Gout, Allopurinol and lifestyle
Discussion
Several months ago I had what was believed to be an attack of Gout in my big toe.
Saw the doctor, got given Naproxen, rode it out for 2 weeks or so and it got better. I was scheduled to have a blood test, which was then cancelled due to Covid.
I had the blood test this week, and my uric acid levels are high. Doctor has instantly prescribed Allopurinol and I'm sitting here looking at the box wondering whether to take them (for life).
My issue is that I've had one gout attack. Shouldn't the first treatment be lifestyle changes, and better hydration or should I just take the tablets? Everything I've read says that Allopurinol should be prescribed for regular gout attacks...I'm not sure 1 counts? Does it?
Saw the doctor, got given Naproxen, rode it out for 2 weeks or so and it got better. I was scheduled to have a blood test, which was then cancelled due to Covid.
I had the blood test this week, and my uric acid levels are high. Doctor has instantly prescribed Allopurinol and I'm sitting here looking at the box wondering whether to take them (for life).
My issue is that I've had one gout attack. Shouldn't the first treatment be lifestyle changes, and better hydration or should I just take the tablets? Everything I've read says that Allopurinol should be prescribed for regular gout attacks...I'm not sure 1 counts? Does it?
Edited by cbmotorsport on Tuesday 14th July 16:02
Occasionally I get an attack of Gout, once every couple of years or so, I take colchicine it's only take a few days to take the tablets IIRC it's about 12 tablets. Relieve the pain after about 24 hours.
https://www.nhs.uk/medicines/colchicine/
HTH
PS there is already a bit thread on here about Gout
https://www.pistonheads.com/gassing/topic.asp?h=0&...
https://www.nhs.uk/medicines/colchicine/
HTH
PS there is already a bit thread on here about Gout
https://www.pistonheads.com/gassing/topic.asp?h=0&...
I suffered with gout for many years, roughly from 28 to 42, usually once every 6 months.
My last attack went to both knees and feet and I was in so much pain that I couldn’t face another episode. That made me accept that allopurinol was my only option.
If I were you OP, I would not go on allopurinol at this early stage. See how often you get it (or not) and how bad before going on drugs full time.
My last attack went to both knees and feet and I was in so much pain that I couldn’t face another episode. That made me accept that allopurinol was my only option.
If I were you OP, I would not go on allopurinol at this early stage. See how often you get it (or not) and how bad before going on drugs full time.
I had a few attacks, starting around when i turned 50. Usually after some drinking / lots of red meat / cheese and so on. Mushrooms and shell fish also a big trigger. I got hit with one on arrival in a ski resort (so before the wall to wall cheese, wine, beer etc had happened) and was surprised to be told that this is quite common by the local doctor.
There was a long gap after the first one and then they gradually began to come closer together as time went on.
Dealt with the initial ones with Naproxen and then Colchichine. The latter is much better - fine after 2-3 days, but still agony until then.
So I went on Allopurinol. Never had an issue since and eat/drink whatever i want. Zero side effects after 8 years.
Before i went on it, i spoke to a friend who is in his late 60's and who has been on it for decades. Also no side effects.
There was a long gap after the first one and then they gradually began to come closer together as time went on.
Dealt with the initial ones with Naproxen and then Colchichine. The latter is much better - fine after 2-3 days, but still agony until then.
So I went on Allopurinol. Never had an issue since and eat/drink whatever i want. Zero side effects after 8 years.
Before i went on it, i spoke to a friend who is in his late 60's and who has been on it for decades. Also no side effects.
Thanks for the replies. I'm just concerned that I've had one attack and seem to have been given the treatment for persistent sufferers. I also don't like the idea of being on it for life.
Perhaps I'm kidding myself that I won't have another one, and should just take them to control my levels.
Perhaps I'm kidding myself that I won't have another one, and should just take them to control my levels.
It depends - I started getting attacks over 10 years ago and it got to the point where I was having one every 3 months or so. At their peak, I'd be in pain for 4 or 5 days and unable to walk for maybe 2 days. I wanted to try and figure out what was triggering the attacks for me so I could do something about it. Going straight on AP means that you won't ever know.
