Fear of allopurinol side effects

[LinkedIn Gouty]

I am 51 with a 4-year history of Gout. I have 2-3 attacks per year mostly precipitated by eating a lot of fructose or being sick. Most are minor lasting 1 day. Uric acid runs between 7.5 and 10.

Doctor suggested Allopurinol, I am hesitant after reading all side effects. But I am concerned with long term effects of gout like kidneys.

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Allopurinol Side Effects are not as bad as Excess Uric Acid!

[Keith Taylor]

[This is from a LinkedIn discussion. Shared here to help other gout sufferers avoiding uric treatment due to side effect fears]

Currently, I’m chatting with a guy at my help desk with similar allopurinol fears. So at some point I’ll gather some resources to address this issue.

For me, it came down to balancing potential allopurinol side effects with very real uric acid main effects. Because I had a broken knee and a gouty ankle at the same time. And I couldn’t distinguish between them pain-wise.

In fact, I dismissed the broken knee as a rare simultaneous joint flare. Until x-rays showed otherwise. So as soon as I got out of hospital I arranged with my doctor to start allopurinol.

By the way, I never discussed Uloric/febuxostat with him. But I’m more fearful of febuxostat side effects than allopurinol.

[nobody]

The risk of serious side effects can be considerably diminished by being careful, more careful than most doctors would tend to be. If there’s no emergency, you can start with very small doses and increase them slowly, getting regular blood tests along the way (and diligently monitoring your vitals).
Depending on your ancestry, I understand there’s a genetic test you can get specifically to prevent very serious allopurinol side effects as well.

[LinkedIn Gouty]

I am still weighing my options with allopurinol my last Uric acid test was 9 mg/dL in February and had an attack this week. I average 3 attacks per year. I am purchasing a gout meter to get more levels. What have you heard about Terminalia bellerica as a possible treatment? I would like to post questions to the forum but don’t know how to.

[Keith Taylor]

After delays, I’ve posted the Original Poster’s (OP) LinkedIn response above. Now, I intend to:
– Address the forum posting difficulty.
– Investigate Terminalia bellerica which I can see has more than one relevant uric acid study.
– Respond direct to the OP on LinkedIn.
– Reply here with relevant updates.

[Malik A.]

I, too, have the same fears. I’m three weeks in an episode, & this flare up is getting the best of me. I have been taking prednisone, which helps temporarily. But the next day, before the next dose, the pain & swelling try to come roaring back. I’m not eating much cause I’m afraid everything (beans, mushrooms, nuts, etc.) will cause the situation to get worse, so I’m dropping weight. This is a mess. I have the Allopurinol, but since my liver enzymes were elevated, I’m terrified to start taking them as well. By the time this is over, I will need counseling on top of Allopurinol. I have an appointment with a podiatrist the end of this week. I don’t see the rheumatologist until the end of the month. I’m truly in gout hell.

[Keith Taylor]

I feel for you Malik. But you should know that there is a simple answer – adequate pain control. Which is why I recommend that people don’t start uric acid treatment until they have confidence in effective pain management.

Professional guidelines take on this is to prescribe colchicine as a preventative for at least the first six months of allopurinol treatment. Now, I don’t necessarily agree with that in all cases. But it’s better than nothing.

Key to getting free from this gout pain hell is to understand you have a mix of 3 tools:
1. Colchicine to stop inflammation getting worse. But it does nothing to reduce existing inflammation. Though that inflammation will subside naturally, it is usually better to use one or both of the other tools in support.
2. Anti-Inflammatory drug to reduce inflammation. Due to the way our pain signaling works, this usually stops pain as well. Everyone is different but some people might still have levels of discomfort that they cannot tolerate. So …
3. Pain blocking analgesics that are compatible with whichever anti-inflammatory you take.

Every gout sufferer needs to work out a plan with their doctor for their own pain management routines. Because you can vary the approach to match the intensity of pain and swelling. But this is something you must discuss with a qualified health professional.

I’ve commented several times before about my personal choice of health professional – hospital ward nurses. Because they are practicing pain management every day with a wide range of patients. Depending on the experience of your doctor, my next choice would be a pharmacist or doctor. Note that gout needs prescription strength pain relief. So your doctor has to get involved at some point. Therefore, your best first option is to discuss a proper gout pain strategy with your doctor. There are lots of options. Especially because some drugs will act as more than one tool. But your plan must include strategies for inflammation control, inflammation reduction, and residual pain blocking.

Getting back on to the topic of allopurinol side effects. There are standard medical procedures for dealing with elevated liver enzymes during allopurinol treatment. So you should discuss these with your doctor at the same time.

If your doctor seems clueless about how to manage uric acid treatment properly, then your rheumatologist should have the answers. In any case, it’s much easier to have those discussions when you are confident in gout pain management.

[Malik A.]

The Battle Royal continues.

Well, I saw the podiatrist. He went over X-rays & my history (I saw him a couple of years ago when I had my last battle). He explained that I need to really sit down with the rheumatologist & nail down a plan of attack. He was aware that I have not seen the rheumatologist in the office, everything has been over the phone, & it’s just been “take the pills.” He read all this in the notes in my file. So, he gave me a steroid shot directly in the joint. It was excruciating, but gave me a few days of relief (bliss). Unfortunately, that reprieve seems to be over. This morning the pain, swelling, & stiffness reared their ugly heads once more. I plan on changing rheumatologists today & see if I can get an emergency appointment with someone right away. I know none of this is easy, but I have to be as proactive as possible.

I agree I need pain management, but I have another question: does gout usually last this long? And is it usually this hard to lick? I ask because you mentioned the swelling, etc. would eventually, naturally go away. This is over a month now. My father has attacks, but they normally go away in a few days to a week at most.

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