Allopurinol and gout attackes
Posted , 43 users are following.
Hi. Any help or advise would be really appreciated please. After having regular gout attacks my doctor has put me on allopurinol. I had to take colchicine for 2 weeks before I started taking one tablet (100mg) of allopurinol per day. I had to continue on the colchince along side the allopurinol for a further 2 weeks in case the allopurinol caused a gout attack (which it did) I had numerous attacks in two months but had no pain relief from the doctor except paracetomal. I had a blood test after 2 months on allopurinol then the doc raised the allopurinal to 200mg per day, still didn't prescribe additional pain relief. I am due another blood test in early december but i'm not sure i am going to continue on the allopurinol as the attacks have been constants since i have been taking 200mg. I have had severe attacks in my toe, then ankle, most recently in my keft elbow and index finger, which were both inflamed and painfully unbearable. my finger was so swollen i went to nhs direct who prescribed diclofenac. when this attack was finally subsiding the gout decided to attack my right shoulder , after speaking with nurse at my doctors surgery i was prescribed dihydrocodeine, along side paracetamol and ibrobrufon. I know i have come a long way on the allopurinol but the thought of the doctor raising the allopurinol again after my next blood test brings me out in a sweat. I don't know how much longer i can bear the pain. I am getting anxious, short tempered and basically quite depressed now. any advise would be really, really appreciated. Thanks.
SYFY
6 likes, 116 replies
ukbabwl Guest
Posted
Have lived with gout for 29 years with around 10 episodes/attacks whatever you want to call them, mainly in my ankles or in the bones in my feet. Does make walking a bit difficult. I was taking diclofenac as an anti-inflamatory and various other tablets for pain relief. I have been taking Allopurinol 300mg daily for many many years, though this does not always seem to ensure I won't have an attack.
I would suggest the following: (most likely heard most of this before)
Limit alcohol intake (as much as possible)
limit the amount of foods that are high in purines (red meat etc)
Drink plenty of water - flush out the uric acid (if possible)
At the moment am fairly gout free thanks mainly to the above and also for taking two capsules daily of tumeric, which I get from holland and barrett. The 10 or more attacks a year have now be reduced to 1 or 2 and the serverity is greatly reduced. Have not taken any diclofenac or painkillers this year (so far - knock on wood).
Would advise that you research and keep track of the foods you eat that bring on attacks, look for a patten and avoid these foods. For me prawns are on the hit list (food to avoid).
Hope this helps.
rustygecko ukbabwl
Posted
If you are still getting any attacks it's because you still have the urate in your tissues. You need to have a higher level of allopurinol to flush this out. You should be having regular blood tests. Remember that having gout approx triples your risk of heart disease; it isn't a simple problem of joints. It must be taken seriously or it will cause your organs serious harm.
Guest rustygecko
Posted
rustygecko Guest
Posted
Colchesine simply represses the immune system. Allopurinol interfere with the production of urate. Once blood urate falls below 6.8 the crystals in the tissue reenter the blood (dissolve) and are flushed out via the kidneys and liver. The lower the level of urate the quicker the flushing.
SailorSSDO rustygecko
Posted
That's correct RustyG. Her's the overall scoop with a modification from what you mentioned.
Gout occurs when the level of uric acid gets to the point that the crystals supersatuate. The supersaturation level is now considered at 6 or above. https://www.ncbi.nlm.nih.gov/pubmed/24867507
You can have crystals floating around doing micro-damage even when you
?do not have an actual gout event.
Allopurinol and other drugs are used to cut down the production of uric acid. However initially Allop.. can actually cause attacks. That's why the MD's usually give you immune suppressors like Colchicine and Prenidsone... to provide relief from attacks. Although anti inflammatory OTC's are the cautious route however.
The average Alloprinol dose is about 300. This is reached by going up by 100 in conjunction with a blood test (titration) to measure the urate level, and, likely, kidney function. 30days seems to be the minimum for each step up.