I have painkillers / anti-inflammatory on prescription and can feel when it is coming and pop a few as a pre-emptive response which does allow me to manage it fairly well. Tends to come on at bedtime and if I take a pill it can be gone by the morning.
For me & over time, the number of attacks have reduced significantly and the impact of them has also reduced. It seems to be something I can now manage and I'm not entirely sure why. I haven't really changed diet although I've tried changing all sorts and often forget to drink enough water. I've never been convinced there is any link to what I've eaten and attacks coming on having kept food diaries and the like. I've also had massive weekends / stag do's etc and it seems random as to whether I get an attack afterwards or not.
In my case, I'm glad I didn't go down the AP route as it's now manageable (with water and pain killers) - I'd at least try and see if you can manage it without the need for a pill every day.
I have painkillers / anti-inflammatory on prescription and can feel when it is coming and pop a few as a pre-emptive response which does allow me to manage it fairly well. Tends to come on at bedtime and if I take a pill it can be gone by the morning.
For me & over time, the number of attacks have reduced significantly and the impact of them has also reduced. It seems to be something I can now manage and I'm not entirely sure why. I haven't really changed diet although I've tried changing all sorts and often forget to drink enough water. I've never been convinced there is any link to what I've eaten and attacks coming on having kept food diaries and the like. I've also had massive weekends / stag do's etc and it seems random as to whether I get an attack afterwards or not.
In my case, I'm glad I didn't go down the AP route as it's now manageable (with water and pain killers) - I'd at least try and see if you can manage it without the need for a pill every day.
fat80b said:
It depends - I started getting attacks over 10 years ago and it got to the point where I was having one every 3 months or so. At their peak, I'd be in pain for 4 or 5 days and unable to walk for maybe 2 days. I wanted to try and figure out what was triggering the attacks for me so I could do something about it. Going straight on AP means that you won't ever know.
I have painkillers / anti-inflammatory on prescription and can feel when it is coming and pop a few as a pre-emptive response which does allow me to manage it fairly well. Tends to come on at bedtime and if I take a pill it can be gone by the morning.
For me & over time, the number of attacks have reduced significantly and the impact of them has also reduced. It seems to be something I can now manage and I'm not entirely sure why. I haven't really changed diet although I've tried changing all sorts and often forget to drink enough water. I've never been convinced there is any link to what I've eaten and attacks coming on having kept food diaries and the like. I've also had massive weekends / stag do's etc and it seems random as to whether I get an attack afterwards or not.
In my case, I'm glad I didn't go down the AP route as it's now manageable (with water and pain killers) - I'd at least try and see if you can manage it without the need for a pill every day.
I think this is the route I'm going to take. I know that my biggest issue is not drinking enough water. I'm a chef and can do a 12 hr shift and pretty much forget to drink, unless it's handed to me....not good. I have painkillers / anti-inflammatory on prescription and can feel when it is coming and pop a few as a pre-emptive response which does allow me to manage it fairly well. Tends to come on at bedtime and if I take a pill it can be gone by the morning.
For me & over time, the number of attacks have reduced significantly and the impact of them has also reduced. It seems to be something I can now manage and I'm not entirely sure why. I haven't really changed diet although I've tried changing all sorts and often forget to drink enough water. I've never been convinced there is any link to what I've eaten and attacks coming on having kept food diaries and the like. I've also had massive weekends / stag do's etc and it seems random as to whether I get an attack afterwards or not.
In my case, I'm glad I didn't go down the AP route as it's now manageable (with water and pain killers) - I'd at least try and see if you can manage it without the need for a pill every day.
I'll cut down my booze intake and make a real effort to drink more water, if I then get flare ups while being a good boy, I'll maybe take the Allopurinol.
35yo here and suffer from occaisional gout in feet. Like you had blood test and had high uric acid in blood. It only happens from certain foods which I now avoid so easy to manage, not on medication. As others have said, work out what are triggers, for me its processed ham, salami etc, tuna, anchovies, mackerel and beer. But wow what a pain, at one point I was crawling up stairs and couldn't put shoes on as pressure was too much. Also upped water intake which has helped alot.
