Allopurinil

[Tom]

I started taking Allopurinol 100mg a day 6 weeks ago and its been tough going with three separate gout attacks since then. I normally get two a year max so needless to say I’m not impressed.

Can anyone tell me how long this process will take before the attacks stop for good?

Thanks

Tom

[Ron Avery]

Hi Tom,

Sorry to hear about your ongoing attacks but do not give up on the Allopurinol ! It will get better. As the Allo helps reduce your uric acid levels in your blood old acid crystals that have accumulated in your joints start to dissolve and that can trigger attacks.

Have you had your uric acid levels tested as that is very important in knowing if you are on the right Allopurinol dosage. Typically, 100mg is just to see if you can tolerate Allo & then the dosage is increased at least until your uric acid level is at a safe level.

Also, you should have anti-inflammatory and pain medication at the ready in case of an attack. Colchicine will also help reduce the spread of inflammation.

It’s very important that you know your uric acid levels and post them on your gout profile along with whatever pain/anti inflammation medication you are taking so that Keith can better help you manage your gout.

You are on the right path. You may need a little tweaking with your meds but stay the course and you will be gout free. It can take up to a year or more to be gout free once you start Allo.

Good luck and keep us informed. We all learn from each other.

Cheers,
Ron

[Tom]

Thanks Ron

I have a Uric acid count of 475 which when i checked the conversion chart is not good at all.

I have been told to come back to the Doctor in 3 months time for another test and stay at 100mg a day of Allopurinol.

I take 250mg a day of Naproxen but in all honesty Naproxen doesn’t stop the attacks.

I’m starting to think that I might need a different Doctor who understands this illness better but I’ll give my GP one last chance I think,

regards

Tom

[Keith Taylor]

Tom, I’m wondering if the naproxen is a prescription dose, or are you self-medicating? It’s not my place to question your doctors instructions, but 250mg per day is much less than the usual gout dose. Gout is one of the most painful inflammatory diseases, and usually requires an appropriate dose of anti-inflammatory.

As for your uric acid, the British Rheumatologists recommendations are very clear. Your allopurinol dose should be adjusted upwards in order to maintain a maximum uric acid level of 300 μmol/L – I would recommend a year lower than this in order to dissolve old crystals faster. It is common in the NHS for doctors to be unaware of this as I found at my group practice. I saw 3 doctors who were quite happy to leave me in the 400s, until I found a 4th doctor who took the trouble to get it right.

It’s a bloody disgrace.

[Tom]

Keith

armed with the excellent info in your post I went into see the original GP who started me on Allopurinol today. I decided if i didn’t like what i heard I would request a referral to a private consultant near where i live. When i explained that i was at the end of my tether with the pain and the flare ups he asked when i had a blood test last and i mentioned the results came back 3 weeks ago when i saw his colleague. He was quite shocked that his colleague hadn’t upped the Allo dose and said that from now on i should see only him as he had alot of experience in Rheumatology. He then upped my dose to 200mg with a blood test in 4 weeks time. He also prescribed colchicine and Etoricoxib for the flare ups. He seemed very on the ball and said he would manage the uric acid level down to safe levels and even mentioned febuxostst as a possible choice if Allopurinol wasn’t working.

I told him that I would stick with him rather than get the referral for now and im very happy with the outcome of this visit. I’ll post again when i get the next set of blood results.

Fingers crossed!!

Tom

[Barry]

Just for info
I was put on 100mg allopurinol 15 weeks ago. Have had a fair few flare-ups but managed with colchicine. Blood test results: 381 mumol/l in Jan, 307 in March and recently 327 in June. Doc has now put me on 200mg allopurinol as he says hopefully that will get it to the safe level (<300). Let’s hope it does the trick! From what I gather on here this seems to be the best course of action? comments appreciated.

[Keith Taylor]

@tdeffley – Tom, it’s good to see you are getting proper medical care now! I’m looking forward to seeing better results from your future blood tests.

@bazzer – Barry, it seems like you’ve struck lucky! You’ve got a doctor who understands what is needed to keep you safe.

I hope both of you can take the time in future to keep everyone updated about your progress. It’s really useful for the silent majority to see that gout can be controlled easily if it’s managed properly.

[Tom]

I had my latest blood test on Tuesday and my uric acid count has dropped from 475 to 418 in a month. I’m going to go back to my Doctor to discuss next steps to reduce this further as its my understanding that the crystals stored in my body won’t dissolve at these levels.

Does anyone have any insight into what my uric acid count should get down to in order to facilitate the crystals starting to dissolve?

Thanks

Tom

[Ron Avery]

Hi Tom,

Under 300 is what you should strive for. The lower the better at the beginning so that the stored Uric acid crystals dissolve quicker.

As long as you stay below 300 all stored crystals will eventually dissolve and no new ones will form.

[Barry]

I’m more than fed up – just ending yet another attack.
Colchicine didn’t seem to help much or if it did then thank goodness cos I’d hate to have been in even more pain!
What I am struggling to comprehend is this: my uric acid levels are coming down – almost at 300 level – so I have had the odd drink – not a lot – about same as govt guidelines (21 units a week).
SO – what causes my attacks now – NEW crystals brought on by the (limited) booze or OLD crystals who suddenly decide to congregate at my knee and give me hell.
People go on about old crystals still floating around and these need to dissolve and supposedly will do over time when uric acid levels get below 300.
What I am really asking is this: are my continued attacks caused by old crystals or am I creating new crystals through poor diet (booze) – albeit I am very careful.
thanks for any enlightenment!
Barry

[Tom]

Hi Barry

sorry to hear that you are in pain as i recently went through a very bad period with it and only another Gout sufferer truly understands what this pain feels like.

In terms of Alcohol I can only drink red wine, not sure what your experience is but beer is out of the question for me as it leads to pain and spirits lead to some pain, weirdly though red wine in moderation does not cause Gout flare ups for me although I have no idea why that should be the case.

I’m going to try and get my levels down to 300 over the coming months and then ill post back about what I can and cant eat/drink then,

Best of luck with it,

cheers

Tom

[Tom]

Thanks Ron ill aim for 300 or less,

cheers

Tom

[Ron Avery]

Barry,

Once your level is below 300 & stays there the old crystals will start to dissolve and that can cause flare ups. These flare ups will decrease in number & severity as time goes on. It can take up to a year for all the crystals in your body to dissolve so hang tough ! It will get better.

Ron

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