Allopurinol for Gout
Discussion
sweet mother of God, had a flare up in my knee last night that left me in tears, walked into local A and E hoping for some stronger pain relief as my usual stuff wasn't working, had to be carried from the car as it wouldn't take my weight, was offered paracetamol, that went down well, would I have really presented at hospital if paracetamol was all it took to fix me, no sleep at all last night
I have ankylosing spondilitis (form of arthritis) and end up with inflammation of various joints including the ankle and during my annual check up at the hospital I complained of what I thought was a flare up in my big toe, well actually at the time I had a broken little toe on the same foot so thought it might even be as a result of me walking strangely trying to keep the weight off it. The specialist sent me for a bloodtest as she suspected gout and not a 'normal' AS flare up.
Blood test has come back showing high levels of uric acid and my AS specialist has recommended my GP prescribe me with allopurinol. I had a telephone appointment with my GP and he told me I had to decide if I wanted to start taking the allopurinol but take into account it could take a while to start working and it would leave me more susceptible to attacks in the early stages and also that I would need to take it for life. He said I should consider this and the potential side effects of it and recommended that I wait until I had 3 gout attacks before starting to take it.
The trouble I have is that I have various flare ups in my ankles, toes, knees, wrists etc. so I could have had a dozen or so episodes in the last 12 months. I also didn't think it was right that he left it up to me wether or not to start the treatment after doing my own research, does this sound familiar or should I be asking for a 2nd opinion, i have been under this gp for years and always found him helpful.
Bit of backround on me, 40 years old, a stone or so 'overweight' but probably the best shape since my teens, train 3 times a week. Consume very small amounts off alcohol and eat small amounts of red meat/shelfish and no offal. Diet is carb heavy with probably too much by the way of bread/spuds etc. I take neproxen for my AS as and when needed and ventolin for asthma.
Blood test has come back showing high levels of uric acid and my AS specialist has recommended my GP prescribe me with allopurinol. I had a telephone appointment with my GP and he told me I had to decide if I wanted to start taking the allopurinol but take into account it could take a while to start working and it would leave me more susceptible to attacks in the early stages and also that I would need to take it for life. He said I should consider this and the potential side effects of it and recommended that I wait until I had 3 gout attacks before starting to take it.
The trouble I have is that I have various flare ups in my ankles, toes, knees, wrists etc. so I could have had a dozen or so episodes in the last 12 months. I also didn't think it was right that he left it up to me wether or not to start the treatment after doing my own research, does this sound familiar or should I be asking for a 2nd opinion, i have been under this gp for years and always found him helpful.
Bit of backround on me, 40 years old, a stone or so 'overweight' but probably the best shape since my teens, train 3 times a week. Consume very small amounts off alcohol and eat small amounts of red meat/shelfish and no offal. Diet is carb heavy with probably too much by the way of bread/spuds etc. I take neproxen for my AS as and when needed and ventolin for asthma.
Hi Tony and sorry to hear about your issues.
Firstly, if it’s gout it’s gout. What I mean is that we all have different trigger foods and no one really knows why we get it. Could be too much uric acid produced, could be an inability to remove it from the body. At the end of the day you MAY find a way to prevent it through diet, but my experience says not!
Secondly, your blood result confuses me. Typically you get High uric levels before an attack. Once the gout attack happens you typically see more normal levels because the acid has crystallised at that point and is no longer in the blood so to speak.
After saying all that, high uric acid does not necessarily lead to gout so maybe your doc wants to be sure before putting you on lifelong drugs. I would suggest another blood test when you’re better
Lastly, Allupurinol is awesome (for me at least). I suffered with gout from years before it became so bad (both feet and knees at same time) that I realised that I could not prevent it myself. Since the allopurinol I’ve not had a single attack in over 10 years.
Yes, when you first take it it CAN cause an attack, but that’s not guaranteed. You also take it at first with an anti-inflammatory to reduce the risk of the attack anyway.
Best of luck.
Firstly, if it’s gout it’s gout. What I mean is that we all have different trigger foods and no one really knows why we get it. Could be too much uric acid produced, could be an inability to remove it from the body. At the end of the day you MAY find a way to prevent it through diet, but my experience says not!
Secondly, your blood result confuses me. Typically you get High uric levels before an attack. Once the gout attack happens you typically see more normal levels because the acid has crystallised at that point and is no longer in the blood so to speak.
