promotes the view that lowering uric acid reduces heart disease risk, but the authors of the original report advise caution. They reply:

We thank Dr. Simon for his comments. He cites several studies evaluating the uricosuric antiplatelet agent, sulfinpyrazone, in the prevention of reinfarction in patients with myocardial infarction (MI).^{1, 2, 3, 4} He notes that these studies demonstrate that patients treated with sulfinpyrazone had significantly lower serum uric acid (SUA) levels, as well as fewer subsequent coronary events. We agree that these studies are of interest, but we have concerns about attributing this effect specifically to uric acid lowering.

There are several other studies taking a similar approach to the question of SUA lowering for coronary heart disease risk reduction. For example, a recent study by Hoieggen et al suggests that losartan may be superior to atenolol for prevention of adverse cardiovascular outcomes in high-risk patients in the losartan intervention for endpoint-reduction in hypertension (LIFE) study due to its SUA lowering properties.⁵

The data from these studies may be misleading. Antiplatelet agents^{6, 7} and angiotensin receptor blockers⁸ have both been shown to prevent adverse cardiovascular events in patients at high risk, including patients with recent MI. In both of these cases it is difficult to determine what benefit, if any, SUA lowering may have had on preventing adverse cardiovascular outcomes with the confounding other potential benefits of each therapy. Even xanthine oxidase inhibition might have benefits in cardiovascular disease prevention, independent of its ability to lower SUA levels.^{9, 10, 11, 12}The question of whether SUA lowering itself is beneficial in high-risk patients may be difficult to answer definitively.
References:
1. Sulfinpyrazone in the prevention of cardiac death after myocardial infarction. The Anturane Reinfarction Study . N Engl J Med . 1978;298:289–295 .

2. The Anturane Trial Research Group . Sulfinpyrazone in the prevention of sudden death after myocardial infarction . N Engl J Med . 1980;302:250–256 .

3. Sulphinpyrazone in post-myocardial infarction. Report from the Anturan Reinfarction Italian Study . Lancet . 1982;1(8266):237–242 .

4. The Anturane Reinfarction Trial (reevaluation of outcome) . N Engl J Med . 1982;306:1005–1008 .

5. Hoieggen AAM , Kjeldsen SE , Julius S , et al. The impact of serum uric acid on cardiovascular outcomes in the LIFE study . Kidney International . 2004;65:1041–1049 .

6. Fox KA , Mehta SR , Peters R , et al. Clopidogrel in unstable angina to prevent recurrent ischemic events trial. Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome: the cClopidogrel in unstable angina to prevent recurrent ischemic events (CURE) trial . Circulation . 2004;110(10):1202–1208 Sep 7; Epub 2004 Aug 16 .

7. Hung J . Medical Issues Committee of the National Heart Foundation of Australia. Aspirin for cardiovascular disease prevention . Med J Aust . 2003;179(3):147–152 Aug 4 .

8. Weir R , McMurray JJ . Treatments that improve outcome in the patient with heart failure, left ventricular systolic dysfunction, or both after acute myocardial infarction . Heart . 2005;91(Suppl 2):ii17–ii20 May; discussion ii31, ii43-8. Review .

9. Kinugasa Y , Ogino K , Furuse Y , et al. Allopurinol improves cardiac dysfunction after ischemia-reperfusion via reduction of oxidative stress in isolated perfused rat hearts . Circ J . 2003;67(9):781–787 Sep .

10. Desco MC , Asensi M , Marquez R , et al. Xanthine oxidase is involved in free radical production in type 1 diabetes (protection by allopurinol) . Diabetes . 2002;51(4):1118–1124 Apr .

11. Cappola TPKD , Nelson GS , Berger RD , et al. Allopurinol improves myocardial efficiency in patients with idiopathic dilated cardiomyopathy . Circulation . 2001;104:2407–2411 .

12. Struthers ADDP , Lindsay P , McNaughton D , Broomhall J , Macdonald TM . Effect of allopurinol on mortality and hospitalizations in congestive heart failure (a retrospecctive cohort study) . Heart . 2002;87:229–234 .

Now, perhaps, it’s my turn to scream. All that info, and the question may be difficult to answer definitively.

OK, I for one will get off the fence, and offer an opinion. Get your heart checked regularly. If your uric acid is high, lower it.

