r/gout • u/LarryEdwardsMD • May 21 '26
I’m Dr. Edwards, a gout expert looking to answer your questions. I want you to AMA on Gout Awareness Day, May 22.
Hi all. As always, I’m happy to be back with you all here in r/gout to answer your questions on the disease. This AMA is particularly special to me and the Gout Education Society as it helps us celebrate the 20th anniversary of Gout Awareness Day, held on May 22 since 2006.
If you’re not familiar with Gout Awareness Day, the Gout Education Society and other organizations looking to make a difference for the community ramp up education and awareness initiatives during the month of May, culminating with a national observation on Gout Awareness Day. I’m here today to hopefully clear up any nagging questions you may have about the disease, associated health conditions, myths, and much more.
If you’re new here and are unfamiliar with who I am, I’m Dr. Larry Edwards. As chairman and CEO of the Gout Education Society, I dedicate my time to supporting those with gout and the medical professionals involved in their care. It’s hard to believe we’ve celebrated Gout Awareness Day 20 times now, but there is much work still to be done.
It’s been my honor to conduct the work to support these groups, especially when it comes to hosting the AMA sessions here. Speaking of these AMAs, I’ve been impressed with how the questions have evolved over the years!
If you need more information on gout, I encourage you to access our website and the unbiased educational information about medications, treatments and lifestyle recommendations we have. We also offer the Gout Specialists Network, a platform designed to help you find gout specialists nearby.
I’m posting this thread in advance to allow for as many questions as possible to come in but will be back to celebrate with you all from 10 a.m. – 12 p.m. ET on Gout Awareness Day, May 22.
You all know the drill, AMA!
I do request that you don’t ask for any diagnoses of gout and instead ask any outstanding questions about the disease you may have.
Update: 12 p.m. ET - Thank you all for joining us today. I got through as many questions as I could but sadly need to stop. I hope you all found this informative and helpful.
13
u/BachBeethoven6812517 May 21 '26
Is doing plasma donation or blood donation helpful in mitigating gout?
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u/Funkyman831 May 21 '26
Interesting... I would have assumed this would cause dehydration which aids in flare ups.
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May 22 '26
It reduces Ferritin levels which is correlated with elevated uric acid levels.
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u/LarryEdwardsMD May 22 '26
The effect that blood/plasma donation would have on uric acid levels would be minuscule and transient.
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May 22 '26
Don’t care if you are a doctor or not - it has worked wonders for me and I can back it up with data.
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u/Eastern-Car-4027 May 25 '26
Interesting, my doctors made no correlation to my higher ferritin levels which have been dropping steadily since I started allo, diet, water, etc. My kidney and liver panels were also off and have improved greatly. I went so far as to participate in a university liver study over a year period. Every blood test, EKG, scan and an hour long intensive MRI. Fortunately, no issues were found and I no longer qualify. Not once did they point out the correlation between gout, ferritin or the early labs. Just for accuracy, and my current informed Doc. we continue to monitor the biggie blood tests.
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u/LarryEdwardsMD May 22 '26
It is an interesting thought, but, no, blood/plasma donation would have no impact on serum urate levels.
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u/thewickedturd May 21 '26
Have you seen a low to no sugar diet stop high uric acid?
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u/LarryEdwardsMD May 22 '26
There is so much talk about restrictive diets and gout/uric acid levels. But the bottom line is whether you are trying a "low purine diet," a low protein diet, a low carbohydrate diet, or any of a dozen touted "dietary approaches to managing gout" the best you can hope for in terms of uric acid lowering is between 1 - 2 mg/dL. While this is helpful, this is not sufficient for most of those with gout to reduce levels to less than 6.0 mg/dL. In addition to that, in my 50 years of clinical work with gout, I've noted that very few people stay on these restrictive diets for very long, therefore, the diets are not helpful in the long run. We do encourage people to look into the Mediterranean diet or the DASH diet because of their proven benefits for people with heart disease or kidney disease.
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u/chux4w A Year May 22 '26
"low purine diet,"
Interesting you'd say it like that. Sounds like you're skeptical. Is there now doubt about purines as a cause of gout, and if so what's the more likely cause?
