Short Term or Long Term Allopurinol?

[Lance]

Hey all! Trying to determine appropriate treatment plan. Diagnosed with gout 4 weeks ago after my first three day zinger on my big toe. Initially I found myself telling my doc that I was going to take on big pharma and fix this through healthy lifestyle alone. After reading more about the disease I’m not so sure.

My understanding: UA reduction of 2+ points can be achieved through diet but progress is likely measured in years. UA reduction through meds can achieve much lower UA levels in under a year. Until UA levels are below 6.5 destructive urate deposits are taking place even if asymptomatic. This is bad even if I’m being good.

My thoughts: I’m having a hard time wrapping my mind around a daily cocktail of pills forevermore. I’d also like to prove to myself that I can do this without medicine. On the other hand I don’t want to be naive about what lies ahead if mismanaged. No need to cut off my nose to spite my face. Did I mention a low tolerance for pain? 🙂

Question: Can Allopurinol be taken up to the UA reduction target and then phased out in favor of weight management and strict gout diet?

My current (and only) UA test showed 7.7 mg/dl this week.

Thanks!

[d q]

Hi Lance,

Sorry about the gout diagnosis mate. Yes, I too initially thought long term medication isn’t something I want to commit too and went for the ‘herbal home remedy” method after my first attack. ACV, cherries, reduction in purines, etc. Frankly speaking no longer enjoying meals.

A year later I got my second attack and was home bound for a week and that was the deciding factor for me. I thought if a pill a day in the morning after breakfast could give me far more flexibility with my food habits (not to mention what all that nasty high uric acid in the blood was doing) then a pill a day was the way.

I started treatment at 100mgs, dropped UA levels from approximately 600ummol to 555 then after a month inncreased to 200 and dropped UA levels from 555 to 388(got a minor attack) then increased allopurinol a few days ago to 300mgs a day got a slightly painful attack yesterday) and am now due a blood test in a few weeks to see the new UA levels whilst on 300mgs.

With regards to start stop treatment, I too asked this to my rheumatologist and he said a trial was conducted where allopurinol was stopped after a year treatment plan and most people got an attack again within 6 months of stopping medication. When I asked why did it take so long to build up yet so quick to come back he simply said “as we get older our kidneys are no longer as efficient at removing uric acid so levels will rise fast and attacks will return..” Personally I’m not a believer of that statement and still to this day don’t understand why it comes back so quick but took years to develop.. but who knows…..

If you do decide to go the meds route (which I advise) be sure to keep some naproxen to hand and hit that tablet for a few days as soon as you feel the “gout attack about to bite” feeling because you will probably get a few attacks while allopurinol starts doing its stuff over a period of a few months.

Anyway good luck mate and keep us posted 🙂

[Keith Taylor]

James, your rheumatologist needs to read something from this century! Send him here for some education.

This is brief, but I’ll expand later as necessary.

I might have given the impression that you have to choose between drugs, herbs, or food to manage uric acid. That’s not true, so I’ll review my gout sufferer advice to ensure it’s clear:
1. You can mix and match drugs, herbs, and food. But normally, one is dominant. Hence Gout Patient, Gout Herbalist, Gout Dieter. That’s the quickest way to start a comprehensive gout recovery plan. Then, in the detail stage, you can pick appropriate therapies from each type.

2. You can change gout sufferer type between different stages of uric acid control:
a) Preparation
b) Titration
c) Debulking
d) Maintenance

Do me a favor guys. If there’s anything obvious in my plans that contradict that, can you let me know. The plans start at Questions for Gout Sufferers, then link to GoutPal Plan for…

Thanks

“Long term high dose allopurinol may be associated with a better mortality “

[Lance]

Thanks Keith! This helps me refine (or better understand) a direction for my medication plan. Must admit I was hoping for a more rosey answer! 🙂

[d q]

Haha! Hence why I said I don’t believe him 🙂

Thanks Keith

[Tom Donnelly]

Starting Allopurinol Treatment

Should I request my Dr. put me on Allopurinol if I have just had one gout attack? I may have had one a few years ago but it may have just been an inflamed bunion but I’m not sure.

I am 58 years old.

Thanks, Tom

[Keith Taylor]

There are several factors that determine when you should start allopurinol. The latest guidelines from professional rheumatologists say you should start allopurinol if any of these are true:
1. More than one flare per year.
2. Visible tophi.
3. Uric acid crystals in joint fluid.
4. Age less than 40.
5. Uric acid blood test result more than 8mg/dL (480μmol/L).
6. Also suffer from kidney disease, high blood pressure, coronary heart disease, or heart failure.

I’d say, the values in point 5 are high. So, I’d recommend discussing allopurinol if uric acid blood tests show more than 7mg/dL (400μmol/L). However, at this level, gout sufferers might also consider lifestyle improvements to lower uric acid. In any case, uric acid should be tested frequently to see if it’s getting worse.

Tom, I hope that helps. But, if not, please ask for clarification. Going forward, if you want better individual help, please post uric acid test results.

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