After saying all that, high uric acid does not necessarily lead to gout so maybe your doc wants to be sure before putting you on lifelong drugs. I would suggest another blood test when you’re better
Lastly, Allupurinol is awesome (for me at least). I suffered with gout from years before it became so bad (both feet and knees at same time) that I realised that I could not prevent it myself. Since the allopurinol I’ve not had a single attack in over 10 years.
Yes, when you first take it it CAN cause an attack, but that’s not guaranteed. You also take it at first with an anti-inflammatory to reduce the risk of the attack anyway.
Best of luck.
Tried to manage mine with diet but last week I had a flare up in my toe and have now decided the allopurinol is the way forward.
As said it may cause a flare up at first but make sure you have your proper pain relief to hand which for me is indomethacin.
It usually kills most of the pain within 8 hours.
As said it may cause a flare up at first but make sure you have your proper pain relief to hand which for me is indomethacin.
It usually kills most of the pain within 8 hours.
Belle427 said:
Tried to manage mine with diet but last week I had a flare up in my toe and have now decided the allopurinol is the way forward.
As said it may cause a flare up at first but make sure you have your proper pain relief to hand which for me is indomethacin.
It usually kills most of the pain within 8 hours.
I understand - but I am open to correction, that the gout needs to be brought under control with colchicine (spelling?) or similar, and then when the gout is under control, allopurinol will maintain it pain free.As said it may cause a flare up at first but make sure you have your proper pain relief to hand which for me is indomethacin.
It usually kills most of the pain within 8 hours.
Well, that's what works for me.
The Mad Monk said:
Belle427 said:
Tried to manage mine with diet but last week I had a flare up in my toe and have now decided the allopurinol is the way forward.
As said it may cause a flare up at first but make sure you have your proper pain relief to hand which for me is indomethacin.
It usually kills most of the pain within 8 hours.
I understand - but I am open to correction, that the gout needs to be brought under control with colchicine (spelling?) or similar, and then when the gout is under control, allopurinol will maintain it pain free.As said it may cause a flare up at first but make sure you have your proper pain relief to hand which for me is indomethacin.
It usually kills most of the pain within 8 hours.
Well, that's what works for me.
Holy thread bump Batman!
Just on a Zoom call with a load of mates in our late 40's, some suffering from lockdown gout that they attribute to to more drinking/less action.
I suffered from gout for 10 years, until my GP put me on Allopurinol in 2017. I thought it would be the answer to my problems. Not so. One of the side effects of Allopurinol can be a heart attack, especially within the first 30 days. I had mine (otherwise healthy) on day 29 .....
As a consequence of my heart attack I now take Losartan, a drug to control hypertension (high blood pressure). A side effect of Losartan is that it reduces uric acid and therefore gout. Therefore I am gout free, but have lost 20% pumping efficiency on one ventricle and am on heart medication for life. This is not a course of therapy I would recommend for obvious reasons!
It should be noted that before my heart attack I did not have high blood pressure - it was measured as normal by my GP on the day she prescribed Allopurinol. Or for absolute clarity, I should say, "on the day I asked her to prescribe Allopurinol"- I went into taking it voluntarily and with enthusiasm to rid me of gout.
I just think it happens to be a very nasty drug for some people, whereas for others it is totally non-problematic. We all read the side effects leaflet and tend to say "Yeah, but it won't affect me" .... I was like this, before I took Allopurinol.
Just on a Zoom call with a load of mates in our late 40's, some suffering from lockdown gout that they attribute to to more drinking/less action.
I suffered from gout for 10 years, until my GP put me on Allopurinol in 2017. I thought it would be the answer to my problems. Not so. One of the side effects of Allopurinol can be a heart attack, especially within the first 30 days. I had mine (otherwise healthy) on day 29 .....
As a consequence of my heart attack I now take Losartan, a drug to control hypertension (high blood pressure). A side effect of Losartan is that it reduces uric acid and therefore gout. Therefore I am gout free, but have lost 20% pumping efficiency on one ventricle and am on heart medication for life. This is not a course of therapy I would recommend for obvious reasons!
It should be noted that before my heart attack I did not have high blood pressure - it was measured as normal by my GP on the day she prescribed Allopurinol. Or for absolute clarity, I should say, "on the day I asked her to prescribe Allopurinol"- I went into taking it voluntarily and with enthusiasm to rid me of gout.
