Forum Replies Created
-
Posts
-
This is a tricky one, Susan.
On the one hand, I firmly believe that you are right to lower uric acid as you have done. I’m appalled that your doctor didn’t advise preventative pain relief, but it sounds as if you now have that under control. It also indicates to me that you do have gout, because you’ve described exactly what happens to most gout sufferers when they start taking allopurinol.
My concern is that you might also be suffering from something else. I have no medical qualifications, so I can’t help you much with that. However, the best thing to do is consult a rheumatologist. It seems like you’ve already done this, so the only other thing I can suggest is to wait and see if allopurinol controls your symptoms. This can take several months, but you can shorten that time by increasing the dose. If I were in your shoes, I’d try to persuade my doctor to prescribe the maximum allopurinol dose for at least six months. At the end of that time, if your pain was significantly improved, you could gradually lower the dose. If not, I’d still recommend keeping your uric acid below 5, but you’d also need to try and find a specialist who could investigate.
I hope this helps. Please let me know what you think.
“Seems a mystery, the whole damn thing.”
Absolutely spot on Tim. Every day the experts are finding new explanations for different aspects of gout. The only truth that bears out is my last response to Barry:
“The only thing that is certain is that, with uric acid safely below 5, attacks will get less frequent, less widespread, and less intense. The lower you go, the faster that happens, but gout attacks remain a risk until most existing uric acid crystals dissolve.”But Barry’s new question is fascinating (at least to me):
“where do this old crystals lurk before they decide to cause a problem?”When we experience a gout attack, it’s our immune system telling us there’s a problem. We’re not supposed to have non-human matter floating round our bodies. Our white blood cells hide the crystals by engulfing them. They die in the process, but the invader is hidden.
Now, that stops our immune system sending out inflammation signals. The pain goes away, but the problem doesn’t. Without stopping the uric acid excess, we just get more of the same. In advanced gout, we can see this as tophi start to burst through our skin. But we don’t see the smaller deposits, or the deposits hidden deep within our bodies. I don’t fully understand the next part of the process, but as deposits grow, they harden. Tophi become solid lumps, so it seems like there’s some sort of calcification process. Anyway, there’s more to the lumps than pure uric acid crystals. Crystals are engulfed in white blood cells, and this hardens into something more.
If you did not treat the excess uric acid, or didn’t treat it well enough, uric acid crystals would continue to form, and at random, these cause gout attacks. I say “at random” because the theme of this thread is beer causing gout attacks, but not other alcoholic drinks. I don’t believe that to be the case. I do believe that alcohol can play a part in the gout problem, but it is one of many factors, so attacks will never correspond directly to alcohol drinking.
If you do get uric acid below 6, through allopurinol or any other means, then uric acid crystals start to dissolve. This is based on the equilibrium laws of inorganic chemistry, but there are confounding factors:
1. As uric acid crystals dissolve into the blood, they raise blood uric acid until it is excreted by the kidneys. In some cases, this might trigger new crystals to form. Adequate hydration is vital, but some gout patients with low excretion rates are best advised to support allopurinol with an uricosuric. If you’re reluctant to add more meds, then there are dietary ways to encourage this.
2. Some of the crystals will be isolated from the bloodstream by the aforementioned coating of white blood cells that have built up and hardened. We’ve had a few reports from long term allopurinol users who have experienced flares after years of no gout symptoms. My best guess in this situation is that a long-hidden cluster of uric acid crystals has suddenly started to dissolve. In any event, this explains why gout attacks appear at random for a few months after you start uric acid treatment.I hope that answers Barry’s question. As for Tim’s ‘tipping point,’ I don’t think it’s that straightforward. There is certainly a tipping point as far as our immune system is concerned. I don’t think anyone knows what it is, but a single uric acid crystal is unlikely to trigger the massive inflammatory response that we experience as a gout attack. So, how many uric acid crystals does it take trigger the attack? I’ve never seen any research that explains this, but I’d love to hear from anyone that knows. One important thing to bear in mind about the ‘tipping point’ is that it only relates to uric acid crystals that the immune system can identify. That means new crystals forming when uric acid is high. It also means old crystals that are partially dissolved to the point where the dead cells that hid them fall away.
There are a few mysterious unknowns that can make gout management very complicated. However, basic understanding of the immune system makes it a little bit less of a mystery.
That’s a shame Barry, when everything was going so well.