The goal is to achieve normal function and a sensible diet. The literature shows two things that appear to be helpful in reducing gout attacks. First, drinking 4-5 cups of coffee a day. (I would advise skipping the doughnuts, however!). Btw, caffeine is not the important part... it's something else in coffee and the scientists haven't nailed it down yet. Second Tart Cherry Juice, about 6 ounces a day also has a preventative effect. Low fat dairy should be part of your diet. Who would of thought I'd get to like yogurt! Recent studies have shown no help from Apple cider vinegar or other acidic preps. The rest seems to all be alchemic ... but if you belief and it doesn't counteract yourdrugs,that's your choice!
Diet control can cut uric acid levels, but the very best any diet showed in studies to my knowlledge was a drop of 1.7 on a very strict regime. Normal decreases due to diet were measured as decreases from 0.5 to 1.0 decrease! I started at 8.4, so drugs are my only choice.
There does seems to be some positive preventative effect from being active, but I'd hesitate to recommend this without checking in with your MD,esp. if your levels are up, except for non load nearing activities like swimming, possible spinning (as long as you don't smash the pedals!) and maybe light walking.
The first two are my mainstays to help me avoid the blues through attacks.
For me the key is to be sensible.
Knowing your triggers is important. A lot of folks key in on purines... sugars are just as important. For some folks the Gout poor folks it's the main trigger.
Finally genetics is something you can't avoid. My favorite uncle had Gout and so do I. I was lucky in the genetic draw though, as all my siblings have diabetes, or prediabetes! I guess I'll be happy with the gout! Cheers
andrew41895 SailorSSDO
Posted
The concern with Allopurinol and Prednisone with many of us here are the potential risks of each. Allopurinol can cause allergic reactions, immune system issues, and can cause problems with bone marrow. Prednisone has the risk of long term use causing a reduction in bone mass. Uloric is a safer urate lowering drug, and is due to come off patent in March 2019.
For joint swelling caused by gout, high GDU (2500 or more) bromelain is the most effect solution that I've found, and it is less expensive than colchicine.
rustygecko andrew41895
Posted
However, you seem to assume that the risk is take allopurinol or have perfect health. If you have uncontrolled levels of uric acid, then that will kill you.
Not treating has to be balanced against the risk of the treatment. Gout is not simply a pain in the toe, it is an underlying metabolic disease which kills its victims.
SailorSSDO andrew41895
Posted
. Some good information is being expressed here. My throughts go on the lines of rustygecko, but I also respect the concerns of others for their own situations, especially about side effects. As a life long athlete, on the surface and underwater, I'm all about balancing the risks... especially after losing one of my kidneys. To me the decision to take drugs is always agonizing... but after intensely reviewing the literature (my doc gave me online access to 100's of studies) it came down to this. Take any drug with side effects and get back to as normal functioning as possible, which means a lot for me, or try to see if I could get alliviate the pain and get guaranteed progressive damage. So, reluctantly, I'm on Allopurinol for now until I can find something shown by science to be better.
?Uloric has its own risks. The maker reports: The most common side effects of ULORIC are liver problems, nausea, gout flares, joint pain, and rash. A small number of heart attacks, strokes, and heart-related deaths were seen in clinical studies.
At this point my side effects are limited. We'll see how this progresses. A couple of other thoughts.
1. There is one other help to prevent gout flares I left out, that's taking 500mg of Vitamin C daily. Here's the quote from "Prevention of recurrent gout: Lifestyle modification and other strategies for risk reduction", Michael A Becker, MD. Vitamin C may have a mild but persistent urate-lowering effect. This was illustrated in a trial that randomly assigned nonsmoking adults to 500 mg of vitamin C or placebo [18]. Vitamin C significantly reduced serum urate levels by 0.5 mg/dL (30 micromol/L) compared with no change with placebo. Additional evaluation of vitamin C in patients with gout is warranted.
* Also Prednisone is for relief of short term flares, not long term. Most treatments last 7 days.
?* Finally, I didn't devote the extensive research time to alternative theraphies as to traditional ones, but did spend quite a few hours... There is some science that has shown some supplements like QUERCETIN? may help... and if they do so for you, Please investigate the side effects as well as the drug counterindications with an MD or other accredited expert.
Here's a couple of the studies on Quercetin and Bromelin
?Quercetin https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808895/
Bromelain: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC538506/
?Cheers!
(Please consider this as an invitation for a tart cherry juice salute!)
rustygecko SailorSSDO
Posted
Would I be correct in thinking the remaining kidney mans-up and expands to accommodate to the extra workload?