I just think it happens to be a very nasty drug for some people, whereas for others it is totally non-problematic. We all read the side effects leaflet and tend to say "Yeah, but it won't affect me" .... I was like this, before I took Allopurinol.
Allopurinal didn't work for me. The next step would have been to increase the dose which made me step back from it. I suffered a few flare-ups meanwhile and the intensity seemed to increase.
Five months ago (for several other reasons) I decided to switch to a predominantly plant-based diet and I can say with a degree of confidence that it has made a difference. I still get a flare-up but it's more of a manageable twinge rather that acute pain and swelling.
If I knocked alcohol on the head...
Five months ago (for several other reasons) I decided to switch to a predominantly plant-based diet and I can say with a degree of confidence that it has made a difference. I still get a flare-up but it's more of a manageable twinge rather that acute pain and swelling.
If I knocked alcohol on the head...
Update:
Over a year on and it's still going well. Still mostly plant based with occasional fish/eggs and the odd bite of a piece of chicken when the kids are tucking in.
Acute flare-ups: none.
Slight hint of gouty pain: occasional.
I'm not stocked up on Colchicine as much as I once used to be and wouldn't dare to be without. I have Ibuprofen to hand just in case, but I've only ever reached for it after a particularly physical footy match. Overall, my joints do not ache like they used to when I was chowing down on meat two or three times a day. My diet is now 90-95% meat free and it seems to be the difference.
Fingers firmly crossed and touching wood etc.
Over a year on and it's still going well. Still mostly plant based with occasional fish/eggs and the odd bite of a piece of chicken when the kids are tucking in.
Acute flare-ups: none.
Slight hint of gouty pain: occasional.
I'm not stocked up on Colchicine as much as I once used to be and wouldn't dare to be without. I have Ibuprofen to hand just in case, but I've only ever reached for it after a particularly physical footy match. Overall, my joints do not ache like they used to when I was chowing down on meat two or three times a day. My diet is now 90-95% meat free and it seems to be the difference.
Fingers firmly crossed and touching wood etc.
Glassman said:
Update:
Over a year on and it's still going well. Still mostly plant based with occasional fish/eggs and the odd bite of a piece of chicken when the kids are tucking in.
Acute flare-ups: none.
Slight hint of gouty pain: occasional.
I'm not stocked up on Colchicine as much as I once used to be and wouldn't dare to be without. I have Ibuprofen to hand just in case, but I've only ever reached for it after a particularly physical footy match. Overall, my joints do not ache like they used to when I was chowing down on meat two or three times a day. My diet is now 90-95% meat free and it seems to be the difference.
Fingers firmly crossed and touching wood etc.
Have you had your uric acid levels checked in the last year though? Over a year on and it's still going well. Still mostly plant based with occasional fish/eggs and the odd bite of a piece of chicken when the kids are tucking in.
Acute flare-ups: none.
Slight hint of gouty pain: occasional.
I'm not stocked up on Colchicine as much as I once used to be and wouldn't dare to be without. I have Ibuprofen to hand just in case, but I've only ever reached for it after a particularly physical footy match. Overall, my joints do not ache like they used to when I was chowing down on meat two or three times a day. My diet is now 90-95% meat free and it seems to be the difference.
Fingers firmly crossed and touching wood etc.
I've said it many times, maybe not on this thread but certainly on others, unless your uric acid levels are brought under control then the silent damage is still a risk, and the risk is far more serious than the pain in a big toe once or twice a year.
The fact you occasionally still get a hint of gouty pain would suggests your uric acid is still high.
By all means go plant based, but at the same time get those levels checked for peace of mind.
The Ferret said:
Have you had your uric acid levels checked in the last year though?
I've said it many times, maybe not on this thread but certainly on others, unless your uric acid levels are brought under control then the silent damage is still a risk, and the risk is far more serious than the pain in a big toe once or twice a year.
The fact you occasionally still get a hint of gouty pain would suggests your uric acid is still high.
By all means go plant based, but at the same time get those levels checked for peace of mind.
This is where I am - I have been managing mild gouty flare ups for the last n years. Firstly with Indomethacin, and more recently with Naproxen. I've said it many times, maybe not on this thread but certainly on others, unless your uric acid levels are brought under control then the silent damage is still a risk, and the risk is far more serious than the pain in a big toe once or twice a year.
The fact you occasionally still get a hint of gouty pain would suggests your uric acid is still high.
By all means go plant based, but at the same time get those levels checked for peace of mind.
