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OK. Here goes: Gout for at least 15 years. Infrequent attacks. Uric acid as high as 13 mg/dL. Since 2009, used steroid based medication successfully to treat attacks. Attacks became more frequent (monthly)?starting 4th quarter 2011. Started allopurinol 600 mg daily?since June 2012. Uric acid = 2.4 mg/dL – 3.7 mg/dL. Attacks still every month. Current site is left knee (often) . Stopped steroid last month. Now looking to find out why attacks despite very low uric acid levels. Plan: colchicine, treat and preventative, lower allopurinol. Advice please. Many Thanks.
@dlanor, please stick with it.
Until DECT becomes more widely available, it is very difficult to judge hidden deposits of uric acid crystals. If they’ve been building up for 15 years, they are going to take some time to get rid of. My numbers are similar to your, but I went for the maximum 900mg allopurinol (UK – it’s 800 mg per day in USA). My attacks stopped completely after 6 months. Up to that time I went from one or two a week to about once a month, but nothing now for about a year.
A significant part of my success is down to my complete faith in my ability to handle gout attacks, coupled with a recognition that the time between my attacks was getting longer. Though I took preventative colchicine for a few weeks, I soon gave this up in favor of “as required” approach.
As required colchicine works best if taken at the first sign of a gout attack. If not resolved within an hour take one more, with a maximum of two per day. After an hour if discomfort was still too much to bear, I took ibuprofen (800mg), and after a further two hours, paracetamol (US: Tylenol) if required. I cannot remember ever having to repeat the ibuprofen/paracetamol sequence, but if necessary you can repeat up to 4 times a day. Of course, there are alternative anti-inflammatories, and alternative analgesics, but the 3 line attack always works. You should discuss packages to suit you with your doctor or pharmacist.
Another helpful habit is plenty of fluids and gentle exercise as much as possible.
As you can see, I don’t agree with lower allopurinol until you have gone six months without a gout attack. I have maintained my maximum despite no attacks because I still have visible tophi on my right elbow. This is quite a solid lump, so I’m guessing that it will take some time to work through the mass of dead blood cells.
I got uric acid down to around 2, so I reckon you might need a bit longer than the 8 months you have had so far. Everyone is different in this regard. Some people benefit from supporting allopurinol with probenecid to encourage uric acid excretion. Very unscientifically, I chose a pint of skim milk a day, and I’ve no idea if it helped or not, but it certainly did no harm.
Getting rid of 15 years of uric acid deposits is never easy, but better if you fight with everything you can. I’m confident that you will get better soon. Just hang in there. If no improvement in another 3 months, I advise a checkup by a rheumatologist to rule out complications.
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