A big problem with gout is that so many different things can cause an attack. Alcohol might be a factor, but I can’t see how type of drink will make a difference. In fact, there’s no way to tell if the gout flare is alcohol related or caused by other common factors such as food, temperature, falling uric acid or something else.
The only thing that is certain is that, with uric acid safely below 5, attacks will get less frequent, less widespread, and less intense. The lower you go, the faster that happens, but gout attacks remain a risk until most existing uric acid crystals dissolve.
Barry, I’d like to echo what Ron say’s about the freedom you get with food and drink once allopurinol has done it’s first job of helping you get rid of old crystals. I notice on your profile, you’re at 287 μmol/L for your uric acid. That’s 4.8 mg/dL, so you’re well on your way to recovery.
Shouldn’t be long now before you can relax and enjoy.
I like Ron’s statement:
“Excessive alcohol, sugar, sodium, saturated fats etc. are bad for your health regardless if you have gout or not. However, I truly believe that if you get and keep your Uric Acid under control, you should be able to eat and drink as you please within moderation. ”Moderation is always good for gout, but it’s important to recognize general health benefits as well. Once I controlled my gout, I found it empowered me to make healthier choices generally. I can still enjoy myself with the occasional drinking session, or blow-out meal. But most of the time I eat healthier, cos I don’t want to be gout-free only to get other health issues. I’m still working on shedding a few more pounds (obviously not hard enough!), but I’m hoping the worst of obesity is in my past now.
I had a few pints and a nice meal on Saturday. The 34″ waist jeans still fit. The 40″ ones that were getting tight last year are in the bin. 🙂
Hi scott, sorry for the delay in replying.
Allopurinol is not bad for your liver.
It sounds to me like you are on the wrong dose. Underdosing allopurinol is very bad for gout.
Allopurinol dose should be adjusted by your doctor to make your uric acid level safe. This is a personal value that depends on your current health and personal history. Normally, it should be under 5mg/dL, though there are some exception for people with kidney disease.
You should have blood tests at least once a year to make sure your uric acid is safe. Where adjustment is needed, you should be retested each month, and dose adjusted until it is safely below your personal maximum.
If you need any help understanding safe uric acid levels, or how to insist you get proper allopurinol dose, please ask.
Please let me know how you get on with your allopurinol dose and uric acid control. If you are worried about any other aspects of gout, please just ask.
Keith
Thanks Tony, sorry about the delay in responding.
I can’t find any reference to Nurobindo, so I can’t comment on it.
Colchicine stops inflammation spreading, but often needs the support of anti-inflammatories, and occasionally additional pain-blocking medicine.
The general consensus in the medical profession seems to be that allopurinol has more benefits than drawbacks for kidney health. However current kidney health is important, and this can only be assessed on an individual basis. If your kidney health is in doubt, I believe you would be better consulting a rheumatologist who has experience with gout treatment where kidney function is compromised.
Part of your treatment to lower uric acid should involve setting targets for months ahead. These targets must be set on an individual basis, and it is right to discuss 5. However, kidney function might mean that 6 is the lowest achievable. If kidney function is not an issue, I always recommend much lower than 5 for around 12 months, then review. At the review, you are looking for 2 things:
1. Uric acid has stayed consistently below 5mg/dL for 6 months.
2. No gout flares.
If both goals are achieved, then allopurinol dose can be reduced to bring it up to around 5mg/dL. If not, carry on with highest dose that is medically sensible until those goals are achieved.I hope this makes sense Tony.
If not, please log in and add your comments. There is some help available on logging in to GoutPal.
Beer and gout discussion continues after this update notice…
Beer and Gout Update
This is an old discussion about beer and gout. But it still contains many relevant and interesting points. But, for the latest gout discussions, you should read:
However, before you join those discussions, it is wise to read the facts about gout and beer:
I’m reviewing all my beer and gout articles. So, please share your questions, opinions, and experiences at Beer and Gout review.
Why worry about gout when you’re drinking beer?
There’s a few ‘sub-plots’ running through this thread. That’s nice, but as Phil started it, I want to give my take on his issues relating to beer and gout.
In your first post, Phil, you indicate that draught beers raise your uric acid levels, but other drinks do not. First I would say that you need to be able to retest this several times to be sure it isn’t a coincidence. For accurate testing, you have to keep everything the same apart from changing beer to something else. This is actually very hard to do in practice. It’s why I gave up with my meter – apart from the cost of test strips. I found I was trying to justify results rather than focus on gathering accurate data.