Colchicine Crisis Background

The FDA have recently approved colchicine as a brand for treatment of gout and Familial Mediterranean Fever (FMF). Colchicine is derived from the autumn crocus and has been recognized as an anti-inflammatory painkiller since ancient times. It has been available as a generic drug for decades, and there is no justification for allowing any branding rights.

In my earlier reports, I was unaware that the FDA gave exclusive colchicine rights to URL Pharma. I have learned that not only is t this true, but also URL Pharma are actively suing, or preparing to sue all other colchicine providers.

We require urgent government investigation into the forces that pushed the FDA into what is quite probably an illegal granting of the license on colchicine. But, more urgently, we need action now to suspend the FDA action immediately to prevent unnecessary suffering, and even death.

Colchicine Killer Crisis

For gout sufferers, there are (less effective) alternatives to colchicine, but this is not the case for FMF sufferers. I cannot state the case more urgently or more eloquently than Nancy Sparks Morrison has done in Colchicine and Colchrys – the PROBLEM. For Nancy and other FMF sufferers Colcrys is a killer that must be stopped now.

Is the misery of painful suffering, and worse, worth a few extra dollars for URL Pharma?

Price for generic colchicine has been about 11 cents per 0.6mg tablet.
Price for colcrys is going to be approx. $5.00 for 0.6mg tablet.

Except for the fact that I will DIE without colchicine treatment which completely stops the production of amyloids leading to death for FMF patients, I would agree with the complete boycott of colcrys.
Secondly, I will be unable to afford colcrys in any case.

I am terrified that I will go back to being bed-ridden and in excruciating pain, and DIE because I can not afford colcrys. I do NOT want to DIE.
,
Someone needs to look into price fixing.

The same substance. The same production cost. Profit from pain has never been more cynical, more unjust, more immoral than this.

Please Help Stop This Profit From Pain

Nancy has set up a FMF support group. Please join it and become active in your support for this campaign against pharmaceutical terror.

I have started 2 new forums, which I hope you will support, and encourage your friends and associates to support.

United States Colchicine Sources is to report places where US citizens can find supplies of quality assured colchicine.

Colchicine Campaign is to generate ideas for ending the Profit From Pain menace, and reporting on your efforts, problems and successes.

Please help those who need colchicine find it at an affordable price.

If you can help campaign against this injustice, I’ll see you in the forums, otherwise please just pass this on.

View Larger Map
Details are few, but the researchers are looking for participants who experience occasional gout flares.

Qualified participants will receive all study related care and investigational medication at no charge and may be compensated up to $350 for time and travel.

If you want to participate, or find out more information, please contact the gout research team at:

Phone: 210.616.0735 (Call Mon-Fri)
8122 Datapoint Drive
Suite 1010
San Antonio
TX

Or see their Clinical Research for Gout web page.

To put this into context, the side-effects of NOT lowering uric acid are extensive bone, cartilage, and tendon damage for gout sufferers. This is permanent damage caused by urate crystals, but so slow that you do not notice until it is too late. Another side-effect of high uric acid in the blood is an increased risk of kidney stones. These can cause permanent kidney damage, and they are extremely painful. So, before you dismiss urate lowering therapy for fear of the (often low) risk of side effects, consider carefully the (almost certain) risks of doing nothing.

I’ve written about allopurinol side effects before, but now that we have a new uric acid lowering drug, febuxostat, gout patients are wondering if this has fewer effects.

A clear side-by-side comparison is beyond the scope of this article. There are several comparative studies, but none, as far as I am aware, are a strict comparison of doses at similar uric acid levels.

Febuxostat launched recently in the US under the brand Uloric. Previously, it was launched in Europe under the brand Adenuric. Earlier this month, the European Public Assessment Report for Adenuric was updated, which includes summaries of side effects from trials of febuxostat for gout patients.

Febuxostat Side Effects

The side effects are grouped as Common, Uncommon, and rare. In alphabetical order (within each group), they are:

Common side effects (more than 1 in 100 patients but less than 1 in 10 patients) are:

• diarrhea
• feeling sick
• headache
• liver test results abnormal
• rashes

Uncommon side effects (more than 1 in 1,000 patients but less than 1 in 100 patients) are:

