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@Keith, good to hear from you mate. I wish my attacks lasted 5-7 days. This Sunday will make this attack 3 weeks. Its much much better now though and I can walk on it albeit painfully. A mistake I made may have been stopping Naproxen 10 days into treatment because I felt it was doing nothing for me (it brought very slight pain relief and I couldn’t see much in the way of inflammation reduction). I was taking the maximum prescribed dose of 500mg twice a day. I’m getting my UA levels tested on Monday and was hoping you could advise if these results would be accurate whilst being at the end of an attack or if I should delay the blood test till later..?

@nobody, yep read that post, thanks. I can guarantee you that soaking my the affected foot in Epsom salt really did work. It definitely brought me relief.
Take a look at this site which also has input from Keith:

Epsom Salts Baths

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@nobody, interesting information there mate, thanks. I really do think this was all due to the increase in allopurinol. My UA levels were 388 just over a month ago when on 200mgs and literally 5 days after starting 300mgs the attack hit. I’m guessing the UA levels must have dropped pretty low after hitting 300mgs which probably caused the attack.

@Patrick, thanks man. I’ll check with my GP next week both about the injection and Colchine and see what they advise going forward whilst the allopurinol does its thing. With regards to naproxen do you take 500mgs twice a day when you get that feeling? And how long for? On another note, have you ever had an attack follow another attack in the same place prior to starting or just after starting Allopurionol..? Thanks pal.

Epsom Salts For Gout

On a general note, whilst dealing with this pain I decided to do some intense googling about relief techniques and came across using Epsom salt and dissolving it in warm water and placing your foot in for a foot soak. Now I know many people will say it may just be psychological or just coincidence but my foot really does feel much better. The inflammation also seems to have come down. Was it the salt or was it the warm water, who knows.. But there seems to be some link to Epsom salt and uric acid. Ultimately what matters is the end result and we’ll see how I feel tomorrow.

@Keith, any advice on length and severity of an attack outside of using any pain relief or anti inflammatories and just allowing the body to deal with the inflammation alone (taking allopurinol only)? Thanks

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@nobody “Sure beats an attack that doesn’t end”..? Now your worrying me! Are there actually attacks that go on for more then 3 weeks? This coming Sunday will mark two weeks of constant pain with varying degree. Any idea about urate test during an attack (numbers being wrong or not)? Are you taking allopurinol by the way..?

@Keith, any advice..?

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Hi guys, thank you both for such fantastic advice, just a few things I’d like your advice on;

@Patrick – tell me about it mate. It’s driving me insane. I’m just worried it’s the allopurinol causing this? I’ll definitely ask my doctor about Methylprednisone packs when I next see him. They sound helpful. Can a local GP do direct steroid injection? I’m based in the UK and the last attack I had she mentioned she can’t do a joint fluid test to confirm gout, Is it as difficult or tricky to perform? By the way Patrick, do you still get attacks whilst being on allopurinol?

@nobody – Thanks for your advice mate, I’m going to ask my gp for colchicine next week, I initially avoided it when it was offered to me at the start of my allopurinol treatment. Is it something I can use whilst in a attack or is it something I can only use when the feeling of an attack is coming? Also the blood form I have is only for urate levels so I don’t really want to use it if the results won’t be accurate? I mean is hit or miss with results or are tests generally completely wrong during an attack..? You also mention your attacks can last longer but are those long attacks you get part of the same chain of days or are they spread across weeks? My first and second attacks were over two weeks long! Lastly are you too taking allopurinol..?

Thanks guys.

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

Thanks Keith

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Hi Keith,

Thanks for your response mate. I’ve got the general gist to what you explained but still a little confused.

1. Ok I think I understand, but I’ll wait for the right words when you have time.. Thanks 🙂

2. Osmosis makes sense on this one. Concentration levels outside the coated crystals meet levels inside and therefore will move to the less concentrated zone (blood stream) exposing the now dissolved crystals as a result UA levels increase in the blood I assume.

3. I’ve read your discussion and love it thanks. I think I may have something to add to this one. My thesis is reasonably straightforward. They dissolve with the lower levels of UA and then the UA levels would naturally increase in the blood because of the dissolution of the crystals increasing the overall UA level once again which in turn may or may not cause new crystals. Depends on the UA level when they dissolved (thus another attack may occur)..?

4. I’m almost positive and agree that temperature is a big factor as my attacks generally start after a hot shower and not as often in the middle of the night. Potential increase in blood flow to the feet when showering which in turns cause a little expansion which may or may not dislodge a few crystals and an immune system attack is also imminent. What do you think on that idea..?

5. I’ve read that article before but it doesn’t seem to explain why it takes such a long time to build up and once they dissolve with treatment why it doesn’t take too long before they build up again and cause joint pain. I’ve had high UA for over 15 years and only got gout 2 years ago so it took 13 years to build up crystals and deposit them in joints and if I stop allopurinol it will only take a few months or let’s say maximum one year for an attack to flare up again. How does that work? Unless I’m understanding your article completely wrong..? 🙂

Thanks For everything Keith 🙂

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Sorry about your swelling. One day attack? You are one lucky chap. My attacks before allopurinol were a minimum of two weeks, I’ve been on allopurinol for 3 months now and am enduring another horrible attack that has lasted about 10 days and still ongoing.

