Gout finally diagnosed after 7 months of pain

Do you think ibufren will do it? Surely he/she has tried that already? Naproxen is great but (s)he must be careful of her stomach.

They both work, just make sure to take with foods, to minimize stomach issues. Hank

Hi Rusty,

Firstly, you are a great asset to this forum with excellent knowledge.

However, you say;

"Uleric will not take 3 months to work. It begins to work on day 1"

Is Uleric more or less the same as Allopurinol.

My rheumatologist told me that Allopurinol would take up to a YEAR to be properly effective.

He put me on daily colchicine for that first year.

This worked well for me.

Is this contrary to your view?  

Uleric is a branded name of allopurinol. 

Allopurinol begins working within one hour of ingestion. Most of its action comes from a breakdown product of the chemical in allopurinol. The half-life from memory is 17 hours. Within one hour of ingestion, the breakdown product is made.

However, the fact of it beginning to work doesn't mean that it will reach maximum effectiveness immediately. It will reduce the blood urate in the body straight away. However, the body will begin to uncover sinks of monosodium urate in tissues in the body. This means that off and on, the level of urate is going to fluctuate. The time for all these stores to be flushed is 3 months to 60 months, with the majority being in under 12 months. 

Therefore, allopurinol will begin to help the patient immediately, (encouraging the breakdown of any crystals in joints) but there will be ups and downs. I am sure that if you asked for clarification from the rheumatologist he would explain that; you have been given the simplified version. It could well be that they give this version because the great problem with allopurinol is that 70% of patients don't stick to the regime. The reason is that they don't stick to it is not well researched but it is guessed that its because it isn't a magic bullet, and people get disheartened. I would not be surprised if they give out the line that it doesn't work for a year, trying to get the patient ot understand that there are going to be a few gout flares on the road to control; thus increasing those who take the allopurinol long-term.

 

A lot of people dont continue with Alluporinol because they make them feel like crap, myself could not take them because of the allergic reactions. You see a lot of people on here with flu like symptoms, generally they feel like crap. I take Adenuric with no side affects.

Do you have any evidence for your belief? The research that I’ve read (and could give you if interested),  indicates only 2% of patients have a problem with allopurinol. Febuxostat (which I’m sure is a great drug for 99% of its users), has the side effect of  liver reactions (including death), for some patients. In a private health care system like the USA it is normal they want to use expensive drugs. In most of the developed  world, in our public health care systems, it is common sense to use the $15 dollar a year drug v the several hundred $ drug, especially in an illnsss as common as hyperuricemia. 

Not strictly correct statistics has many patients do not even return to there GP after these symptoms. My opinion is most drugs on the market will eventually shorten life, as where herbal will not. Herbal is natural and allopurinol is not, hence the side affects. You have to understand that cheapness does not appeal to a lot of the population , but looking after there body the natural way whatever the cost is. All drugs have side affects and even if you have no side affects you still dont know what it is doing to your insides. I have taken Adenuric now for 18 months and do not like the idea of this medication one bit and have been looking into herbal remedies and will most certainly be taking this option in the future.It does not matter how much you research a subject like gout, statistics dont mean s**t.  

a) Do you think that the people who do the stats do not think of those who do not return to their GP? I think we must assume that professional statisticians with doctorates in sums have thought of that.  

If that were the case the stats would be skewed, giving the impression that the drop out rate for treatment is even higher than it is (70%). 

b) "Most drugs on the market shorten life". Do you have any evidence for this or is this simply your hunch?

c) "...whereas herbal (sic) will not." Why do you believe that herbs are somehow magical and do not have the side effects of "drugs"? I can give you a whole list of herbal remedies which can easily kill you with the wrong dose. Just take fox-glove. It is a herbal remedy for congestive heart failure. Take too much or take a foxglove that has grown in a different place - and you end up dead very easily. It is for this that we take the active component of foxglove and produce digitalis. Digitalis is taken long term by everyone who has heart problems. Alternatively, they could go into their garden and eat foxglove. I think there is NO DOUBT that digitalis keeps heart patients living for decades longer than they would otherwise.

c) I understand that there is a considerable part of the population assumes that expensive drugs are better than cheap ones. For example, a lot of patients believe that that generic (copy) drugs are not as good as the branded original, despite the fact that they are *exact* copies of the original. Indeed, often they are produced by the same manufacturer and simply put in different packaging. 

Another example is for example branded Ibufren compared to unbranded - both produced in the same factories, but a huge part of the population believes that the branded at ten times the cost is somehow better.

Allopurinol is cheaper than Febuxostat. Do you think Allopurinol was always cheap? The reason is it is cheap (not in the USA btw) is that it was discovered 50+ years ago and the product we buy today is a generic copy of the original. Febuxostat, on the other hand, is expensive because it was only discovered 10 years ago. Very shortly it will go off patent and the price will plummet. If it is as successful as allopurinol then it too will be dirt cheap by 2040. I doubt that will ever happen though as the latest research indicates that Febuxostat causes heart attacks, and will therefore always remain a second-line treatment for those that cannot tolerate allopurinol. 

d) as you say, all drugs have side effects. If they did not have a side effect they would be having no effect. THEREFORE all herbs must also have side effects, or they too would be having no effect. 

e) I understand that "Statistics don't mean sh*t" for those that have never studied statistics. In fact, stats are the most powerful method that we have in identifying which treatment is successful and which isn't. Without stats we would, for example, be unaware of the increase in heart attacks with those that use febuxostat compared to allopurinol. If you don't believe in the power of statistics I suggest you look at the following: Google and search engines are completely based on the power of stats; look at the profits of insurance companies - all based on the power of stats. Look at the evidence that cigarettes cause cancer - again based on stats. In fact, while those that have never been near a university except to admire the architecture don't appreciate it - much of modern society is based on statistics.

Sorry but i totally disagree. You make it sound like side affects are a good thing, but with every box of pills comes a leaflet with many side affects that are not good. You also have no proof that pills do not shorten life, so your belief is different to mine. You dont have to have any medical knowledge to agree or disagree. Remember also, there are many drugs on the market today are cancer causing drugs. You can argue both ways for herbal and non herbal. You still cannot prove either way whever they shorten life its just my belief. The body was never made to absorb these drugs. Look how long the chinese live for through good diet and and a vast array of herbal remedies. You cannot question it.

I’m a female, never had a gout flare before. I demanded colchicine and got it but stopped taking it today due to side effects.  I’m weening off Gabapentin so can’t do naproxen yet.  They thought I had neuropathy as I guess the gout was so bad it irritated my nerves too.  Now I just have tired feet like you get after being on your feet all day.   Can’t wait until all is normal again. Thanks for the information. 

Yes, some people swear by it, but there’s a paucity of anything but anecdotal evidence. 

That's really good they are giving you monthly blood tests - that is the way that it should be done, but very often isn't. Can I ask you in which country you are? I take my hat off to your doc for doing the job to the full.