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Uric acid crystals and gout

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Crystals format and dissolve in a person with gout.

Excess uric acid crystalizes and it is our immune system that causes pain as it tries to isolate these crystals by covering them up with some coating. Once the crystals are coated they become "invisible" to the immune system and the pain stops. So far this explanation is just like at icuredmygout.org.

When the uric acid drops below some level, the body uncovers the crystals and starts to dissolve them to bring up the level of uric acid. This is where it gets interesting at goutpal.com: Apparently this ALSO causes pain because once again the immune system "sees" and attacks the crystals before they dissolve. This pain should go away if (1) all the crystals dissolve or (2) if the immune system coats the remaining crystals before they had a chance to dissolve, or (3) the level of uric acid goes back up above that threshold level and no more crystals need to dissolve and the immune system coats the remaining crystals. (If the uric acid goes above another threshold level, then that would lead to a new crystal deposits and new pain. So, as long as the uric acid fluctuates between these upper and lower threshold levels, you should not get gout attacks.)

I find this interesting because it could explain what has been happening to me. I got my first gout attack about 3 weeks ago by now. After a very painful period of about 5 days (treatment consisted of cortisone injection, colchicine, etc.) the pain subsided. I then started the baking soda treatment, following the procedure at icuredmygout.org. After a couple of days the pain returned and I couldn't figure out why because I drastically changed my diet and I didn't think the baking soda could make it worse. Now I think that it is possible that because of the baking soda I had a significant drop of uric acid, which led to an uncovering and dissolution of crystals, which led to the pain.

Have other people who started doing the baking soda treatment and who have stated that it helped them have also had these secondary periods of pain?

Stan
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replied January 23rd, 2008
Re: Uric acid crystals and gout
stanl wrote:
Have other people who started doing the baking soda treatment and who have stated that it helped them have also had these secondary periods of pain?

Stan


Yes. But not a full-on attack, just a mild, localized soreness. I've been using 1 tsp of baking soda daily as a supplement for the past couple weeks, and drinking little alcohol plus eating less meat. I have had some pain in exactly the first place I ever had twinges of gout (outside of foot), but not in places where I had recent attacks (big toes). What this says to me is that the locations that have been affected the longest are possibly opening up due to more effective removal of uric acid. One day I drank a lot of beer and when I woke up the soreness was completely gone. Then after a few days of baking soda and little alcohol (1-2 drinks per day) it came back.

I interpret this as my body slowly removing some of the excess UA, and exposing buried crystals, causing mild soreness. I'd suggest soaking the feet in hot water (not too hot) every day to speed up the process of cleaning the tissue. The feet are usually significantly cooler than the rest of the body, so warming them up for an extra 30 min. per day could have a significant effect. It feels nice too, and soothes stiff muscles and ligaments.
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replied June 17th, 2010
I have exactly the same scenario you described in your post
after a couple of days of starting to feel better the pain returned in-spite of all the measures I toke to treat this gout episode.
I have seen other people with the same complaint
dissolved uric acid crystals reveal area that the immune system just discovered & start attacking. I hope that is a correct explanation & thing will get better after a while.
RZ
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