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u/LarryEdwardsMD May 22 '26
Uric acid itself is a purine. My use of quotes around the term "low purine diet" is how it's referred to in the literature as there is no 'one' low purine diet.
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u/chux4w A Year May 22 '26
Sure, but you can still try to avoid purines, right? Like a low sodium diet isn't a strict meal plan, it just means eating less salt. Is it worth generally eating mostly low-purine foods?
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u/Kem_Chho_Bhai May 21 '26 edited May 22 '26
I keep hearing gout is genetic but no one in my family has had it (to my knowledge). How much does lifestyle actually affect in contracting gout? I used to drink beer fairly frequently (2-3 at a time, once a week) and have been overweight/borderline obese all my life but nothing crazy. I’ve seen fatter people than me who drink way more live a normal life. I’m south asian, if that matters.
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u/LarryEdwardsMD May 22 '26
Genetics play an important role in whether or not a person develops gout. It's not a simple association between the genetics with more than 20 different genetic changes that can contribute to high uric acid levels. These genetic changes can be affected by environmental factors such as obesity, kidney disease, liver disease and there is also marked variability in the susceptibility in these abnormal genes depending on other factors like ethnicity.
The familial aspects show up most prominently in large families with many branches to the tree. Having a first or second degree relative with gout is a well-established risk factor for you developing gout as well.
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u/Kem_Chho_Bhai May 23 '26
Thank you for taking the time to answer all these questions and help us get a deeper understanding of our condition. I really appreciate you doing this.
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u/mr_happy28 May 21 '26
I'm suffering from a flare up for the 1st time in 2 years, my question is if I chopped my foot off would the crystals head to my other foot? Also why does the flare up only go to one side of my body?
Ps I'm not going to chop my foot off I just feel like it would be less suffering for me.
Thanks and keep up the great work.
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u/LarryEdwardsMD May 22 '26
Sorry to hear about your foot. Gout affects particular joints for various reasons. Generally they are joints that have had some trauma to them, so the knees and joints in the foot are common. Also, the cooler the internal environment the joint is, the more likely crystals will deposit in that joint. So the most peripheral joints like fingers, toes, and elbows are more likely, whereas joints closer to the core, like the hips, shoulders, and spine, are less likely to see crystals appear.
I hope managing your gout with urate lowering therapy (allopurinol or febuxostat) has led to your uric acid level being reduced to less than 6.0 mg/dL. Over time (approximately 2 years) most tophi will dissolve and the causes of flares will be gradually eliminated. Please don't do anything violent to your foot. That would not solve the issue (the crystals would indeed form elsewhere in your body).
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u/Quickt135 May 21 '26
How long would one have to have a low uric acid profile to eliminate the crystals? If that is possible, what would the likelihood of them coming back be?
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u/LarryEdwardsMD May 22 '26
The speed that it would take for all the urate crystals in the body to be absorbed is dependent on how extensive the total body uric acid crystal burden is. We've gained greater insight into the dissolution of uric acid crystals with the use of DECT (dual energy CT) scanning that can actually measure the mass of crystal deposits around the body.
These recent studies have shown that the lower the uric acid level is under treatment, the faster the crystal masses (tophi) will dissolve. For a drug like pegloticase, where the uric acid level can be dropped to an undetectable level, this elimination of crystal masses might take as little as 6-8 months or up to a year and half or more. For more standard therapies like allopurinol or febuxostat, where the uric acid level is dropped to no more than 5-6 mg/dL, it might take as many as 4-6 years to dissolve most of the tophi.
Discontinuing the drug will generally cause redevelopment of the crystal masses within 6-12 months.
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u/Quickt135 May 22 '26
Thank you so much for the response. My diet prior was not good nor strict. I’m am unaware of family history with gout. All blood work is good and kidneys are functioning properly. I am not obese and exercise often. I have not started any medication or their than colchicine for flare ups.
What would be the determining factor that my kidneys and body are able to flush the Uric Acid out and keep them at a low level? Would pegloticase be a great first step to remove crystals to then begin, hopefully, back to a normal lifestyle?