Gout is a systemic illness, not just manifest with joint inflammation and pain.
Current guidelines are treat to numbers; get the urate level below 6mg/dL.
This provides joint protection and reduces the chronic systemic inflammation that increases all risks such as cardiovascular mortality.
If you can get your urate to target with lifestyle changes well done. It is pretty rare. Most need allopurinol.
Current guidelines are treat to numbers; get the urate level below 6mg/dL.
This provides joint protection and reduces the chronic systemic inflammation that increases all risks such as cardiovascular mortality.
If you can get your urate to target with lifestyle changes well done. It is pretty rare. Most need allopurinol.
I thought the blood test was supposed to be during or close to an attack? Although if if shows elevated levels anyway...
Have one or two attacks per year... Have decided to manage it with naproxen which normally brings it under control within the day, rather than allupurinol as I gather its a drug-for-life and it comes with a vengeance if you lapse?
Have one or two attacks per year... Have decided to manage it with naproxen which normally brings it under control within the day, rather than allupurinol as I gather its a drug-for-life and it comes with a vengeance if you lapse?
cbmotorsport said:
Thanks for the replies. I'm just concerned that I've had one attack and seem to have been given the treatment for persistent sufferers. I also don't like the idea of being on it for life.
It doesn't have to be for life.I had it for the first time last year - misdiagnosis meant I became more and more immobile over a 6 week period. Naproxen didn't really help so went on allopurinol for a bit. Once on the mend, came off and been fine every since.
I think mine was caused by a combination of factors - not drinking enough water, too much beer, poor diet and stress. Positive lifestyle changes since made, obviously.
Full disclosure - not a doctor!
Blood test best done not during an attack as levels can be falsely low (due to the heightened inflammatory response causing increase renal excretion).
Bloods 6w after an attack to diagnose, and then regularly to titrate treatment.
DOI - a doctor, with gout, and managing lots of patients with gout.
Bloods 6w after an attack to diagnose, and then regularly to titrate treatment.
DOI - a doctor, with gout, and managing lots of patients with gout.
It has traditionally been taught that urate-lowering therapy should not be started until 2 weeks after an acute attack, as starting too early may precipitate a further attack. The evidence base to support this however looks weak.
The British Society of Rheumatology Guidelines now advocate offering urate-lowering therapy (i.e. allopurinol) to all patients after their first attack of gout
The British Society of Rheumatology Guidelines now advocate offering urate-lowering therapy (i.e. allopurinol) to all patients after their first attack of gout
MSBravo said:
It has traditionally been taught that urate-lowering therapy should not be started until 2 weeks after an acute attack, as starting too early may precipitate a further attack. The evidence base to support this however looks weak.
The British Society of Rheumatology Guidelines now advocate offering urate-lowering therapy (i.e. allopurinol) to all patients after their first attack of gout
And cover the initiation and any dose increases with NSAIDs to prevent flare-ups.The British Society of Rheumatology Guidelines now advocate offering urate-lowering therapy (i.e. allopurinol) to all patients after their first attack of gout
Belle427 said:
I found Naproxen didn’t do anything for my pain but Indomethacin would kill most of it within 4 hours or so.
It’s not prescribed much these days according to my doctor.
Gout really is a different beast to different people.It’s not prescribed much these days according to my doctor.
Some get it mildly and can take drugs to sort it out. Some of those react differently to the various drugs so it’s not a one size fits all. Others get it so badly (like me) that nothing works and have to go to Allopurinol. And then there are the trigger foods which come in a seemingly infinite variety - fizzy drinks for some, certain foods for others etc.
It’s a very personal beast.
Thank you for all the replies, particularly the Doctors. Your comments about it being systemic and not necessarily manifesting as gout made me think, so I've opted to take the drugs and so far they're not disagreeing with me.
I'll see how I go, and hopefully my levels will drop.
Thanks!
I'll see how I go, and hopefully my levels will drop.
Thanks!
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