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1st time poster here but have been reading this site for weeks, best gout site on the web by far. Anyway, heres my story. 30 years old, family history of gout on both sides of the family, (dad has it as well as my uncle on my mothers side), I'm pretty sure now that I had an attack last winter but the podiatrist I went to assured me that it was not gout but post tibular tendonitis. That gave me a sigh of relief at the time, but now I am quite certain that it was gout. I had another attack at the end of august in my right big toe with the usual symptons. Woke me up about 3 am, constant pain, etc. It then jumped to my ankle a couple of days later, at which point I decided I would go to the doctor. Went to the doctor, he said no doubt that it is gout, gave me prednisone to take for 2 weeks. Well, the prednisone helped with the swelling which in turn made me feel better so being the stubborn person that I am, I stopped my dosage after about a week. No problems for about a week after that, then I took my daughter to the fair, which requires a lot of walking, and that night my knee starting aching, but not bad enough to be concerned. Well later that night I was awoken with worse pain than I could imagine. Went back to the doctor, (with my wife and daughter so they could hear what the doctor said), he gave me another round of prednisone, which I completed, which helped initially but didn't solve the problem. I've have 4 or 5 minor attacks since, and I still can't straighten my leg completely. Went back to the doctor last week for a follow up and to get a kidney and ua test. Doctor called back today said kidney test is good, but ua level is 10.8. WOW. Didn't expect that. He's putting me on 100 mg once daily for a week, then 200 daily for a week, and then another ua test.
Since i've been in pain i've been doing the following:
1 tbs a.c.v. daily
cherry juice daily
10-12 20 oz. bottles of water daily
vitamin c daily
I truly enjoy a good beer, (especially guinness), and a good steak, and most of the things that apparently I shouldn't.
My question is this: Do you guys think that this is the correct dosage of allopurinol to start with, and when I get my levels under control, will I be able to enjoy a cold stout and steak while on the allapurinol.
Sorry for the lengthy post, but I wanted to make sure I covered everything.
Normally is NOT a good idea to start Alopurinol during an acute attack, it make take longer to stop.
My rheumatologist put me on AP after several weeks after the attack subsided, also gave me colchicine 2pills/day as a prophylactic and told me that I should take it for at least 1 year. You may know that when starting AP there could be several initial gout flares.
In your case there is a two step solution:
- Control the actual gout attack. Predinisone + colchicine + NSAID, RX by a Dr.
- After the attack is controlled then AP + colchicine to control hyperuricemia. Or any other med. your Dr. prescribes.
Water, cherries, vitamin C, diet, others, may help but a real solution is AP. After some months taking AP you can go back to a normal life, normal diet.
I suggest to go with a rheumatologist.
I really like a start of 300 mg. to start, but at least the 100-200-300 progression is better than nothing.
Alas 100 or 200 mg. allopurinol will not help with a 10.8 uric acid/
The faster you get to 300 or 400 mg. allopurinol and an SUA below. 5 the better. Honest, 100 mg will do more harm than good.
An aside: I am beginning to question the old saw about waiting til the END of an attack to begin allopurinol. I'd like to see some proof and I am getting tired of ancient accepted wisdom based on nothing,
“Hey guys, mercury is deadly poison so lets put it in every kid's mouth!” Wrong, it's a POISON!
“You have an ulcer, what you need is a milk diet”…Wrong, you need antibiotics for an H. pylorii infection.
“Oh, George Wahington has the flu…Let's BLEED HIM!”…Nope, you killed the first U.S. president.
Thanks for the replys. Currently I'm not having the pain in my knee, I just can't straighten my leg. (I'm assuming b/c I walked with my leg bent for 2 weeks), that's why the doc went ahead and prescribed the ap. My question for you guys is, if I do have a flare up initialy with the ap, should I take the prednisone and stop the ap, or up the dose of the ap? Also do you guys think that colchicine is a better alternative that the prednisone? Last thing, the past 2 months I have eaten better, no beer, tons of water, and my level is 10.8? I was under the impression that drinking a lot of water wouldn't remedy the situation, but it would at least lower my ua levels. Do you think my levels could have been much higher? Or is this probably just bad genes passed down. And also how high can ua levels be?
Quick reply: SUA can go over 12 in bad cases.[Rep. here, various]
It's important that you get blood checks- you need time to prove your meds are ok with you and see what flares.
Seems like your Dr has a better than usual understanding of gout, and like many cautious of overdoing it in the early stages.
There's no one formula for gout- other than not ignoring it and measuring your blood often. Personal UA meters are popular for this reason.
What you do right now is a slow effect on what has built up over years, imo. Daily changes mask variations too- diet etc. Water is good, but only in time with the right amount of UL meds/diet change -which you have yet to establish @ correct level.
Keep going on AP now assuming no side effects. Your Dr should advise on this and a flare is to be expected ,but not guaranteed..
Colchicine is not a pain killer and needs to be tailored to the individual [trial and error]- it is effective in reducing the immune response causing the whole shebang of gout attack -Stay near a toilet,though!
thanks trev, I think the 1st time I went to my doctor with these he wasn't very knowledgable on gout. But by the 3rd visit it was obvious that he had done a lot of research. I go back for another ua test in 2 weeks, and another 2 weeks after that. I'll post my results after each.
I have just read an article on differential treatment of gout and the preferred method for using prednisone is by injection into the afflicted joint if only one joint is affected. With more than one joint, then the oral is the better route. Seems to make sense to get the most antiinfammatory drug INTO the inflammation site. Why treat your head, heart, liver and kidneys when your FOOT hurts?
Get to 400 mg. allopurinol as quickly as possible and test your SUA after a couple weeks. Depending on that number, go from there. The longer you hang at 100 or 200 mg,, the longer you will prolong your pain.
The best oral drug for an acute attack is still colchicine and the second indomethacin (ignoring narcotics that is.) The only reason colchicine is superceded with less effective drugs is that for some silly reasons doctors think they will be sued for malpractice if someone gets diarrhea??? Go figger.
Suffice to say that your uric acid levels are very high and it may take more than the normal 300 mg. allopurinol to get them down to the 5 level. Once you start the allopurinol NEVER stop it, attack nor not, unless you show a serious allergic reaction (swollen lips and eyelids, throat closing down, difficulty breathing…called angioedema. Hives are another syptom to beware.)
Allergic reactions to allopurinol are rare.
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