• abdominal pain/discomfort or wind
• abnormal ECG heart tracing
• abnormal frequent urination
• abnormal urine tests (increased level of proteins in urine)
• blood in the urine
• change in blood sugar levels (diabetes) of which a symptom may be excessive thirst, increased blood fat levels
• changes in blood chemistry or amount of blood cells (abnormal blood test results)
• constipation
• cough, shortness of breath, flu-like symptoms
• difficulty in sleeping
• dizziness
• dry mouth
• erectile difficulties and/or loss of sex drive
• fatigue
• impaired sense of taste
• heartburn/indigestion
• hot flushes or blushing (e.g. redness of the face or neck)
• increased appetite
• increased blood pressure
• itching, hives, skin inflammation or discoloration, other type of skin conditions
• kidney stones
• localized swelling due to the retention of fluids in the tissues (edema)
• more frequent passing of stools
• muscle cramp, pain/ache in muscles/joints, bursitis or arthritis (inflammation of joints usually accompanied by pain, swelling and/or stiffness)
• numbness or tingling sensation
• reduction in sensation of touch
• reduction in the ability of the kidneys to function properly
• sleepiness
• vomiting
• weight gain

Rare side effects (more than 1 in 10,000 patients but less than 1 in 1,000 patients) are:

• feeling thirsty
• feeling your heartbeat
• nervousness
• weakness

If you have any interest in gout whatsoever, then you need to know the exact level of uric acid in your blood.

When you ask the bank manager for your account balance, does “OK, Nothing to worry about?” make you happy? Do you accept “Normal” and rush out on a spending spree?

Of course not. You need the number. And here is why.

Results may vary from lab to lab, but the assessment routines have a common flaw. They use averages to determine low, normal and high values. And those averages contain gouty people. So if you have a uric acid level of 8mg/dL (see Uric Acid Levels for details of other common measurement scales), you may be statistically normal, but you are highly at risk for gout.

Also, the test is a snapshot, usually taken when you have not eaten for 14 hours. If that reads 8, what is your daily average? 9 or 10, perhaps? What is your peak level? 11 or 12 perhaps? You will probably never know exactly, but you should certainly know that any test result above 6mg/dL is a risk for gout, and 8 is almost a certainty.

So never, never, never accept a low/normal/high assessment of uric acid in your blood (sUA – Serum Uric Acid). Get your uric acid number.

And once you have it, what do you do with it?

Simple. Lower it.

Newly Diagnosed Gout

Now there is a common trait amongst newly diagnosed gout patients to seek to lower uric acid through diet and lifestyle changes. There is nothing inherently wrong with this, and you might get your uric acid number back into the safe range. The problem is might. You might reduce uric acid, and you might not. You might change your lifestyle and avoid gout forever. But you might merely slow down the growth of uric acid crystals.

Slow it down, and you just prolong the period when uric acid crystals build up in your body, weakening tendons. Slow it down, and you merely postpone the agony of crippling bone erosion from gout until you are older and less able to cope.

The sensible option is to see allopurinol (or other uric acid lowering treatments like febuxostat or probenecid) as a support tool. Go for an immediate drop in uric acid, below 6mg/dL, to help you cope with the rigors of your new lifestyle changes. Rapid weight loss can increase your uric acid level – no problem with the aid of allopurinol. The exertion of new exercise routines can increase uric acid – no problem with your febuxostat friend.

It’s the safe sensible way to go, but you will need to persuade your doctors that uric acid lowering treatments are suitable for short term consideration. They may stick to the view that uric acid lowering treatments are a last resort, and then for life. The new approach is better. The logic is clear.

If lifestyle changes can work, then you are better protected, and more likely to succeed if you introduce the temporary support of uric acid lowering treatments. If they can work, you have the crutch of uric acid lowering therapy for just as long as you need it, and you can avoid long term treatment (but annual uric acid monitoring remains compulsory).

If your lifestyle changes can’t work, then you have not wasted months or years of your time. You have not prolonged the problem and postponed the agony – you will be that much quicker to the path for long-term gout management.

Long Term Gout Sufferer

So what are the uric acid numbers for long term gout sufferers?

The numbers vary through 3 phases:

1. Target Phase
2. Urate Lowering Phase
3. Maintenance Phase

Uric Acid Target Phase

Depending on how long you have had gout, you will have a varying amount of uric acid in your blood, and more uric acid lodged as crystals in your joints and other tissues. This is often referred to as the urate pool, or urate stores. Getting your blood uric acid to 6mg/dL will stop new crystals forming, and may start to dissolve old urate deposits.