I think if you do find conclusively that uric acid rises with beer, then it’s best to avoid it.
To me, the bigger issue is that your uric acid level is simply not low enough. Every gout sufferer needs to be below 5mg/dL, except those who have other illnesses that might make 6 the upper limit. During the first few months of uric acid lowering treatment it makes sense to aim much lower – i.e 2 or 3 mg/dL. That way, the uric acid crystals that have built up over several years will dissolve faster. Whilst they exist, I believe they can easily confuse any attempt to measure uric acid levels accurately.
If I’d been good enough to answer you earlier, I would have recommended getting your allopurinol dose increased for six months to a year, until you get stable results and no gout flares. Then you can start experimenting to see which drinks, or other foods, allow you to reduce your allopurinol dose the most.
Unfortunately, I’m late answering, and now you’ve added more information that disturbs me. It sounds like you are trying to avoid allopurinol altogether, and rely on diet changes. Now, I’m not saying that you cannot do that, but it’s not an easy path.
I’m not sure what to suggest next.
If drowsiness is a problem, has it been constant throughout the time you took it? Unfortunately, my early allopurinol experience was accompanied by recovery from an accident, so I put drowsiness down to that and other meds. It might have been a side-effect. I can’t be sure, but I do know that I did not feel any drowsiness after a few weeks. Sorry to be vague, but I never associated drowsiness with allopurinol. If it did happen, it soon passed.
Another thought on that is that, when you first start lowering uric acid, you are starting a recovery process from a disease that’s been eating away at you for years. In those circumstances a little tiredness might be expected. Certainly, with any other disease, you would be expected to take extra rest during your recovery period.
All of this is why I advocate starting with a plan. That should include target uric acid levels over the next 12 months. The plan needs appraisals every so often to review targets, and change doses, or even switch treatments.
As I say, I’m not sure what to suggest next. I want to help you get your uric acid under control, but I’m not sure how I can help you best. What’s most important to you now, Phil?
Hi Jay, welcome to the gout forum.
My first response has to be “what does your doctor think about it?”
I say that, because if it is a tophus, you’re in serious trouble.
The only way to prove it, is to get a rheumatologist to sample it. We can guess if it is or if it isn’t, but that’s largely a waste of time.
What I will say is that your description sounds exactly like the first appearance of gouty tophi in my experience. If it is a tophus, it will have started weeks, or months ago, but too small to notice. At some time it becomes noticeable. Of course, it could be something else, but if it is a tophus, it will continue to grow in size, and get harder. Eventually, it will cause serious discomfort, and probably burst the skin, risking infection.
The serious part is that visible tophi are just a signal that your body is riddled with uric acid crystals. In the joints they prevent natural repair, so bone, cartilage and tendons gradually crumble. You’ve noticed it in your largest organ, the skin, but uric acid crystals will spread to other organs, commonly causing damage to kidneys and heart valves.
Fortunately, this is completely avoidable by getting uric acid safe. I notice from your profile that you haven’t been tested for uric acid, so my advice is to get that done as soon as you can. Then please come back and share your results, and your doctor’s opinions. We can easily work out a plan to control your uric acid.
Hi Jason,
I’m not sure what you mean by Q1. Do you mean general proof that this happens, or do you mean personal testing for you or me as individuals.
For 2, it’s the age old misunderstanding of how gout damage occurs. Uric acid crystals do not abrade, or otherwise physically interfere with joint tissues. It’s a biological process.
All tissues and bones in our bodies have a lifetime that is much less than ours. As we go through life, some parts of us grow, but most is just replaced. Bone and tissue replacement is a constant process that relies on specialist cells. Joints are made up of bone, cartilage, and tendons. Each part has specialist cells that our bodies manufacture when healthy. Similarly, we have white blood cells that fight infection, and other threats, such as uric acid crystals. White blood cells form part of the protein covering that you refer to. Unfortunately, other specialist cells that should be repairing and renewing joints get caught up in the fight. Therefore, joints gradually crumble as they fail to be repaired. This obviously takes several years, but it means that joint replacement or amputation becomes an issue at a time in our lives when we should be enjoying retirement.
It annoys me that frontline health specialists, especially those focused on pain relief, do not pay enough attention to the long term destructive effects of gout.
I’ve managed to respond to the top two members in the GoutPal Leaderboard today. More tomorrow, and the HelpDesk at the weekend.