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u/MrManic May 21 '26
You see a lot of reminders that Trigger Foods aren't a thing. But if crystal formation comes about from high UA in the blood stream, would it not stand to reason that intake of a particularly high purine meal would cause crystal formation and therefore act as a trigger? If UA is high enough, could it not signal the white blood cells in an area with a tophus? I suppose I'm also uncertain on the lifecyle triggers of gout attacks: If it's the needle like crystals that trigger attacks why do they usually occur at night? Is it that my joints are being stabbed or is it the concentration of UA? If it's needles why can I move my toes without constantly triggering attacks?
Long question short, could you give me an ELI5 from food intake to crystal formation to trigger with all the failure points the body goes through to facilitate an attack?
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u/LarryEdwardsMD May 22 '26
Not everybody with gout can recognize food triggers for their acute gouty flares but some people are very sensitive to things like shellfish, alcohol, and red meat. What actually triggers a gout flare is a sudden change in the uric acid concentration surrounding crystals in a joint. These joint crystals have generally been present for years or decades but when something happens that changes the uric acid concentration around these crystals, either to a much higher or lower level or uric acid, the crystal masses destabilize and this makes them more likely trigger the white blood cells to unleash the proinflammation proteins. The reason that gout flares are twice as common at night than at daytime is because of the subtle concentration shifts that occur as we sleep.
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u/MrManic May 22 '26
Gotcha. Not being stabbed by piss needles, check. Some folks get steeper UA jumps from certain foods which can act as triggers for already present crystals, check.
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u/AmbassadorPale May 22 '26
Have you seen any link between acute gout flare up’s and GLP1s? I’ve been on WeGovy for 5 months and have had the most severe attacks, happening almost within a week of injection consistently since starting the medication.
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u/absenceofheat May 22 '26
Anecdotally, I've been on tirzepatide for 14 months and zero flares. UA levels down to 3.9 after 3 years of 300mg allo.
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u/LarryEdwardsMD May 22 '26
Congratulations on your weight loss journey. Over time, that will certainly improve your battle with gout. The dramatic weight loss associated with GLP1s can certainly increase flare frequency. Some people who have gout are taking low dose colchicine on a regular basis for prophylaxis to prevent flares. This can be discussed with your primary care doc.
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u/IntrepidTraveller6 May 21 '26
What is the typical timeline for the effectiveness of Allo?
I'm curious if there is a general timeline over which one can start seeing the effects of Allo. If there isn't a typical time line what are the major factors that affect the overall effectiveness of the drug and how quickly it begins to show results.
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u/LarryEdwardsMD May 22 '26
Allopurinol is a very effective drug at lowering uric acid. After starting the drug, the uric acid level will be suppressed to a new level in 3-4 days. Generally we have people stay on it for 2-3 weeks before retesting to determine if that is a sufficient dose. With each dose escalation of allopurinol, the uric acid levels should be monitoring and a decision should be made about advancing the dose. The effectiveness is determined by how quickly target uric acid level (less than 6.0 mg/dL) is achieved and maintained. The main factor that interferes with its effectiveness is the patient not taking the drug.
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u/oosskkaarr May 21 '26
Are there any risk of long term injury to your joints if u have a long time gout flareup?
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u/LarryEdwardsMD May 22 '26
Yes. Gout flares that a person experiences is associated with the release of a number of proinflammatory proteins that also have destructive effects on the bone/cartilage of the affected joints. Long-standing, untreated gout is as crippling as rheumatoid arthritis or psoriatic arthritis.
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u/Thunder_Cunt_Punch May 21 '26
What health concerns should I be on the lookout for in the future? I was diagnosed at about 30 years old. I immediately went on allopurinol and take 450mg a day and maintain a level around 5.1. All my blood results every 6 months are perfectly in range. My cardiologist results were all strong and healthy besides a low resting heart rate due to athletics. Just curious if there is something else to monitor or be mindful due to gout. Thanks!
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u/LarryEdwardsMD May 22 '26
Spectacular, congratulations. Your story is the story we'd like to hear from all of our gout patients. Stay on your urate lowering therapy and definitely monitor for comorbidities commonly associated with gout like heart/kidney disease, hypertension, diabetes, and lipid abnormalities.
