Gout For Twenty Years

[Keith Taylor (GoutPal Admin)]

Hi,

I have suffered gout for twenty years and have managed it by using Indometacin at early detection however I seem to have aching joints most of the time now which I believe is gout related.

The doctors have not really been as informative as yourself and I have tried using allopurinol on several occasions and the pain becomes that unbearable I stop using it.

Another strange scenario is that I drink alchohol in moderation about 3 times a week, however if i abstain from drink for a period of more than 10 days or so I appear to start to get  more gout symtoms is this because the twenty year build up of uric acid crystals, when I give my body a rest from drink the existing uric acid starts to solidify and cause gout again?

When I come back from my holiday in April I am going to give it my best shot at getting rid of the gout. Bear in mind I have had gout for twenty years and my Urate level has always been above the accepted level. What do you reccomend as starting dosage (may be 100mg) and how long will I have to endure the pains for before It will eventually rid my body of the already established crystals

[Keith Taylor (GoutPal Admin)]

Rob Shaw said:

Hi,

I have suffered gout for twenty years and have managed it by using indometacin at early detection however I seem to have aching joints most of the time now which I believe is gout related.

Hi Rob,

I don't want to sound contrary, but you haven't really been managing the gout. Indometacin is just a pain killer, so all you are managing is your pain. It does nothing to lower uric acid levels, so all this time, the crystals continue to increase.

The doctors have not really been as informative as yourself and I have tried using allopurinol on several occasions and the pain becomes that unbearable I stop using it.

The most important thing to realise is that, initiially, allopurinol can cause gout pain, and usually needs to be supported by pain relief. The second most important thing is that once started, you should not stop unless advised to do so by your doctor. Allopurinol is only effective for about a day, so once you stop taking it, you are back where you started.

Another strange scenario is that I drink alchohol in moderation about 3 times a week, however if i abstain from drink for a period of more than 10 days or so I appear to start to get  more gout symtoms is this because the twenty year build up of uric acid crystals, when I give my body a rest from drink the existing uric acid starts to solidify and cause gout again?

There are many many reasons why a change in habits can affect your gout. Many people maintain that moderate wine intake can help reduce inflammation. If the drink is normally at the pub, stopping going out might encourage some stiffness through reduced mobility. Etc, Etc. I would not worry about this too much at the moment. The best thing to focus on is lowering uric acid. Once this is being monitored properly, you have a measure by which to judge things. Even then, it can be very difficult to work out what is happening with gout. The next best thing, after managing uric acid levels, in my opinion, is to focus on enjoying yourself.

When I come back from my holiday in April I am going to give it my best shot at getting rid of the gout. Bear in mind I have had gout for twenty years and my Urate level has always been above the accepted level. What do you reccomend as starting dosage (may be 100mg) and how long will I have to endure the pains for before It will eventually rid my body of the already established crystals

I would see what your doctor advises – it's a good measure of the level of care you can expect to receive, and you can discuss that here. Normal procedure would be to start at 100mg and increase until uric acid is maintained around 5mg/dL. Pain will continue for a few months, but should become less frequent and less intense every week, as long as the uric acid level is kept to around 5. After 3 pain free months, the dose might be relaxed a little to maintain levels around 6mg/dL. Make sure you continue to monitor uric acid even when you feel well – you do not want to go through this and fix your gout pain only to have the crystals creep back up again in future.

Please keep us informed of your progress.

[zip2play]

I started my allopurinol at 300 mg. and kept it there for almost 20 years. I didn't have any problems with attacks after starting.

I like what you say about “however I seem to have aching joints most of the time now which I believe is gout related.” I have more than a sneaking hunch that LOTS of arthritic type pains are uric acid related. In fact, a rather prominent orthopedic surgeon got excellent results with his severe back pain patients with regular injections  of colchicine. So once you have gout you can never be sure when your shoulder or knee hurts, or you come down with a backache, what is causing what.

Do you have any tophi that you can see or feel?

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