If you want to move up the leaderboard faster, here are some tips:
Read Forum posts (gout-pal.com)
Log in every day
Reply to Forum Posts
Make suggestions. I’m particularly interested in your thoughts about your favorite gout guidelines on GoutPal.com@dorian-kramer I’ve moved the link above from for those who cant or dont want to take medications to this discussion.
That report is about acupuncture, so I though it best to move it here to avoid diluting the discussion. I don’t make a habit of this, but I happened to spot it as I worked through my backlog.
For some reason, acupuncture has always fascinated me. I’ve never tried it, but I’m convinced it can be effective for many gout sufferers. Given the increasing fears about NSAIDs, it’s great to discuss alternatives.
The report you linked to is titled: Study on mechanisms of electroacupuncture treatment of acute gouty arthritis
It concludes (my paraphrasing):
“Electroacupuncture can reduce the production of uric acid and promote the excretion of uric acid and has a better treatment effect. And there are no harmful effects on kidney function. Electroacupuncture is an effective therapeutic method for treatment of gout with kidney problems.”
I’d have thought, if that is repeatable, electroacupuncture would be a good choice for all gout sufferers, not just those with kidney disease!
This is a great discussion, Dorian and Ron. It raises some important issues about uric acid testing, but even more important issues about uric acid test results.
Dorian, you are right that the crystallization point for uric acid is 6.8mg/dL. But, this is at normal blood temperature. Most joints are well below normal body temperature, especially if you are exposed to low environmental temperatures.
In extreme cases, even 5mg/dL might be above the crystallization point. I think a review of the facts is overdue, as my explanation at http://www.goutpal.com/uric-acid/hyperuricemia/gout-without-hyperuricemia/ is rather long-winded (as usual??!!??)
However, it is clear from the references that it is quite easy to get crystals forming at 4.5mg/dL.
As Ron points out, even if you get uric acid down to 5, you ca still get gout flares from old crystals that are dissolving.
There’s often no easy answers with gout, but always easier when all individual circumstances are considered.
I’m not discounting TCM, but I have absolutely no knowledge of it. I’m very willing to learn!!
For now, let me give my Western Medicine view on ” a portion of gout sufferers who have good UA levels and still years later suddenly have attacks”
I believe this has to be considered on a case-by-case basis. Important factors are:
– Duration of untreated high uric acid
– Typical level when untreated
– Duration of treated uric acid
– Typical levels achieved during treatmentThe overriding factor is that we cannot see uric acid deposits in our bodies. Our best “gold standard” test is a fallible joint fluid test. That only measures floating crystals in the joints. It never shows deposits locked up in tophi that are the main source of prolonged gout attacks during uric acid lowering treatment.
This can be resolved using the latest DECT techniques, but such tests are not readily available.
One thing is certain to me – Western Medicine does not have all the answers. We do not understand how gout attacks actually occur. We suspect that gout flares require the presence of uric acid crystals plus “something else.” Leading researchers might have some ideas about the “something else” but it is bound to be very complex. It is not likely to be one single factor, but perhaps a combination of factors – some of which promote gout flares, and some which inhibit them.
There is a chance that traditional medicines have ways of suppressing gout flares that WM practitioners have missed.
Personally, I believe that you need to find what is right for you. That’s why discussions like this are important to me. It’s also why I’m constantly seeking ways to make my gout support services completely focused on individual needs.
I’m with Barry on tramadol. It made me feel completely spaced out. Having said that, it was a very effective painkiller for me, so it might be worth considering. This seems especially relevant given the increased FDA warnings about heart risks from NSAIDs. It’s also relevant for people who cannot tolerate NSAIDs.
Like all pain relief for gout, it has to be a personal decision based on your unique circumstances. I would definitely warn against taking tramadol whilst driving, or any other task that requires concentration.
I’m very suspicious of the data that links it with higher uric acid. It just looks like a collection of trawled “facts” to me, with no clear evidence about the source of the data, or the medical history of the 4 cases mentioned.
That article is called “The relationship between uric acid and potassium in normal subjects”
I’m struggling to see it’s relevance, but I can’t really understand what it is saying? Is it suggesting potassium is good for gout, bad for gout, or indifferent?
In my limited nutritional experience, I’m stuck with the notion that potassium intake is mainly an issue because most people on a typical Western Diet, consume far too much sodium at the expense of potassium. I.e. it is usually a diet balance problem. However, the only other discussion about potassium for gout raises questions about lowering potassium intake for gout patients with kidney problems. That it now a very old discussion: https://gout-pal.com/food-list-high-in-potassium/2007/08/
Is there enough interest in potassium for gout patients to encourage me to review this topic?