I spoke to the doc last month to get some more tablets, and she said that the advice has now changed and they really don't want to be managing Gout this way any more. The advice now is that if your Uric Acid levels are high, this needs to be managed with Allopurinol.
I'm just waiting for a mild flare up to flare down and I will have a blood test with the likely outcome that I go on the everyday pill.
The Ferret said:
Have you had your uric acid levels checked in the last year though?
I've said it many times, maybe not on this thread but certainly on others, unless your uric acid levels are brought under control then the silent damage is still a risk, and the risk is far more serious than the pain in a big toe once or twice a year.
The fact you occasionally still get a hint of gouty pain would suggests your uric acid is still high.
By all means go plant based, but at the same time get those levels checked for peace of mind.
I'm trying as much as I can to not depend on meds. I've said it many times, maybe not on this thread but certainly on others, unless your uric acid levels are brought under control then the silent damage is still a risk, and the risk is far more serious than the pain in a big toe once or twice a year.
The fact you occasionally still get a hint of gouty pain would suggests your uric acid is still high.
By all means go plant based, but at the same time get those levels checked for peace of mind.
The Ferret said:
...unless your uric acid levels are brought under control then the silent damage is still a risk, and the risk is far more serious than the pain in a big toe once or twice a year.
Either of these two books are well worth reading:
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Glassman said:
I'm trying as much as I can to not depend on meds.
I'm on allo, 200mg daily, havent had a flare since I started until one looked like it was about to happen 2 days ago. Have an emergency prednisone prescription for when it happens (had to get it renewed since I'd thrown the last lot out since I'd never needed it!), 5 day course, stopped after 2 days all fine. Levels checked last month, right where they want it to be.I'm not a huge beer drinker anyway, but I limit myself in no way whatsoever with what foods I eat and enjoy, apart from currently trying to get a bit fitter. I'd rather take the meds then eat mushy peas on toast the rest of my life. Working back what I ate the last few days when my flare up occurred it seems that in particular for me dehydration is my biggest cause. I remember thinking a few days ago while taking a wizz that I needed to drink more water that day.
Having said that I'm actually going to oktoberfest this year, and there will be a fair bit of beer consumed. Lets see....
HotJambalaya said:
I'm on allo, 200mg daily, havent had a flare since I started until one looked like it was about to happen 2 days ago. Have an emergency prednisone prescription for when it happens (had to get it renewed since I'd thrown the last lot out since I'd never needed it!), 5 day course, stopped after 2 days all fine. Levels checked last month, right where they want it to be.
I'm not a huge beer drinker anyway, but I limit myself in no way whatsoever with what foods I eat and enjoy, apart from currently trying to get a bit fitter. I'd rather take the meds then eat mushy peas on toast the rest of my life. Working back what I ate the last few days when my flare up occurred it seems that in particular for me dehydration is my biggest cause. I remember thinking a few days ago while taking a wizz that I needed to drink more water that day.
Having said that I'm actually going to oktoberfest this year, and there will be a fair bit of beer consumed. Lets see....
I've been on Allopurinol. I got the big flare up they warn about when you start. Six months later, I got another. GP then suggested upping the dose which made me think hard about the way forward. I'm not a huge beer drinker anyway, but I limit myself in no way whatsoever with what foods I eat and enjoy, apart from currently trying to get a bit fitter. I'd rather take the meds then eat mushy peas on toast the rest of my life. Working back what I ate the last few days when my flare up occurred it seems that in particular for me dehydration is my biggest cause. I remember thinking a few days ago while taking a wizz that I needed to drink more water that day.
Having said that I'm actually going to oktoberfest this year, and there will be a fair bit of beer consumed. Lets see....
As you say, they biggest factor here is hydration. You can do yourself a big favour by drinking water and plenty of it. It's not always practical, especially during the colder months (speaking for myself).
My diet/staple isn't boring. I have quite a wide range of food that I enjoy. Yes, the meat and meat products element has all but gone, but sometimes eggs and fish maybe once a week. I'm enjoying my cooking and I'm planning meals more than I ever did (it's also very cost effective and less wasteful).
Age becomes a factor too; at 52 (or 43 + VAT) the inevitability of change is becoming more and more apparent. That said, diet isn't the only lifestyle change. I'm still playing sport and still in a physical job. Not being ruled by gout (and the attacks used to be quite frequent) means I am enjoying life a lot better without that affliction. The mild flare-ups usually come after a heavy sesh over the weekend.
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