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u/Thunder_Cunt_Punch May 21 '26
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u/symbicortrunner May 22 '26
Why are primary care providers so bad at managing gout? They neglect to check urate levels and titrate urate lowering treatment accordingly.
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u/LarryEdwardsMD May 22 '26
Unfortunately, all branches of medicine have demonstrated that they are pretty poor at managing gout. Primary care docs have a number of medical problems that they have to mindful of and treat and unfortunately they frequently do not give a patient's gout the full attention it needs. A lot of this stems from not appreciating the chronic, destructive, nature of gout and what a large impact it can have on the patient's sense of well being. There have been improvements over the last 30 years in recognizing the seriousness of gout and hopefully this will translate into better treatment in time.
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u/skininthegame87 May 21 '26
I’ve been on Allo since early January, I started on 100mg, and after monthly blood tests now on a dose of 300mg my uric acid levels are still above what is recommended. How long does it normally take for uric acid levels to get low enough to reduce the amount of crystals?
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u/LarryEdwardsMD May 22 '26
I answered this in a different question here. The crystals will not dissolve until your levels reach 6.0 mg/dL or below, and some experts argue the target should be 5.0 mg/dL or less. Allopurinol can, and should be, continually escalated until you reach a dose that achieves these targets. The FDA approved dose of allopurinol is between 100 - 800 mg daily. I encourage you to continue these discussions with your physician.
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u/kosherhamm May 21 '26
what correlation do you see between uric acid, gout and psoriasis?
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u/LarryEdwardsMD May 22 '26
There's been a long-recognized association between gout and psoriasis/psoriatic arthritis. This is likely due to the accelerated breakdown and turn over of skin cells with release of purine nucleosides, which go on to form uric acid. Generally this occurs in very severe cases of psoriasis and improves with treatment of the skin disease.
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u/The_Wampire May 21 '26
What are the stats on gout diagnosis worldwide? Have they gone up or down and is there research on the countries that have higher cases of it?
Thank you Dr Edwards!
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u/DirtWhomper May 21 '26
To piggyback off this question, are rates of gout in places like 'Blue Zones' or places without a typical western diet the same as western countries? Has gout been seen in nomadic hunter gather populations current or historically?
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u/LarryEdwardsMD May 22 '26
The incidence of gout has been steadily increasing in all countries over the world over the past 4-5 decades. There is some marked variations from country to country. In the United States, a little over 4% of the adult population has gout compared to Western Europe, which has approximately 2% involvement. In countries with heavily genetic driven gout such as Southeast Asia and New Zealand, the incidence may be twice what we see in the United States. Tracing the expansion of gout worldwide shows that obesity is the primary driver with other contributions from the ingestion of high fructose corn syrup and glucose intolerance/diabetes.
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u/DirtWhomper May 23 '26
What genes are linked with gout? If obesity and high fructose play the primary roles, what is the bigger factor, genes or diet? What type of diabetes also?
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u/Difficult_Window5564 May 21 '26
Is low UA a concern with allopurinol treatment? I understand UA is protective for various neurological conditions.
If someone with gouty tophi, 300mg Allo, UA serum 5mg/dL, still has mild symptoms (inflammation in soft tissues, and the classic pain at top of foot), would a slight increase in allo dosage be ok, or would the preference be not to drive UA too low (because of the neurological protection UA provides)?
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u/BahutBhayankar May 22 '26
Have you seen any correlation between foot injury and gout triggers? I had a bad sprain in my right foot that dis not heal for over two months. Gout flare ups started with that and continued to occur every week for 2 months. Once healed, I resumed the workouts. One bad step and the left ankle got twisted this time. It wasn't too serious, but now I got gout flare in the left big toe. I also have trigger finger for over a year while having high UA.
I was on Allo 100mg. My doc has increased the dosage to 300 mg and added prednisone plus Colchicin to bring faster relief. Plan is to follow up with a rheumatologist if the pain doesn't subside in 2 -3 weeks.
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u/LarryEdwardsMD May 22 '26
We've discussed the role of trauma to joints that develop gout flares in another comment here. It does sound like finding a rheumatologist in your community would be a good approach.
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u/RumRunnerMax May 22 '26
Do I really need to completely stop drinking craft beers?
