Gout Attacks despite 12 months Allopurinol Treatment

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Gout attacks 12 months into allopurinol treatment

First had gout 20 years ago with 2 attacks but then had a fallow period for 18 years with no attacks. 3 years ago started UK standard drug regime of aspirin, bisoprolol, atorvastatin and ramipril following mild heart attack and angioplasty.
After 3 gout attacks in 12 months started allopurinol treatment Oct 2018 initially 100 mg, then titrated up to 300 mg to achieve target level of 300 mg uric acid. Been at this level since March but have suffered 4 attacks since then. Each attack treated with short course of coclchicine and naproxen.
Also had x-rays on both feet which identified osteoarthritis in both big toe joints.
Diet has been changed to cut out beer and avoid high purine foods.
Q1. Can I expect to flush out all the embedded uric acid crystals and am I being impatient?
Q2. Should the allopurinol dose be increased to accelerate the process.
Q3 Am I confusing the pain as gout rather than osteoarthritis pain

I have tried to research average time for Allopurinol to achieve attack free status without success.

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coclchicine = colchicine

[nobody]

Especially after failing to treat gout for many years, flushing out uric acid can take a very long time (possibly several years).
Diet-wise I would recommend avoiding all diuretics (not just beer), drinking a lot of water and eating foods containing a lot of minerals (such as most vegetables).

I really can’t venture an opinion with regards to your allopurinol dose based on the limited information you have shared. I can only say that, if your SUA test results (notice the plural) are under 300 umol/l, your current dose is serving you well already.

If you have OA at the typical locations where you get gout attacks, your symptoms must be confusing.
It is unfortunately next to impossible to tell gout symptoms suppressed by colchicine and naproxen from other problems, except perhaps by drawing sinuvial fluid which isn’t the most reliable of procedures. And for the time being, I would not recommend you stop taking drugs to suppress inflammation whenever your symptoms look like they are flaring up…

[Author]

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