My advice would be to check your UA levels first before starting any treatment and work from there but I am no doctor.

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I agree with nobody on this. If your not getting any side effects whilst being on allopurinol and your kidney tests seem fine then why risk the possibility of gout attacks? NSAIDs are just temporary corrective relief but not long term preventative treatment.

With regards to medicine for life, well the real question is what choice do you have? You could potentially try an extremely strict diet and check your UA levels whilst on allopurinol then drop your dose to 200mgs and see how your body reacts with another UA test and again to 100mgs and then check levels again but balance this all with life. Is it worth the pain you’ll have to suffer should you get frequent attacks?

James

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Hi Lance, I’m glad this post might be helpful to you.

I’m extremely anxious of what the experts have to say too!
I’ve been completely confused about the above and would love to get the insights as to how it all works in more details.

Thanks everyone 🙂

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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 🙂

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Hi Keith, a few days ago I started taking 300mgs of Allopurinol every other day so that my body gets use to the higher dose rather then going straight to 300mgs from 200mgs (also hoping an attack won’t occur if going up slower). Unlucky for me I got caught up in a gout flare today.

I’m assuming I should not go back to 200mgs from tomorrow and stick with 300mgs going forward now correct?

Could it be that the increase to 300mgs caused the flare up and started dissolving more / older crystals?

I would have thought 388 ummol was reasonably safe and another increase wouldn’t “really” be necessary.

It’s the same left toe as before…

🙁

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@Keith Great response!

By the way Keith I read your fantastic explanation of why the “road to recovery hurts article” and I’d like to thank you for it. Especially the sentance devoting it to me 🙂

I do have a few questions regarding it though, do you want me to raise them in this thread or start a new one?

Thanks again!

@nobody, I totally agree on the NSAID.. When I’ve had a flare up and start my course of them (Naproxen) the first tablet always causes me painful stomach cramps then things get a little better. I’ve managed to get my hands on the gastro resistant tablets which I will try next time (hopefully there won’t be a next time or a need for them though). 😀

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@nobody, whilst I totally agree that you shouldn’t let the severe or not so severe symptoms deter you from your goal of lowering UA levels some people might not actually have a choice but to tolerate the medication unless there is a medical interaction with another medication one may be taking, even then there are other UA lowering medications to try.

From all the research I’ve done and the fantastic source of information this site provides everyone will quickly come to realise what harm high UA levels can do to our bodies.

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Hi Keith, thank you so much for that fantastic article!
I’ll get started reading it and get back to you if I have any questions. Thank again mate 🙂

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Hello Keith,

I’ll be seeing my haematologist tomorrow to discuss the haemoglobin issues etc. I’ve personally decided not to start 300mg until we see what the latest results are. I’m currently taking 200mgs daily and sit at around 388 ummol. Let’s hope things are ok for me to increase further. He has no issues but I’m the one who is a little worried as my haemoglobin levels have come down a little since starting but thats necessarily allopurinol.

Keith I would really appreciate if you could explain why I’m getting pains that I never got before. It would really help me understand further.

Thanks mate.

James

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Thank you for your encouraging words Keith / Patrick.
I’ll definitely try and get those joints moving more.

Just an update, I got my UA results back yesterday!
We’ve gone down from 555 to 388..! I am shocked and extremely excited to say the least. My elbow pain has also reduced slightly but my left toe still feels a little painful when bending it far back (which wasn’t painful before gout). I’m hoping all these joint pains are crystals dissolving away rather then side effects of the Allopurinol. The only one thing that my haematologist wasn’t to happy with was my haemoglobin dropped by approximately 1 point so from around 7hgb to 6hgb. He asked me to come next week and do another blood test to verify if that is indeed case. I asked him several times if it’s the allopurinol that may be causing this hub drop and he feels reasonably confident that’s it’s not. In fact he felt increasing the allopurinol dose to 300mg to drop UA further is the a good idea.

My worry now is if allopurinol may be causing my haemoglobin drop?
I’ve done a little research on blood counts and allopurinol and that it may interfere with haematological counts (including the leaflet in the box). All other results seem normal enough though.

Any advice or test one can do apart from stopping allopurinol to see if my haemoglobin returns to my normal levels?

Thanks guys

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Patrick, following your last post, I just wanted to say I admire people like you (firefighters). It’s people like you that make a huge differences in people’s life let alone saving lives.

I’m constantly worried about doing any physical exercise in case I cause an attack whilst finding my optimum allopurinol dose. 🙁

My left toe has never felt right since the first attack and I’m really hoping in time allopurinol will fix that and I’ll regain complete flexibility.

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