If you have had gout for a long time, the uric acid crystal deposits, especially if tophi have formed, will be high. There is good evidence to suggest that the lower you can get uric acid, the swifter you will dissolve those uric acid crystals. The latest addition to this evidence concludes:

[patients with low uric acid] indicate that maintaining sUA near or below 2 mg/dl would probably be safe. Targeting low sUA could improve the elimination of tissue urate stores

I’ve added a more complete excerpt from this report to the uric acid forum, where you can discuss your uric acid numbers.

In the light of your medical history, and other relevant factors, you need to discuss this with your doctor and agree a Target sUA. With your target uric acid number in clear view, you can adjust dosage and retest each week until you have achieved target for two consecutive weeks.

Urate Lowering Phase

During Phase 1 and 2, you will probably experience gout flares as old crystals are temporarily exposed to your immune system. Pain relief will cover these, and they will become less frequent and less intense. Uric acid testing can be relaxed to monthly, and maybe three monthly. The phase ends when you have gone 6 months without a gout flare, during which time your uric acid test results must never be more than Target sUA. One gout flare OR one test result above target, and you start counting the 6 months again.

Uric Acid Maintenance Phase

Tests every 3 to 6 months. Relax medication dose if desired, but NEVER allow uric acid over 6mg/dL

But am I clever enough to recognize Willful Ignorance? Am I bold enough to promote Aggressive Skepticism?

I had a chance encounter with screaming ignorance recently when Ben insisted that alcohol causes gout. A first class example of the ignorance that Seth describes as:

screaming is often a tool used to balance out the lazy ignorance of someone parroting opposition to an idea that they don’t understand

My skeptism, probably provoked by rudeness, was overly aggressive as I laid down a challenge to the no-alcohol-for-gout-sufferers brigade. I fear that my unwitting ignorance of the ways of the tribe leader might have caused upset to a caring contributor whilst doing nothing to weed out the menace of screaming ignorance.

Well, I’ll mark that as part of the learning curve. Learning about gout AND learning to lead the GoutPal tribe. It’s an interesting life.

Can you make the call on willfully ignorant vs. aggressively skeptical? Or can you accept a leader with unwitting ignorance and gentle skepticism?

One thing is for certain. The GoutPal tribe is wise, wonderful and witty.

I’ve started to pull out the gems from the forum, and opened topics for outstanding posts about gout cures and gout symptoms. I know there are many more, so please tell me when you spot them.

There is some benefit to gout sufferers – clearer dosage information. But fruit juice addicts need to be wary.

As part of the approval submission, URL Pharma have done dosage tests and conclude that lower doses than the “traditional” 4.8mg per day are just as effective. They suggest that 2 tablets (1.2mg) followed by a further .6mg tablet one hour later is the best dose.

You can read more patient information about colchicine dosing and side effects in the colchicine drug guide. FDA information to healthcare providers includes a note that they “carefully consider the need for additional subsequent dosing”.

The colchicine drug guide provides an extensive list of drugs that might interact with colchicine. Included in this list is grapefruit juice. Note that other potential CYP3A4 inhibitors include pomegranate, Seville oranges, pomello and star fruit.

Resubmission is possible, but this is not feasible until 2010.

Pegloticase has been shown to be effective in lowering uric acid in clinical trials, and is aimed at those gout patients who cannot tolerate allopurinol. It uses a genetically engineered form of uricase to breakdown uric acid in the body. This enzyme is common in many animals, but not humans.

The failure of Krystexxa to gain FDA approval means that it will be unavailable to help gout patients for some time, though there may still be access through ongoing clinical trials.

Apparently, Savient have changed the manufacturing process for pegloticase. Resubmission will require either a return to the previous method, or rerunning the clinical trials with the output from the changed process. It is expected that Savient will revert to the original process.

Approval is also dependent on Savient providing:

• A Medication Guide for using Krystexxa safely and effectively.
• A Communication Plan for Savient to correctly notify healthcare providers about infusion risks, life threatening allergic reactions, and risks for patients who also have Glucose-6-phosphate dehydrogenase deficiency (G-6-PD), or heart problems.
• An Assessment Plan for ensuring that the other 2 plans ensure that the risks o Krystexxa are properly communicated to doctor and patient.

“Why is he always telling us that uric acid management is much more important than gout pain management?”

OK, I have not gone mad. First, let me remind you why managing uric acid levels is much more important than managing gout pain, then I will explain why I say “lowering uric acid is useless.”

