Allopurinol and gout attackes

Hi,

It took a long time before my first attack subsided, I am on 300mg Allopurinol per day.

My acid levels are seldom reading low on my blood tester, I regulate my diet as well.

I have come to realise that all of us are different in our response to medication.

Some people I know very happily exist on 100mg a day with out any problems.

My brother has had Gout for most of his life, during which he has eaten and drunk whatever he wished to.

Largely without any ill effect, you just have to try and find what's best for you.

Sorry I can't be more helpfull.

James

Hi. just scrolled down the responses, and interestingly it appears that 

it's chaps who suffer most So, just to break the chain Heres my imput

for what it's worth,as I am around somewhere on other gouty forums.

Mega pain ,very hot swollen big toe, woke me up at 5am  ,couldn't

put foot to he floor, couldn't get a shoe on. so phoned for a taxi, the

driver very kindly found a wheelchair and took me into A&E

A nurse took one look and said GOUT, gave me some painkillers

a pair of crutches, told me to see the G.P and sent me home

Given drugs by said Dr ,and suffered for months, then one day,

limped into a health store, which I do use, but visits had been

curtailed.She knew immediately what was wrong, and suggested

Cherry Effect capsules ,to disperse the crysals (they actually cause

the pain) and Bromelain tablets,  pineapple based ,for the actual pain.

and they worked, almost immediately, I do keep some in hand ,and if I feel a gouty twinge ,I am prepared, and the nasties  are kicked into

touch   I now tend to steer clear of prescription drugs, and usually 

find a herbal helping hand, with NO side effects.

 

No one likes being on prescription drugs by choice. How are you sure that your herbal remedy is working? Have you monitored your blood uric acid levels to see the difference?

Lack of attack for even many years does not mean that everythign is ok internally.

Can't answer that one. All I know is that I have not been attacked in over two years  

Exactly my point. 2 years without attack means nothing :-) Someone who is not taking any meds can also go 2+ years without any attacks.

That does not mean that Gout is not doing it's dirty work internally. Also how without any regular data on your blood uric acid levels can you reccomend that herbal remedies work? :-)

 

What is the ""Exactly "" for ? There are no meds for D.D only for 

the pain when it flares.

Why are you obsessed about blood data.??

Just watch what you eat and don't aggravate the little b----------- ds

thanks James

as said - my uric acid levels seem to have responded to 100mg of allopurinol a day but I got yet another attack last week.

just want to know why I am getting attacks when my uric acid levels have been in the normal region for a while

anybody have similar?

Your understanding of Gout as of many people online is very lacking :-) Not being a smart ass just saying it as I see it.

Not getting an attack on it's own is not enough. If you want to risk joint damage, tendon/muscle damge, kidney disease, heart disease etc etc then continue not testing your blood uric acid levels.

I am obsessed with blood data because that is one of the measurable markers to identify if your treatment is actually working, herbal or non herbal.

 

I have a little gadget that allows you to measure the urate levels in your blood bought from

www. Goutcare.co.uk I have checked it against an official hospital tests and its accurate to about +/- 15%. Anyway I have monitored my urate levels over several years now and noticed some increase this year with more gout attacks. Have therefore increased the dose of Allupurinol fm 200 mmg to 400 mmg/day. The urate levels have dropped right down into the  250 range (healthy range 428 -179) However I have had quite a severe gout attacks following the increases in allopurinol so one must assume that getting the gout crystals out of the system takes several months (2-3?). I have also modified my diet - no beer - no shellfish but whether this has had an effect I don't know. I did notice however that a large dish of mussels preceded an attack some months ago.

The forum is really interesting and shows that Gout is complicated and different for everyone in symptoms and effects. I will continue reading and look forward to the day when more research effort is put into alleviating the effects of this distressing complaint.

The time to remove stored urate in the system is (from memory) 3-33 months,  with the vast majority in the first year.... certainly the first few months will be the worst.

Getting your blood urate down low is excellent , but I think yours could even go a tad higher, could it not? That would allow you to go to say 300 or 350 of allopurinol.

Has your doctor not given you any colchicine to pop at the first sign of a flare or as prophylaxis for the first few months? 

As for your machine +|- 15% gives a range of 30%. I wonder if this is accurate enough?

Anyway, whatever you decide - good luck n good health. 

rustygecko - thks for your response -. re your 3 - 33 month estimate to remove stored urate - Are we at cross purposes here? In my case my blood urate levels reduced from around 420mmol/L to 250 mmol/L in 3 months following an increased allopurinol dosage. However in spite of this (250 mmol/L meaning much greater solubility of urate in blood) I have had a really crippling gout attack. Does this mean that gout crystals are still present in the joints in spite of the much lower urate level?

Are you saying that it might take more than 2 years to get rid of the urate crystals? What evidence do you have about the 3 - 33mo. period? My doctor was surprised at the appearance of gout at 250 mmol/L urate and said that 2/3 months should be more than adequate to flush out all gout crystals.

Any comments would be appreciated.

If your doctor is surprised he doesn’t know what he’s talking about. I would guess that I’ve s spent 300 hours more reading about gout than he has. If you search online you’ll youll  find the research papers. (You doctor knows about 1000 diseases - I only know about 1, and have a very personal interest in it).

What happens when you get too much mono sodium urate is it deposits in crystals - the body protects it from the immune system by covering it with layers of protein. Then more crystals, then more protein. Once your blood urate falls the protein is dissolved (don’t know why), exposing the crystals, which crest gout attack before they dissolve and are flushed by the kidneys. This process goes on until it’s all cleaned out. It is the reason that 70% of patients give up though.

Your doctor should read the N.I.CE. Guidelines and he would have prescribed you colchesine.

The reason doctors know little about gout is they are only given about 3 hours o it as undergrads and it’s not very sexy, so they never bother with it. Unless they have done a speciality in nephrology or rheumatology they know probably as much as you. 

Thks again for your response. I am inclined to agree with your opinion of the average doctor's knowledge or experience of gout.

I will continue to monitor the urate levels in my blood and take the allopurinol regularly. (I did allow a reduction in the taking of the pills last year as I did not seem to be having gout attacks.)

As to colchicine, I have tried this at 3 X 500mmg pills/day and it did have a positive effect on previous gout attacks but the side effects were worse than the disease - diarrhoea - so I don't use it now.

Colchesine:

THe trouble is the therapeutic level is close to the omg I’m in the loo level.

I’ve read that the best way to take it is 1 tab every 12 hours (NICE suggests 2 to start and then 1 x 12 hours).  However if you go to the loo - wait a couple of days and start on lower dose by cutting the tabs in half (not easy). They also suggest 1/2 tab every 6 hours was more tolerated than 1 every 12. If that doesn’t work try 1/2 ever 8 hours, then 1/2 every 6 hours. For most people there comes a point where a balance if found. 

PS there are alternatives to colchesine that do the same thing (calm the immune attack), but they are more expensive and possibly less well understood. Colchesine can be nasty (spectacular even!), but it’s an old cheap well understood therapy.