Please share your thoughts about potassium and gout here.
Hi Dorian,
I’ve lost where we are with reference to acupuncture for gout.
Ideally, I’d like to update my article on GoutPal.com with some more current guidelines.
I’ve changed the Personal Gout Profile here to add a box for important questions. For the moment, I see this as a good way to keep track of any personal gout issues that haven’t been resolved yet.
As I get back on track, I will focus most on any issues that you flag up in that box. If acupuncture is one of them, I will review all the latest references that I have for it.
In theory, cheese should be good for gout, as a source of protein without purines from animal flesh. However, single foods are always difficult to discuss in relation to gout. Total diet affects gout, and individual food items should not normally be significant enough to worry about.
Can you link to the information sources that you mention?
Here’s a quick update @stephen-q-shannon
I’ve started doing proactive personal reviews of each GoutPal member. I’m working my way down the GoutPal Leaderboard. I’m fairly certain that, if you had any current issues, you would have brought them to my attention.
This is just a friendly reminder that I’m still around if you need me. There is no need to respond to this, unless you wish to do so.
I’ll continue to add occasional messages like this, unless you ask me not to. I won’t add any more unless there are some changes in your circumstances that warrant my input.
Take care of yourself sQs, and thank you for your support.
Thank you for your kind words. Thank you even more for raising the interesting topic of acupuncture again. I’ve had discussions with an Australian acupuncturist about gout, so I’ll see if he has any updates about his work.
The links that I should have included in that report are Clinical application of acupuncture and moxibustion to the treatment of gouty arthritis and analysis on their therapeutic effects and Observation on therapeutic effect of electroacupuncture plus blood-letting puncture and cupping combined with diet intervention for treatment of acute.
For gout studies, I’ve recently been using ResearchGate more than PubMed. Quite often you can get full copies of articles on ResearchGate that only have abstracts on PubMed. I couldn’t find those two, but I’ve found some interesting new stuff:
Chinese herbal medicine for gout: a systematic review of randomized clinical trials
I suspect there’s many more, but I’ve got to dash for an appointment now. More soon.
This is absolutely fascinating, Dorian, though I’m not sure how much I can help.
I’m accepting of other medical philosophies, and whenever TCM is raised here, the discussions are always interesting. For myself, I’m happy with my Western Medicine approach, but I would never say it is the only way for everybody.
When I first set out to learn about gout, I was astonished and appalled at the amount of misinformation I was faced with. Some through ignorance, and much through greed. I started GoutPal with the hope that I could document my learning process. I started to make sense of gout facts, and recognize gout myths. So, all I can really offer is a chance for you to do something similar. Options I can think of off the top of my head are:
- A TCM for gout forum here, but maybe it should be all traditional medicines or alternatives to Western Medicine?
- Your own website. A project I’ve had in mind is yourgoutsite.goutpal.net, where yourgoutsite can be anything you like.
- Guest Author on GoutPal.com
I’d love to see opinions from other GoutPal members too. Also, non-members can comment via the orange gout support button, or the Gout Helpdesk.
Please start new topics in the new gout forum. Or continue this discussion at Alcohol abstinence and Gout Flares
But before posting, it’s best to read Best Alcohol For Gout.
Are you on the update list, limpy? If not, you can sign up at https://feedburner.google.com/fb/a/mailverify?uri=GoutForumGoutPalInteractive
You’ll see that there are definitely people posting every day. My work pattern is:
1. Respond to Patrons
2. Respond to forum messages in the order they were posted in the Members Activity: https://gout-pal.com/gout-forum-activity/
3. Respond to Helpdesk messages.I’m sorry I can’t respond quicker, but I’m not going to restrict my responses to 10 minutes. Some questions take a few hours of research, but I’ll respond to everyone in turn. I’ve just finished the post from @dennis
Next in turn are @james-faulkner @mary-johnson-howes then it’s @limpyI hope nobody feels they are being ignored, hence I’ve answered this out of turn to try let everyone know.
The best thing I can suggest is, while you are waiting, respond to some other messages. Even better, add as many facts as you can to your Better Personal Gout Profile.
By the way, I hope nobody thinks that I’m prioritizing Patrons because I’m in this for the money. It’s just that they have shown a level of commitment to me that deserves my attention. I intend to refine my priority system soon. My priorities will be based on the GoutPal Leaderboard. That reflects how much of a commitment members are making towards controlling their gout. I will award significant points for good ideas in my new Suggestion Box.