Gout Pain And Tooth Decay

There is no link between gout and tooth decay, but regular readers will recognize my oft-vaunted (overused?) analogy.

When you visit a dentist to treat toothache, you expect an examination for decay, treatment of that decay, and pain relief to help you endure the treatment and associated soreness and gum inflammation.

Treatment for gout, ignoring complications such as allergies, and other health conditions, should be just as simple. Take allopurinol (or some other uric acid lowering therapy) and support this with pain relief, such as colchicine, until the allopurinol has removed the excess uric acid threat.

But what should be simple, rarely is.

Tooth decay treatment starts with drilling, and you know this is going to hurt. Do you know that, as with any uric acid lowering therapy, including diet, allopurinol treatment for gout can hurt? Many gout patients do not understand this, and so they stop taking the uric acid lowering treatment. The equivalent of leaving the dentist’s chair half way into the drilling process.

All dentists, and most of their patients, understand that all the decay must be drilled out before the cavity can be filled. Almost no gout patients, and very few healthcare practitioners understand that uric acid levels must be maintained below 6mg/dL (preferably below 5) to get rid of existing uric acid crystals. Frequent uric acid tests during uric acid lowering treatment are just as vital as frequent checks to see if all decay is removed.

Tooth decay treatment ends with agreeing an appointment for the next inspection. Nobody assumes that one dentist visit fixes everything. We continue with daily teeth cleaning and return to check all is well. The gout patient who has lowered uric acid long enough for all existing crystals to dissolve must continue with a daily maintenance dose of allopurinol (if necessary) and return for a uric acid test every three to six months. Even when symptom free, it is unwise to go longer than 12 months without testing blood for uric acid.

You can stop being a gout sufferer, but you can never stop being a gout patient.

Once you have had a gout attack, you have changed. You have lost your gout virginity. You can never become a person who has never had gout, but you do not need to return to being a gout sufferer. You just need to manage your uric acid level, and never let it rise above 6mg/dL again. Standard uric acid tests might declare you “normal” at 7 or even 8 mg/dL.

You are not standard. You are not a gout virgin. You must not let uric acid rise above 6mg/dL.

Managing uric acid

So if I feel so strongly about the importance of uric acid, why do I say “Lowering uric acid is useless?”

Because “Lowering” is not enough – you need to manage it.

Lowering uric acid from 9mg/dL to 7mg/dL is pointless. It might slow down the rate at which new uric acid crystals form, but it will do nothing for the existing urate deposits that are eating into your bones.

Lowering uric acid to below 6mg/dL, then letting it rise back up to 7 is worse than pointless. You will get pain from old crystals dissolving, then pain from new ones forming. You will be in a mess.

Lowering uric acid is simply not enough. Here is how to manage it.

Phase 1

Get uric acid down to Phase 1 Target Level (usually 5mg/dL – agree something lower than 6 with your doctor). It does not matter how you do it, just do it. Allopurinol is the obvious choice, but there are medical alternatives.

You may be tempted to rely on dietary / lifestyle changes – this is fine, as long as you definitely lower uric acid, and not just seek to stop the pain. In practice, dietary and lifestyle changes are not quick enough to get uric acid levels down immediately, so it is better to support your lifestyle plan with immediate allopurinol support. I call this my allopurinol / gout diet Combination Therapy.

Phase 2

Maintain uric acid below the Phase 1 target level until you achieve six consecutive months without a gout flare. During this phase, you will experience gout flares, but they will become less frequent, and less intense.

These gout flares are due to your immune system reacting to old uric acid crystals as they dissolve. I know it is hard to convince you that such pain should bring you joy, but each time you experience a gout flare when uric acid is permanently below 6mg/dL, you are getting better. Compare this with occasional gout flares from new crystals when your uric acid level is higher – every day moving nearer and nearer becoming crippled.

After 6 months without a gout flare, you can be certain all existing gout crystals have gone, and you are no longer a gout sufferer.

Phase 3

No longer a gout sufferer, but still a gout patient. Uric acid tests every 6 months to stay below 6mg/dL.

Read on to find out why this is at best a waste of time, and at worst a very dangerous game to play.

How many times have you heard or read a gout sufferer bemoaning the fact that their favorite food triggers gout?

We sympathize. Maybe offer condolences. Maybe offer alternatives. But we never congratulate.

So, why would we congratulate anyone who finds a gout trigger?

Because, in the right context, it is the key to controlling gout.

