I’d like to thank you for the comments so far but we really are not getting close to an answer. Here’s hoping. I’m not talking high purine fish, I’m talking fish that’s often regarded as safe.
I’ve been getting gout attacks for over 12 months.
The first put me in hospital but since then these have been minor in comparison. I hydrate, take vitamin C and drink pomegranate juice which appears to bring symptoms under control within just a day or two. I do not take allopurinol and don’t wish to. I’m on B12 injections, omeprazole and Mometasome. I’m intolerant to statins (liver damage caused by a trial of statins) and cholesterol is therefore controlled through diet. It’s elevated and good to bad is at a healthy ratio.
My question is this:-
The first attack was triggered by crab meat and subsequent attacks by fish protein such as having 4 portions of fish in a week.
I drink beer, as many others do but despite having been on stag do’s, etc, this has never triggered a flare up. Is there any evidence out there that might suggest why?
Thanks.
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Perhaps but I’m not in an area where crab is perhaps prevalent. I live in land but have a diverse diet.
I was really hoping that someone from those charities might read this page, considering it’s content. I know other charities monitor areas relevant to them. I have spoken with one charity but the nurse I spoke to didn’t know which really didn’t get me anywhere.
I’ve a feeling that a volunteer from one of the charities sometimes responds to posts here. There are several arthritis charities though so you could try one of the others. As the person you spoke to didn’t know, it’s quite likely that no research has been done??
With gout it's best to only dabble in dishes of mussels, scallops, squid, shrimp, oysters, crab, and lobsters. They tend to be in the high purine category.
My husband has had some painful gout episodes, but hasn’t had an attack in over a year now. He keeps it under control by avoiding seafood (shellfish) but can eat salmon and sea bass with no problem. He drinks wine rather than beer, and has to remember to drink plenty of water when he goes hiking. He also avoids mushrooms, cauliflower and eats Turkey in moderation as these foods are known to be high in purines. He uses Naproxen (NSAID) at the first twinge and has found this helped. I hope you find the best solution for your condition!
If your aware then you should know that reducing the amount / type of seafood your eating could prevent some gout attacks. Beer has a high purine impact according to what I read but it also seems gout is like a game of chance (random). My mother suffers with the occasional gout attack hers comes from medication she is on for unrelated issues.
Generally caused by high Uric Acid levels which lead to the formation of Uric Acid Crystals that usually first manifest in the big toe or foot but can and do happen over any and all joints in the body. I’ve had CKD since 1996 (stage 4) kidney function at about 20% and have for many years. I had my first case of gout in 2002 (high Uric Acid is caused by severe Kidney Disease as well as other things but my longstanding CKD finally led to gout that was uncontrolled by 2004 where I was going to see urgent care doctors neatly once a week for 3 out of 4 weeks a month. The good news is it’s manageable. First start with diet eliminate shellfish and most fish in general, red meat vegetables such as asparagus and spinach, no organ or glandular meats not just from cows but all so no chicken livers (my wife’s favorite but ewwww), limit sugars and fats, eat complex carbs, and absolutely no alcohol. Gout was first called the Disease of Kings or just the King’s Disease as one of the first terrible sufferers of gout in recorded history was King Henry VIII. Only Royals and their courts were regular consumers of rich foods and red meats. All the above foods contain Purines and those raise Uric Acid immediately and while high Uric Acid is usually the cause of the first flare, after it happens ANY FLUCTUATION of Uric Acid will cause another flare. Further, In people already diagnosed with gout (referred to as "established gout"), there are also certain characteristics that increase the risk of repeated gout flares. These include:
●Fasting
●Consuming excessive amounts of alcohol
●Overeating
●Taking medications that induce sudden changes in blood urate levels
●Dehydration
In my case in 2006 I was referred to a god-send of a Rheumatologist who knew her stuff. By that time I had tophi (hard spherical deposits of crystals that are left subcutaneously in joints afflicted with many flares of gout) in my elbows, toes, fingers, ankles well you get it…her plan was to start me on 100 mg of allopurinol with .6 mg colchicine twice a week (a terrific anti-inflammatory much better than NSAIDS which are contraindicated with Kidney issues anyway but colchicine can be toxic if used too much thus the 2X a week) and 10mg prednisone daily as prophylaxis to counter the potential flares causing self by the Uric Acid lowering allopurinol while still lowering my Uric Acid. She gradually raised the dose to 300mg of allopurinol and continued the prophylaxis treatments of colchicine and prednisone for 6 months. Then I continued only the allopurinol and no more gout from 2006 until 2020. I switched from private ins to VA health care and my great doc will not accept referrals from the VAThus after 14 years gout free now it’s back.