SailorSSDO rustygecko
Posted
No one knows exactly for sure. When I was diving and working for the CG I was exposed to lots of haz chems and took a lot of physical abuse. Looking more like the haz chems caused it though. Only indication that something was going wrong was when my immune system started to crash. Then the Docs figured I had some kind of nasty immune suppressing virus. Quite awhile later they figured out my kidney was unexpectedly atrophied and now not functional. The other kidney got enlarged and is doing fine, thanks! Took about 4 years afterwards to get back up to higher level physically functioning. However it's an issue always looming in the background, especially when taking any form of meds, script or OTC. No NASAIDs etc.
That's why I strongly advocate getting frequent blood tests to monitor uric acid levels to ensure you are at least below 6, if not lower, even if you choose to go non traditional. A person can "feel" fine and not know that they are still experiencing a persistent long term degradation of the joints and organs. Gout can surely suck, but life is precious. Live long and prosper!
rustygecko SailorSSDO
Posted
I agree completely. Gout is not the disease. It's a symptom of the hyperuricemia. It's not just joints getting damaged - blood vessels and organs.
genomics Guest
Posted
I just wanted to contribute a warning regarding Allopurinol. I experienced a very serious reaction to this drug that put me in the hospital for weeks. I initially developed a rash that spread over my entire body. Eventually, I lost the first layer of skin over my entire body. I think other gout sufferers need to know about the potential side effects of Allopurinol. I wish there were more effective treatments.
timothy12884 Guest
Posted
So what's left I had to change my diet, it was hard at first - but now it's easy. I'm coming up on a year now without an attack, that's after 5 years of pain and missery.
I cut back on sugar, HFCS, any meat in a case like sausage and hot dogs, hamburgers and beef ( now I'm having a steak once a month ). Mostly I eat fish, salmon included among the many varieties and I also eat a lot of chicken. I try to eat more alkaline foods than acidic like sodas are. Haven't had a soda in a year.
I drink mostly water, but also some iced tea and lemonade/ limeaide occationally for a little variety. Getting back to an alkaline state took about 10 weeks from when I started and I kept feeling better and better up to 3 months from the start.
Then I was normal and without any pain from then on I also walk and do yard work and have lost 20 lbs. so far. I'm hopeing for another 20. Eat lots of vegetables and fruits daily, not volume but just a large variety of them. I eat maybe 20 grapes, a banana, plum, and just a few rasberries. I substitute a apple or orange for any of the above. Do the same with your vegetables. I think it best to eat them raw if you can like a few stalks of celery, a couple of radishes, lettus and spinach on sandwiches. I'm eating more broccoli instead of rice or potatoes.
Another switch is to eat breads that have the first word of ingredients: WHOLE , it's much better for you.
Another thing is don't try to figure out what triggers the gout attack, it's the total amount of everything. Think of it as trying to put 3 cups of water into a pint jar the jar can only hold part of the liquid, the rest over flows. Now think the kidneys are the jar. So the excess goes into the blood and crystalizes.
Good Luck!!! Research gout diets, some contradict each other but you'll get the jist of the information. Check Web MD, different hospitals for their info. on gout diet. It has helped me. Also nutritionists were more help than doctors were for me.
andrew41895 Guest
Posted
I find the 3000 GDU Bromelian/500 Mg to be more effective than colchicine, much cheaper, doesn't have the toxicity issues that colchicine has - and doesn't require a prescription. I wonder why it isn't more widely used, although some doctors (e.g. Doctor Oz) recommend it.
Further, oolong tea is also helps with any lingering uric acid in your joints, and also helps you lose weight by blocking some fats absorption. Multiple medical studies in Japan have shown that.
I'm concerned about taking allopurinol and colchicine, their cost, and effect on your body, especially on your liver. As far as I'm concerned, anything that can keep me healthy, and keep me off medications, and out of the doctors office is the right long term solution to high uric acid and gout.
I hope this helps.
Andrew
andrew41895 Guest
Posted
3000 GDU/500 Mg Bromelain works much better than cholchicine in my experience, its cheaper, and you can take it several times a day if needed without toxicity.