To understand why, you need to understand what gout is, and how gout pain is caused.

Gout pain is not a reaction to the food we eat, or not directly. Gout pain is the product of a pathway I call UDRP – excess Uric acid leads to urate Deposits which invoke an immune system Response that causes gout Pain.

Thus, a true gout trigger is one that triggers our immune system response. It is not a food that might (or might not) raise uric acid. It is not a chill to the joint that might encourage uric acid crystals to form. It is not a night on the town that leads to alcohol suppressing uric acid excretion. There is only one true gout trigger – the uric acid crystal.

So, why would we congratulate anyone who finds a uric acid crystal?

Because, if it is an old uric acid crystal, that is now exposed because it is dissolving, it is a sign that you are controlling your gout.

Of course, if this is just a random event, you are not in control, but if it is part of a uric acid lowering program then congratulations – you are winning the gout trigger game.

Each time you trigger a gout attack by lowering uric acid, you are winning the gout war, but if all you do is avoid gout triggers you are playing a dangerous game. The best gout treatment might trigger a gout attack by exposing old uric acid crystals as they dissolve.

If you avoid those good gout triggers, you can never win against gout.

The answer, “Nowhere yet,” is probably not what you want to hear, but read on for the latest news.

Pegloticase is a generic name for PEG-uricase – a genetically engineered form of uricase. Uricase is an enzyme present in some animals that breaks down uric acid in the body. Humans do not produce uricase, so techniques have been developed to produce a type of uricase that humans can use.

Various versions of this treatment are being developed. The one that is most advanced is expected to be approved soon under the brand name Krystexxa, in the USA.

This was recommended for approval in June this year, and the FDA are expected to give final approval on August 1st.

So does this mean you can rush out and buy some in August?

Absolutely not.

Even when production gets up to speed, this is not a gout medication for self-administration. You need to go to your doctor, a clinic, or hospital for pegloticase to be given by intravenous infusion.

I suggest that you discuss this now with your doctor. There may be perfectly acceptable uric acid lowering therapies available to you. We have certainly discussed many other options in the gout forum, from the ubiquitous allopurinol to the newly launched febuxostat (Uloric / Adenuric). Surprisingly, even some blood pressure and cholesterol lowering medicines can have uric acid lowering effects.

If the discussion with your doctor reveals that you are a candidate for pegloticase, then he is in the best position to find a source of the medicine, or refer you to a suitable specialist. He may even know of clinical trials in your area, where you gain access to the treatment prior to it being on general release.

You can upload your gout pictures via the gout forum. Please not that whilst anyone can post topics to the gout forum, only registered, logged in members can upload pictures. Registration is free, and adds many other useful features, so you may as well register. See the gout health forum guidelines for more information.

Most of your pictures will be relevant to the gout symptoms forum, but please note that I am interested in seeing any gout related pictures, so please feel free to send all your gout pictures.

How about pictures that reflect your gout treatment, or even your gout diet. Ours is a multi-national, multi-cultural gout forum, so what might seem mundane to you can be extremely interesting and valuable to other people.

For more information, or if you have questions, about uploading your pictures, please discuss in the gout pictures forum.

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Adding your own gout information is very easy. The box at the end of each gout article is like a mini word processor.

Please keep your comments “on topic”. They should add value to the article, or ask questions about it. If your comments are not relevant to the article, I will move them to the Gout Forum.

Please note that gout info comments are threaded. This means that you can respond to the article, or respond to a comment.

If you are responding to the article, add your information about gout in the Leave a Reply box at the end of the article.

If you are responding to a comment, first click the Reply link at the end of that comment.

The purpose of this gout research is to examine the safety and effectiveness of different doses of an injectable medication. The medication will be compared to an approved oral medication versus placebo for prevention of acute gout flares. In addition all volunteers will be required to take allopurinol, which will be supplied.

This study involves 9 visits to the test center over 24 weeks.

To qualify for the study you must have a confirmed diagnosis of gout with at least 2 acute attacks in the last 12 months. You will need to consent to a physical exam, EKG, height and weight, blood pressure and pulse, and fasting lab tests. You will need to complete a daily diary during a gout flare.

There is no cost to you and you will be compensated at $40.00 per completed visit. In order to determine if you qualify for this research study, please complete the gout study application form.

Rochester Clinical Research is located at 500 Helendale Road Rochester, NY 14609. GoutPal has no association with this organization, and I provide this information solely to keep you informed of current gout research.

