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High Uric Acid & Gout
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High Uric Acid & Gout

Did you have elevated uric acid in your blood while undergoing HCV treatment?

If you did have elevated uric acid, did it result in gout either during or shortly after treatment?

I recently completed 24 weeks of HCV triple therapy (Incivek). My uric acid was a couple of points high throughout treatment. About a week before I completed treatment, I started experiencing discomfort in the joints at the base of my big toes. During the past week this has progressed to a painful swollen big toe joint on my right foot.

According to the NIH (http://www.niams.nih.gov/Health_Info/Gout/default.asp), gout is caused by high uric acid and high uric acid can be caused by, "an excessively rapid turnover of cells, such as ...... hemolytic anemia".

I suspect I have gout resulting from treatment. I'm wondering if other people have experienced this condition and how long it may take to resolve after treatment. Cheers, GB
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17 Comments Post a Comment
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979080_tn?1323437239
What does your diet look like ?
Purine in purine rich foods gets broken down to uric acid.
Judging by my own own experience I dought hemolytic anemia being the reason. My HgB went as low as 8.9 on tx but my uric acid was always normal.
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2062453_tn?1350336542
Hi Bali: Thanks for your response. My diet was a disaster while I was on treatment. I basically ate whatever I could stomach given the nausea. The nausea is starting to pass so I'll focus on improving my diet to help address the gout. I'm also hoping I can soon stomach water again (after 6 months of primarily flavored juice). I read that drinking lots of water helps relieve gout, and I used to drink lots of water, so hopefully I can again soon! Cheers, GB
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979080_tn?1323437239
I would try addressing it with diet changes and follow up with new blood test. Uric acid level in serum should respond relatively quickly and the test itself is not very expensive nor does it take long to get result.

Good luck.
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Avatar_f_tn
Yes and all I can say is black cherry juice, black cherry juice, and more black cherry juice!  Look in health food items. It tastes like prune juice to me (aka yuck), but it does work wonders quickly. Just remember that it is cherries with all the delightful side effects. :0)
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766573_tn?1365170066
Exactly! I actually read that it was tart cherry juice but the more I read I discovered that it could be black (or dark cherry juice) so I drank a lot of that during the Incivek stage of treatment.  I followed a low purine diet from week 2 to week 10. At first it was no big deal since I do not eat meat anyway but after a while I needed more variety when taking my Incivek.

Anyway, I wondered if the fat requirement with the Incivek was the cause for possible elevated uric acid levels but never stopped to research it. In answer of your question, I don't know much about Gout or if it can actually develop that fast but I would definitely ask your doctor about it. Who knows, maybe even the Gout Forum on here.

Either way, it sounds like this is something you do not want to ignore. Trust me on this: any kind of foot or toe problem can be very incapacitating.
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2062453_tn?1350336542
Thank you for your comments and suggestions. Here is an update.

Yesterday, I drank my first glass of water since the day I vomited water when treatment started. It stayed down! Also yesterday, I started taking 800mg of Ibuprofen 3 times a day. Have not bought cherry juice yet, but I had some jars of dark morello cherries in the pantry that I had bought from Trader Joe's -- ate lots of them!

Last night, after my toe was so swollen and stiff for over a week, it magically loosened up! I couldn't resist massaging it and stretching it -- like an itch that I could finally scratch for a long time. It's sore again today, so it's more ibufrofen, water, cherries, and ice packs, but I think I've turned the corner.

My doctor input a couple of uric acid tests into the system -- I'll get the first one the next time I'm in the city. Cheers, GB
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163305_tn?1333672171
Do be careful with iburpofren, that stuff is terrible for our livers.
I use arnica or bromelian to reduce inflamation (inflammation).
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Avatar_m_tn
And be careful massaging/stretching your toe. I would rest it - I have seen suggestions that ice application can help.

"...Acute Treatment

The main aim of acute treatment is to provide rapid relief of pain and inflammation and exclude joint sepsis. Without acute treatment, the pain from an attack can last at least a week. Time from treatment to termination of attack is the only guide to efficacy as few placebo-controlled trials exist.

In addition to pharmacological agents, affected joints should be rested and treated with ice, which has a significant anti-inflammatory effect additionally.[13] ..."

From: Up-to-date Management of Gout
          Kelsey M. Jordan
          Posted: 02/21/2012

http://www.medscape.com/viewarticle/758477_2
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766573_tn?1365170066
Yay. I am glad you are doing a little better. You sound better. I understand it takes extremely (and consistently) high uric acid levels before Gout is considered.

