Lower Uric Acid Gives Faster Gout Cure
Your gout symptoms clear faster with lower uric acid, but how low should you go?
It is very difficult to measure how fast old uric acid crystals are dissolving, but for chronic tophaceous gout sufferers, we can measure how fast their tophi shrink.
Allopurinol for gout has been around for 40 years, and febuxostat is the latest weapon in a growing list of medicines that will lower uric acid. But still people are unsure how low they need to go.
Uric Acid Deposits
Uric acid crystals are deposited in and around the joints and under the skin. If uric acid is not controlled then these deposits will continue to grow, and become lumps under the skin. Keeping uric acid levels to around 6.5mg/dL will stop them growing.
At around 6mg/dL, there is a slow but noticeable reduction in the size of tophi, as old uric acid crystals dissolve. This process varies because some tophi become “walled off” from the blood supply as they coagulate into increasingly harder lumps.
However, they have been used to try and assess how different concentrations of uric acid affect how tophi can reduce in size.
Uric Acid Lowering & Tophi Reduction
Perez-Ruiz et al[1] studied the effects of different levels of blood uric acid on the rate of reduction of tophi. Even if you do not have tophi, their investigation is important as uric acid will also be dissolving from the joints at a similar rate.
They mainly used allopurinol to as urate lowering treatment, though some patients also used benzbromarone (not available in US) or a combination of both.
The study showed that the speed at which tophi reduced was directly in line with the lowering of uric acid. In their groups, the average rates of reduction are shown in the chart above. Some members of the group acheived even faster reduction rates – over 2 millimeters per month in some patients who managed to maintain uric acid in the 3 to 4 mg/dL range. The report authors conclude:
the lower the serum urate level achieved during ULT [Urate Lowering Therapy], the faster the reduction in tophaceous deposits. [...] There is much more to the therapy of hyperuricemia [excess uric acid] than simply prescribing 300mg/day of allopurinol. How much? As much as necessary to obtain low serum urate levels.
Next Uric Acid Lowering Steps
You should always know your uric acid level and have a plan for managing uric acid in consultation with your doctor. Make sure your plan will get rid of old uric acid crystals as quickly as possible.
Lower Uric Acid References
- Perez-Ruiz F, Calabozo M, Pijoan JI, Herrero-Beites AM, Ruibal A. Effect of urate-lowering therapy on the velocity of size reduction of tophi in chronic gout. Arthritis Rheum. 2002;47(4):356-360.Lower Uric Acid Gives Faster Gout Cure – Full Text (PDF)
~GoutPal
Tags: allopurinol for gout, Arthritis Rheum, benzbromarone, lower uric acid, tophi