Hot on the heals of Uloric, the US brandname for febuxostat, pegloticase (formerly known as PEG-uricase) seeks release under Savient’s brand new name of Krystexxa.

FDA review has been postponed from February to give time for additional analysis of cardiovascular risks.

You can find full details of the meeting, including Savient’s briefing submission on the FDA site.

So what does this mean for gout sufferers?

Assuming approval is given, do not be thinking that you have a newer, easier option for controlling your uric acid.

Krystexxa cannot be taken orally. You get dosed up every two weeks with 8mg delivered by intravenous injection.

As well as being inconvenient, there are fairly high documented reaction rates. On a positve side, it is good that severe gout sufferers have an alternative if they cannot tolerate allopurinol.

So expect plenty drug company stimulated hype over the next few weeks. In fact a gout forum regular has spotted early signs of the latest outbreak of gout hype.

It is such a pity that similar money and exposure does not go into fixing the two great fallacies inherent in healthcare regimes throughout the world:

1. Gout sufferers need better diagnosis. Too many patients are dismissed without gout because “normal” uric acid range is set too high.
2. Allopurinol is rarely prescribed properly. Most gout patients do not get the right dose, the right monitoring, or the right support.

Back in May,

zip2play said:

My research has shown one antihypertensive regimen that lowers uric acid.  I will repeat it here.

It involves the use of two antihypertensive drugs, furosemide and losartan, (Lasix and Cozaar) but they must be taken in a particular way: first take the Lasix (which causes brisk diuresis) and then several hours later, take the Cozaar which causes uric acid elimination. Dosage of both drugs is titrated to get reasonable blood pressure control. Needless to say, people with NORMAL BP should not use this regimen.

The study confirming this regimen is small but rather convincing, but studies showing the uricosuric effect of losartan are all over the net. It;s the ONLY antihypertensive with this capability but used alone its effect is not large.

The name of the study is “Effects of the uricosuric action by losartan on the patients taking furosemide”, and the results show clearly in the chart above.

Furosemide alone raises uric acid on average by one third. If it is taken at the same time as losartan, then this increase is reduced to just over one fifth.

Losartan alone gives a slight reduction in uric acid, but as zip2play has pointed out in the gout forum, it is not especially effective at reducing high blood pressure. The correct procedure for gout sufferers with high blood pressure, as described by zip2play, is to take losartan a few hours after taking furosemide. The study shows that this can promote an average 15% drop in uric acid.

If you are not on this regime, discuss it with your doctor today. If you are, share your experience in the Gout Cure Forum.

One change is the ability to change the editor that you use to write your gouty stories. To do this, you first need to register as a member. I always recommend this as it gives so many extra features. In fact, I cannot see any reason for not registering, so if you have a reason, perhaps you could tell me by adding your comments below. Once you register, you can change the editor in your gout forum user profile. Try different options, and see which suits you best.

The second change is the ability for you to let the world know which gout topics you like, and also a chance to give the “thumbs down” to any that do not appeal to you. My main reason for doing this is to allow visitors to vote for improvemnts and research projects that I will start adding soon. More of that in another post soon, but I have already found an excellent use for this voting feature.

There is an excellent thread about some of the iniquities suffered by the gout patient.

There are several interesting points raised, which I hope to summarize later, but for now, I’m pleased to be able to vote for the outstanding contributions.

I am truly amazed and grateful for the depth of feeling expressed by the contributors to this topic. More than I could ever have hoped for, and an inspiration to me. Gout philosophy and life philosophy rolled into a thought provoking and educational discussion.

It doesn’t get better than this.

This intrigued me also, as it has others, and I found “Growth of monosodium urate monohydrate crystals: effect of cartilage and synovial fluid components on in vitro growth rates.”

In this study, Burt and Dutt found that

“Albumin significantly inhibited MSUM [monosodium urate monohydrate] crystallisation.”

Their findings apparently contradict other studies, which they suggest might be due to the difficulty of studying albumin which can be absorbed by lab equipment.

It is unfortunate that this is not the subject of much more analysis. It seems to me that there are substances (probably including iron), which promote uric acid crystallization. There must be others which inhibit it.

Interestingly, albumin is found in dairy products that have been shown to have a statistical link to lower incidence of gout.

Does anyone know of any current, or more recent, research in this area? The study I refer to was published in 1986.