Gout will most likely be both acute in the middle of a flare, chronic because until uric acid is lowered and controlled by meds like allopurinol or Uloric gout will become a constant companion and affect shoulders, elbows, knees, hips etc. When one flare subsided in a few days it’ll be back in another joint. I’ve had 22 orthopedic surgeries fron’98-‘14 to include bilateral hip replacement, bilateral ankle fusions, and bilateral knee replacements. I’ve had bilateral epididymis (often described as the most painful affliction a man can have) in 1986 with three Arthroscopic surgeries of the Reproductive system to help relieve issues (no surgical incisions..lol) and by far an acute gout flare in the hand, wrist and elbow is more painful! The clinical practice guidelines for Rheumatology states specifically that us of a Uric Acid lowering medication with colchicine and prednisone as prophylaxis for a 6 month period is best practice to treat all gout especially with several flares as you describe. If desired I can provide links for all assertions here so ask if wanted or needed. Further for me best treatment for the flare was/is a methylphenidate 5 day pack or prednisone relief in 2 days like clockwork. However, (keep in mind that you must control the underlying cause to prevent any more flares) steroids are dangerous in extended use as are NSAIDS (think Vioxx) and colchicine can be toxic so you can’t just manage the flares with those…on the Homeopathic side, some proof Vitamin C helps, along with moderate coffee (fully loaded…lol) drinking and cherry juice or cherry consumption. I found none of those helped me but may help you. Uric Acid is the cause of gout period and once you’ve had a flare it’s fluctuations in the acid levels so the goal is to get it controlled and became se it’s hard to do with dirt, exercise and cessation of Alcohol consumption either meds indicated to do just that are your only choice. If you continue to allow gout (and uric acid) to go untreated here are the facts…There are three main phases of gout: gout flare, intercritical gout, and tophaceous gout. Gout flare — Initial gout flares usually involve a single joint, most often the big toe or knee. Over time, flares can begin to involve multiple joints at once and may be accompanied by fever.
Intercritical gout — The time between gout flares is known as an "intercritical" period. A second gout flare typically occurs within two years, and additional gout flares may occur thereafter. If your gout is untreated over a period of several years, the time between gout flares may shorten, and your gout flares may become increasingly severe and prolonged and involve multiple joints.
Tophaceous gout — People who have repeated gout flares develop tophaceous gout. This term describes the accumulation of large numbers of urate crystals in masses called "tophi." People with this form of gout develop tophi in joints, bursae (the fluid-filled sacs that cushion and protect tissues), bones and cartilage, or under the skin. Tophi may cause erosion of the bone and eventually joint damage and deformity.
Some complications of untreated gout include twice the risk for kidney stones and large one at that often leading to tubular blockage and either AKI or CKD, increased risk of heart attack, heart failure, or stroke, Left untreated, repeated gout attacks can permanently damage your joints and inhibit your mobility. Studies show that gout is associated with an increased risk of prostate cancer in men. Liver, lung, and colon cancers have also commonly been detected in people with gout. Others include increased risk of diabetes, sleep disorders, and mental health issues.
Most common side effects of allopurinol are diarrhea, nausea, laboratory test changes and occasionally drowsiness. Sure some bad side effects are extremely rare much more rare than the gout complications listed. Common side effects of Uloric include nausea, joint pain and rash. But it has a Black Box Warning due to increased CVD events. So in the US allopurinol is the 1st-line treatment.
I am not a doctor nor in the medical field, I related my own experiences with gout as we do not diagnose nor recommend treatments, only hope it helps. My best to you!
Sorry I am usually long-winded and write these novels but this one will be short…gotta give up the beer period. Alcohol is the worst culprit for raising or changing Uric Acid levels and those specific foods and drinks may now be the cause of the gout because after the first attack it’s more about fluctuating levels of Uric Acid than high levels. For example mine is currently the highest it’s ever been at 11.3. No gout because it’s not 11.3 then 10.4 because I ate better one day then 11.6 because I went to the bar. That would cause an outbreak. Further I’m guessing you are a resident of the UK (pardon me for assuming but your post sounded British…lol. No intent to offend just wanted to offer some UK specific info, if so.) Here are a couple of UK websites that are extremely helpful in my opinion:
Hope those help you some. Gout is an insidious disease as the pain and increasing frequency of the flares mess with your head. Inevitably the attacks happen late on a Friday afternoon/evening leaving you with an ER visit as the only choice for relief and who wants to go to an ER anytime. The flares can be so bad they immobilize you and will occur in multiple joints at once like 3 fingers, wrist and elbow. Then when that flare is subsiding the same starts on the opposite side same joints. That happened to me in March of this year as I had the longest flare I’ve ever had, 7 days in right arm those afore mentioned joints and 8 on the left side. I was able to make my former Rheumatologist appointment and we sat there about 30 minutes as she debated proper treatment (biologic versus allopurinol) and I knew a 5 day steroid pack or 5 10mg prednisone tablets would stop the pain in 36 hours. Her response was “not till I know if you have chronic or acute gout” so I said look doc it always both I’ve had the symptoms se for 6 days and it’s just the first day for the left side. She then started in on I’m the doctor, I’ve been to medical school, I know better crap so I told her she was violating her Hippocratic Oath of “Do no harm” sending me home without th pain she at least understood from treating similar patients for 25 years if never experiencing that pain herself and she lost it with that comment. She started yelling that I was a fool who knew nothing so I fired her. She was flabbergasted but you have to be your own best advocate especially with a condition you’ve dealt with for 20 plus years. Nobody will ever fight for your best outcomes and well-being more than you. So see you trusted medical professionals and ask about treatment to never have another flare. I’ve succeeded with that once and have a different doc now who’s started me on the 100mg allopurinol, colchicine and prednisone. So in about 6-8 months I can eat a hamburger again as my wife makes a mean burger and in a year a bone-in Ribeye (better start saving now!) but only 1 every 6 months. If you decided de to use allopurinol or a similar drug in about 6 months to a year you can enjoy your beer again…in extreme moderation because none of those meds can stand up to normal consumption of red meat and alcohol…lol! I truly wish you the best. I’ll close with a picture that may help you see what could possibly happen if you can’t control your Uric Acid with diet, vitamins and cherry juice or cherries (never heard of the pomegranate juice as it’s not purine lowering and can’t find it in any US litature). Hope it works for you but the meds aren’t the end of the world and certainly better than a gout flare…lol! As always good luck on your journey to your best health!
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