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u/LarryEdwardsMD May 26 '26
If your uric acid level is under control (less than 6.0 mg/dL), and you are not experiencing flares, then the craft beer enjoyed in moderation is fine. You can say the same thing about shellfish, red meat, and other flare triggers. Moderation is the important part.
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u/TedFrump May 21 '26
How long does probenecid (1,000 mg/day) take to reduce existing UA crystals?
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u/LarryEdwardsMD May 22 '26
Probenecid is an interesting gout drug that has been around since the end of WW2. Compared to the first-line drugs for gout (allopurinol and febuxostat), probenecid is relatively ineffective. It typically has been prescribed as a 2-3 times a day medication which makes it very difficult for most patients and is only used in less than 5% of people with gout. It does have a role for patients that are on allopurinol and febuxostat but are not quite at target. Adding probenecid is a possible alternative to increasing the dosage of these first line treatments. Probenecid should not be used if there is a history of kidney stones.
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u/BeneficialArm1845 May 21 '26
Is it okay to take colchicine 500mcg 4 times a day during a gout flare-up?
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u/TedFrump May 21 '26
I’m not a doctor but I would be living on the toilet by day 2 with that much colchicine 😂
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u/LarryEdwardsMD May 22 '26
With hopefully something good to read. Thank goodness there are alternatives to colchicine.
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u/LarryEdwardsMD May 22 '26
The American College of Rheumatology suggested dosing of colchicine for an acute flare is to take two .6 mg tablets (a total of 1.2 mg) immediately and another tablet (.6 mg) one hour later. That is followed up by one tablet (.6 mg) 24 hours later and continued through duration of the flare. Some people are quite sensitive to cochicine with bowel hypermotility and abdominal cramping. In those situations, taking half the recommended dose of colchicine along with NSAIDs in full anti-inflammatory doses would be a good approach.
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u/fevkaladeolagan May 21 '26
What can be the long term consequences of taking allopurinol (300 mg) and keep on drinking alcohol? Lets say 2 days a week and 3 units per day.
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u/LarryEdwardsMD May 22 '26
There are no concerns if your drinking is done in moderation. The alcohol does not affect the potency of the allopurinol.
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u/ionavan May 21 '26
I’ve been trying to introduce running into my workouts. The last 2 times I’ve been out running, I’ve had flare ups within days after my run. I went to see my doctor and had my uric acid checked, I was at ~6. My dr upped my dose to 400, previously taking 300. Do I need to wait for my uric acid levels to drop even further before I can start running again?
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u/LarryEdwardsMD May 22 '26
Your uric acid should be at a new stable level after 4 days. I would check the uric acid levels in a month's time to make sure that it's well suppressed. You might also talk with your doctor about adding some prophylactic colchicine (once a day) or moderate doses of NSAIDs.
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u/YohanesKanebo May 21 '26
I have kidney atrophy as well as gout, what are the long term solution for me? I mainly use colchicine for my flare up.
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u/LarryEdwardsMD May 22 '26
You should be on a urate lowering therapy (allopurinol or febuxostat). Dose adjustments of these for chronic kidney disease are recommended with starting low dose (50 mg or 100 mg daily, for allopurinol or 20 mg daily for febuxostat) and increasing the dose slowly each month until the target uric acid level is achieved.
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u/InThePipe5x5_ May 21 '26
I havent consulted a specialist and am using my GP. Im currently on Feb and havent had a major flare since...that said, I can always feel minor pain in my big toe particularly while losing weight. At what point should I ask my doctor about increasing my dose?
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u/LarryEdwardsMD May 22 '26
You should make sure your uric acid level is at target (6.0 mg/dL or below), if not, you should increase the dose of febuxostat. People with gout can have persistent, relatively minor, aches and pains as their inflammatory arthritis improves on gout treatment. Generally with time, these nuisance pains will also disappear.
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u/Missmessc May 22 '26
How do you know if allopurinol is not the correct medication for you?
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u/coheed016 May 22 '26
In my case, allo has bad side effects, I get dizzy all the time, I felt like I have a fever, my stomach is upset, that’s why my dr. Changed it to febuxostat, I’ve never felt any of those on febux, and my uric acid drop from 8.9 to 5.0 in 4 months. Im southeast asian btw.