I’ll finish with a personal note to all members regarding my new Suggestion Box. I’m disappointed in the lack of ideas, the lack of comments on my starter idea, and the lack of votes for the one existing idea.
So, to summarize, here is what you should be doing while you are waiting for a response from me:
- Contribute ideas, comments, and votes in the Suggestion Box.
- Check and update your Personal Gout Profile
- Respond to other members recent messages.
- Search for gout topics that you are interested in, and add to discussions, or start new ones.
- Any more ideas?
Barry, that’s great news. It’s great when you can begin to feel you’re controlling the gout beast.
Dennis, I’m glad the Canada source for colchicine works for you. I find it disgusting to see that Prasco appear to be continuing the profiteering that Colcrys started. Anyway, for anyone wanting cheaper colchicine, ring 1-800-CAN-DRUG (226-3784) and tell ’em Dennis Roucek sent you.
It’s good to see that your uric acid levels have fallen, but I think your plan to start the allopurinol is wise. Rheumatologists recommend getting uric acid below 5 where there are any visible signs of tophi. If you can get down to 3, or even lower, for a year, it gives your gouty joints the best chance for recovery.
http://www.goutpal.com/5405/unusual-side-effects-of-allopurinol/ is even more interesting. I’m struggling to post from my phone. What does this kind of research mean to you?
Barry, I’m pleased the allopurinol is progressing nicely. When are you scheduled for another uric acid test?
Dennis, I’m going to cover your points in sequence, now, then I’ll try to summarize where I think you’re at. I’ve got to leave for an appointment soon, so I’ll do what I can, then catch up later.
I agree with your doctor. Start allopurinol as soon as you can. 6.6mg/dL is too high for safety, but should be easy to control. Though gout attacks on allopurinol are not mandatory, it is good to have a good pain prevention and relief plan, just in case.
I’ll come back on the colchicine and your most recent post next time. Sorry for the delay.
No!
In my opinion, it’s wrong to only test uric acid to monitor allopurinol dose. In fact, this also applies to Uloric (febuxostat) and probably most other meds.
I believe it is important to get kidney function and liver function tests whenever you get a uric acid test. That way, your doctor can spot any early signs of significant side-effects.
I know it makes your treatment expensive, but let’s find a way to do it. Earn $20 by submitting the first suggestion for GoutPal to get 20 votes. Work with me on a website about your gout, and share the revenue (90% to you). Work with me on a website about anything, and share the revenue (up to 100% to you). If a gouty, tophi-squeezing, Aussie in Spain can’t make enough for gout treatment, what hope is there for the rest of us? 😉
Hi Tim,
It’s right to be careful about allopurinol, but it has to be balanced. The biggest worry is doing nothing about high uric acid. That has very scary implications, and I don’t think these are emphasized enough. Untreated gout is a crippling killer. Allopurinol is usually safe.
Recent research shows that bad side effects are largely genetic, and can be screened for. Han Chinese, Thai, and Korean ancestry is high-risk. Positive tests for the relevant gene indicate that Uloric (febuxostat) should be used instead of allopurinol.
The first allopurinol dose should be 100mg, and uric acid tests should be accompanied with liver function and kidney function. Increasing allopurinol according to blood test results is very safe, and has been successful for many decades. It all goes wrong when follow-up is poor. That is common, so you usually have to take control yourself. Insist on blood tests – monthly at first, but never less than once a year. Insist on safe uric acid levels – never more than 5mg/dL.
That way, you stand a chance of still being alive and healthy when future uric acid lowering treatments replace daily allopurinol with an annual shot. Beyond that, genetic engineering will fix the faulty genes. Gout, and GoutPal, will be history! Don’t worry – I’ll find something else to do in my long retirement. 🙂
The 100mg starting dose is sensible. It’s a good safe option to ensure that side-effects risks are minimized.
It’s very important to return after 2-4 weeks to get uric acid tested. Then dose can be adjusted to get uric acid safely below 5mg/dL. There is no point in taking allopurinol if it does not get uric acid safe. Under-dosing will not reduce gout attacks, and can make gout worse.
The tiredness issue is interesting. I experienced it a bit, but can’t prove if it was the allo, or the stress of medical treatment. It passed quickly for me, and it was never dose dependent.
Hi @carol
Any news on your uric acid test?