On my chart that came with my shots it says that I could take 200 mg of Ibuprofen with meals (max 9/day) or Tylenol 325, 2 every 4 - 8 hours (max 6/day). I wouldn't ignore ice though. Keep it as elevated as you can and most of all see what your doctor says. If it continues to hurt I would consider seeing a podiatrist or maybe just your regular family doctor.
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766573_tn?1365170066
Actually, I have yet to stumble across literature saying meds like Ibuprofen are OK with HCV. MY GI says it is OK while treating and I trust the guy but as I search the Net the support just isn't there. I just thought I would add that.
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2062453_tn?1350336542
Thanks for the ibuprofen comments. Fortunately, I may no longer have HCV for that to be a constraint -- looking forward to my 2-week post treatment viral load blood test next week. Also looking forward to my post-treatment liver biopsy next week, whose results will help me determine how gingerly I need to treat my liver with drugs like ibuprofen and acetaminophen. Cheers.
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163305_tn?1333672171
I'm a big fan of good old aspirin. It doesn't harm your liver and if you don't have low platelets, or an allergy to it,  there's no reason not to use it.

Over usage of tylenol by itself has caused Emergency liver transplants.It was almost pulled from the market a few years back.
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Avatar_m_tn
Definitely.  Just finished triple with boceprevir for 28 weeks May 3rd.  I've had minor flairs of gout for the last 5 or 6 years prior to treating.  1 week after treating the gout exploded in both toes and is still going off from time to time.  Uric acid was 7.2 and I went on a low dose of allopurinal 100mg and it dropped to 5.2.  You have to keep your uric acid under 6.0 forever if you want to solve your gout problem.  Doctor told me absolutely, that high cell turnover from 7 months of anemia was a major contributor of the high uric acid. On the allopurinal instructions it says its given to cancer patients after treatment because of gout induced from high cell turnover.  I'm on a lacto-ovo vegetarian diet and of course I do the cherry juice, apple cider vinegar with mothers, celery seed extract and those things which help naturally with lowering uric acid and are good for you anyway plus the vitamins we need after treatment like the b vitamins, D-3, C and others. I'm not sure where you live but in the U.S. I now go to Labcorp and pay $70.00 once a month to moniter my uric acid.  No doctor needed.  Hope this helps, you're not alone my friend.
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Avatar_m_tn
Definitely.  Just finished triple with boceprevir for 28 weeks May 3rd.  I've had minor flairs of gout for the last 5 or 6 years prior to treating.  1 week after treating the gout exploded in both toes and is still going off from time to time.  Uric acid was 7.2 and I went on a low dose of allopurinal 100mg and it dropped to 5.2.  You have to keep your uric acid under 6.0 forever if you want to solve your gout problem.  Doctor told me absolutely, that high cell turnover from 7 months of anemia was a major contributor of the high uric acid. On the allopurinal instructions it says its given to cancer patients after treatment because of gout induced from high cell turnover.  I'm on a lacto-ovo vegetarian diet and of course I do the cherry juice, apple cider vinegar with mothers, celery seed extract and those things which help naturally with lowering uric acid and are good for you anyway plus the vitamins we need after treatment like the b vitamins, D-3, C and others. I'm not sure where you live but in the U.S. I now go to Labcorp and pay $70.00 once a month to moniter my uric acid.  No doctor needed.  Hope this helps, you're not alone my friend.
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Avatar_m_tn
My original post here at Meds was regarding gout/swollen feet.

I have not been to a doctor in ages, Im 57 year old guy, decent health,exept,I have Hep C. It started with my ankle I noticed a couple month ago & it's gotten progressively worse.

I have not been TX'ed in 10 yrs. I'm assuming this is something caused by  my liver disease. I'm trying to do some hill billy research on the web about gout & Hep C lol. I'm no mental giant for sure, but it sounds like gout is no stranger to Hep C?
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2249505_tn?1343513406
I have had high uric acid for 5years but never had a flare up of gout. Dr put me on alpurnal back then. Have had hep c 40+ years. Uric acid went up about the same time as BP and most lab #s  started fluctuating more than in the past. Always wondered if Hep c was involved??
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2159080_tn?1336794002
  Hi ev1 i have Hep C  and RA my sister has GOUT and i was wondering if i have GOUT because my big toe has been hurting alot my legs stay swollen,very painful and the swelling never goes down no matter what i do my legs feel almost like there is no feeling left in  them they feel numb all the time and tingly can this be gout. I bruised my leg real bad and did't even know that i had bruised my leg.Thanks ev1
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