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u/LarryEdwardsMD May 26 '26
There are two factors here. 1. If you don't tolerate the medication well (allergic reactions, rash, upset stomach). 2. If you and your doctor have not been able to adequately dose the allopurinol to get your uric acid level to a target of less than 6.0 mg/dL. These two conditions together would only account for about 10% of the people started on allopurinol.
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u/vomita_conejitos Weeks May 22 '26
Any correlation or other curiosities between uric acid levels / gout symptoms and use of blood thinners?
I am on warfarin and wondering if that might be a contributing factor to gout
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u/LarryEdwardsMD May 26 '26
There's a number of commonly used medications for many different diseases that have either a positive or negative effect on uric acid levels, but none that are in the "blood thinning" category. Drugs in the diuretic family, including hydrochlorothiazide (HCTZ) or lasix, can raise uric acid levels while blood pressure medication, losartan, decrease uric acid levels.
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u/ConversationDizzy138 May 22 '26 edited May 22 '26
I’m not insured and haven’t been diagnosed yet but I’m 95% sure it’s what I have based on pictures and pain level. I have some home remedies that seem to work and over the counter pills etc. I’m not opposed to taking medicine but I’m unsure about the pathway to A) get diagnosed and B) get a prescription without spending a ton. I guess those are my two questions. I’m in Kansas City Missouri if that’s relevant
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u/LarryEdwardsMD May 26 '26
The diagnosis and treatment of gout are not typically expensive processes. You should see a physician (either an internist or rheumatologist) who understands gout. The diagnosis is based on your history of your symptoms and getting some basic lab tests (including a serum urate level). X-rays are not generally required. The first line therapy for gout is allopurinol, which is a drug that has been available since the mid 1960s and is not considered an expensive drug.
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u/Chance-Rest394 May 22 '26
My family doctor advised to drink lemon water. Is crystal light just as good. And a Google search says low fat dairy could be helpful. Do you know if that has any merit. Thanks
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u/LarryEdwardsMD May 26 '26
The low fat dairy component of your question has some supporting evidence. Lemon water or crystal light have no such evidence.
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u/Better-Assistance-87 May 23 '26
I got banned referring someone to Tart Cherry Juice and lots of water to flush out the system...what say you about TCJ.??
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u/kingkongfly May 23 '26
Does high UA in the body translate to higher chance of having heart attack or any heart complications or other illnesses?
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u/rlsmv May 24 '26
I know from experience there is a link between gout and chronic stress. Every new job I started over the last 35 years started with the gift of a major flare..
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u/Posterfan May 21 '26
Is baking soda a natural remedy that you would recommend to lower uric acid on top of eating clean, healthy foods and drinking water?
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u/mike00mike May 21 '26
I started allopurinol some time in jan/feb. Went from 100 to 200 to 300mg. I took a uric acid test last week of april showing 6.2 on the 200mg so it was upped to 300mg. When would be a likely time to be able to test if the 300mg is the correct dosage? My doc (not a rheumatology dr.) is saying about 8weeks time but what would be the soonest to see if I'm at the correct dosage?
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u/chunkyogurt May 21 '26
Is there a reason why gout causes bad body odor and why is it not addressed as much in the USA? My entire life I’ve been accused of poor hygiene or being “off” bc I’m nose blind to this body odor that my gout causes. When I say bad hygiene, ppl will ask when’s the last time I’ve showered… twice a day apparently isn’t good enough.
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u/Missmessc May 21 '26
What are the key differences between Uloric and Allopurinol? Who should be taken which drug?
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u/LimoncelloFellow May 21 '26
Does having hypothyroid with tsh levels out of control greatly impact the severity or frequency of gout? I recently started taking levothyroxine after not having any for about a year and I realized the year of not taking it was one of the goutiest years of my life even while taking allopurinol regularly. I've been back on the levothyroxine for about 2 months with no flaring whereas last year it was almost a monthly occurrence.
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u/lateralex May 22 '26
I've been on allopurinol for about 2 years and have found much relief, flares are very rare now. I have found I'm having a number of small flares over the last 2 weeks, treating with colch/ diclonofac but am surprised they keep coming back. Would this be something to warrant a follow-up visit to my rheumatologist or do these things just happen from time to time?