A recent report has just hit the gout news network – a survey about how ignorant people are about gout.

The “shocking” statistics reveal that:

• 65% of adults admitted to being “not at all knowledgeable” about gout.
• Over 70% did not know that gout is a form of arthritis.
• 83% said they have not had their uric acid levels checked in the last five years, or weren’t sure if they had.
• 35% of gout sufferers said they have not had their uric acid levels checked in the last five years, or weren’t sure if they had.
• 49% of adults were not aware of the potential crippling effects of gout, such as needing to use a cane or walker, or having to stop working because of limited mobility.

But where did this data come from, and why does it matter?

It matters, because raising gout awareness might push more people into seeking early treatment. By controlling uric acid at the earliest opportunity, people can avoid or reduce the crippling effects of gout.

Such awareness would be good if it encouraged people to get wise advice on managing uric acid and safe alternatives for pain relief until uric acid was correctly controlled. It would be wonderful if the general practice doctor could be relied on for simple proven therapy that will allow gout patients to keep uric acid below 6mg/dL and live a pain free life.

We should praise the Gout & Uric Acid Education Society for pushing confirmed gout sufferers to seek treatment, and unconfirmed gout patients to seek diagnosis.

Unfortunately, experience (and abundant research) tells us that the doctor we rush to has, in many cases, little more knowledge about gout than we do.

Except, of course, they will have been primed by the manufacturers of recently released Uloric (febuxostat) and soon to be released Krystexxa (pegloticase / PEG-uricase / Puricase). They will know all about the new wonder drugs from Takeda and Savient – the very same pharmaceutical companies who sponsor the Gout & Uric Acid Education Society.

Your doctor should be testing you every few months – more frequently if you have started a new treatment, changed diet, or made some other change that might affect your uric acid level.

If you do not know the amount of uric acid in your blood (often called serum uric acid), make sure you arrange for a test today. And get the exact number – not an opinion such as high, normal or low. Often, uric acid test results are described as normal when they are at a dangerous level for gout sufferers.

One complication of the results is that different testers use two different measurements. Conventional measurements are mg/dL, which is the most common. Some countries, especially in Europe, have adopted SI units which are either mmol/L or more commonly µmol/L (pronounced mewmol per liter or litre).

Please remember that interpretation of your uric acid level test results should be done by a qualified medical practitioner, preferably a rheumatologist. You might consider supporting these “official” tests with your own interim uric acid level tests at home.

The values in the table are simply meant as a rough guide to show what you need to focus on. Some people can have quite high levels of uric acid yet never experience gout.

The values in each column have been rounded. The exact conversion is to multiply mg/dL by 59.48 for µmol/L, or divide µmol/L by 59.48 for mg/dL. For mmol/L, just divide by 1000. In your head, 60 or .06 is quite near enough for converting uric acid levels in different units.

Join the forum discussion on this post

Pointers to important gout information especially facts and reference material.

A new section, so please tell me what gout info you would like to see here.

I’m kicking off with the most important number for gout sufferers – the uric acid level in your blood. This is the most important information on gout that you need to know.

The Department of Health in Hong Kong has withdrawn Purinol from sale, and is investigating other drugs manufactured by Europharm. Please note that this only affects Europharm Laboratories in Hong Kong.

The contamination appears to have occurred due to delays in the process of converting the active ingredients mixture into tablet form. It does not affect other manufacturers of allopurinol.

Patients receiving Purinol are urged to seek alternative allopurinol supplies from the clinics where there drugs where dispensed. It is vital that you do this immediately, as suspected medicines should never be used, but allopurinol should not be discontinued without the advice of your doctor.

Please check your allopurinol packaging immediately. You only need to take action if the medicine was manufactured by Europharm Labs of Hong Kong. Note that you should do this even if you live outside Hong Kong, as the drug is exported from there to other countries.

Free Gout Guides: Your Prescription For Finding Gout Answers

I’ve got several ideas, but not sure which to tackle next.

Should it be an overview of gout management? A guide to gout food and diet?

Perhaps gout triggers to avoid, or ways to manage uric acid?

What is most important to you?

Please share your thoughts.

Also, I would appreciate a review of my first gout guide on gout pain treatments.

No holds barred – tell me what you think. Is the format right? Is it too wordy or too shallow? Does it make sense? Have I missed anything?

It is so easy to miss the obvious, so I really appreciate all input.