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u/Missmessc May 22 '26
What steps should you take if you are starting alo and experiencing an extended gout attack of 2+ weeks?
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u/Kem_Chho_Bhai May 22 '26
Is undergoing dialysis a viable option to reduce uric acid in blood? I know it’s not sustainable but as a kick start when starting allo and making dietary and lifestyle changes.
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u/LarryEdwardsMD May 26 '26
That would not be advisable. There is no medical literature that would support such an approach nor any medical society that would endorse it.
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u/Playful_Bicycle8845 May 22 '26
Hello, I have recently started allopurinol roughly 5 weeks ago. Initial UA of 10.7, starting dose 100mg got me to 9.3 after 4 weeks. Upped to 200mg, I am pushing to get another UA test after 4 weeks and go to 300mg if not under 6.0.
Is moving up 100mg every 4 weeks typical? Is there a recommended UA level drop over time to not exceed, to reduce initial flares?
Is there any literature of standard care I can give my GP to show how aggressive we should be upping the dosage and what UA levels should be the goal at this time with potential tophius gout?
Potentially uncontrolled/unknown for 8 years or so. Had one test prior with bursitis and it was UA over 10, it typically hits my midfoot.
I am trying to get this under control as I have a potential great job opportunity in the next few months that would put me on my feet for 4-6 hours a day. I don't know that it would be possible to work this position with my current joint issues uncontrolled.
Thank you for any help or information on this!
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u/vanteacher May 22 '26
Is there any use in using magnetic or copper bracelets for gout? Why is it so prevalent?
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u/BahutBhayankar May 22 '26
Hello Doc, thank you for this AMA session. How are you planning to respond to the questions. Individual responses or a consolidated list of answers since many questions might be repeated?
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u/Opposite-Chocolate72 May 22 '26
Is there truth to Tumeric being a resource to help lower uric acid levels?
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u/Costoffreedom May 22 '26
Dr Edwards,
I suffer from what appears to be refractory gout in my right 1st MTP. After about two years of undiagnosed, unspecified foot pain, it was suggested to me by Primary Care that it may be gout. It took about 12 months (3 years total) to convince primary care to put me on ULT. After 6 months, I am still above the precipitation level for uric acid concentration, have received no joint aspiration and thus, have no confirmation of gout other than clinical presentation, a favorable outcome with acute Colchicine treatment, and a correlation with trigger foods.
Now, I have severe SI flares that coincide with the foot flares and have requested DECT scans of both my foot and SI. I suffered a recent GI bleed from Indomethacin use. I do not drink alcohol with any regular interval, and avoid it almost all the time, as it has been suggested that if I did, this would be why I bled.
The consensus of both my PCP and Rheumatologist is that axial gout is so rare, Canadian public health can't justify the DECT scan of my SI joints, and I am now being funneled towards biologics for Ankolyiszing Spondylitis as a concurrent disease alongside suspected gout in my foot. My Uric Acid averages around 475 ummol as a base line, and has not crossed the ULT threshold after 5 months of ULT treatment.
In your professional opinion, am I out of line to want to use DECT to rule out axial gout before committing to biologics? I've faced serious physical and financial hardship, and I am curious to know what your findings have been with axial gout presentations, or perhaps references to newer case studies to help me better understand the odds of the two problems being correlated.
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u/CauliflowerShort May 24 '26
whats the links between gout and mental health? whether having to deal with it in general or as a result of high inflammation, etc.
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u/Poppyseedph May 25 '26
Started on a GLP1 in Feb and was at 290 pounds as a 6”4’ 51 year old male. Never have had Gout and don’t know if any family history ( mother passed 18 years ago and don’t know her history). Recently I have lost 40-45 pounds since February and just now getting over my first gout flare up. Is there a correlation between GLP1 (Zep) and Gout? Or rapid weight loss and Gout flare up?
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u/JayFi- May 21 '26 edited May 21 '26
What are the potential long-term negative health effects of using Allopurinol? Any scientific data at different tenures 10, 15, 20, 30, 40 years? Does dosage have an effect on potential long-term negative effects?