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I have had gout now for the past six years, and was able to control it reasonably well by a combination of diclofenac sodium. Last September the gout spread to both ankles and left me house bound for 10 -12 days. At the time, until I was prescribed colchicine, the gout continued to circulate from place to place until it finally abated. I have been pretty clear for almost a year, and now at precisely the same moment in time it has struck again. I always seem to get it in September. I have been prescribed 100ml of allopurinol a day which I am taking and told to resort to colchicine if it's not working. The colchicine can only be taken 12 tablets at a time with 3 days in between usage. The gout has in the meantime left my ankle and is now moving into my big toe joint and I'm not supposed to take the colchicine again until tomorrow. It's the weekend and the doctor isn't about – what should I do? Up the Allopurinol without his permission to 300g? Any answers welcome in the face of another impending onslaught.
Peter,
Firstly, how many times have you taken the 12 dose colchicine? When was the last time?
There is no problem upping the allopurinol to 300 on your own becasue that is the common dose…BUT DON'T DO IT NOW. The worst time to begin or to up your allopurinol is at the very beginning of an acute attack…it will only make it worse.
If I were in you shoes, I would abort the attack even if it's a day early with colchicine. If you start immediately maybe you can stop the attack with less than the 12. But do the first 2 pills as soon as you read this then and one and hour…if you have to take the 12, you do. Stop at diarrhea because usually the pain relief follows quickly.
(I hope you have stopped the dicolfenac, it is singularly bad for gout sufferers becasue it retains uric acid.)
Continue taking the 100 mg. allopurinol and have your uric acid tested as soon as you get to the doctor but you should soon be on a higher dose becaue almost no gout sufferers get low enough uric acid on 100 mg. Your goal will be a uric acid level below 6.0 mg./dL.
(I think there is something to the gout attacks in early Fall but I have never seen anything about its seasonality in print. I've got a similar phenomenon…migraine attacks in April and October.
)Thanks so much for this reply. I'm delighted to have found this forum as very few people seem to know specifically what is going on.
So far I've never had to use the full (twelve) dosage of colchicine and managed to abort the last attack in my ankle with 6. The expeditionary unit of gout in my big toe seems to be trying to make up its mind as to whether to go for the big attack at the moment and is still lingering at an early stage. However, it is still only 3pm in the UK and the witching hour usually arrives at around 5 as the sun goes down. If the gout makes a big move before midnight I'll take the colchicine. I've been taking it every three hours to date and it took twelve hours to bring the last attack under control. I only started to take the Allopurinol two and a half weeks ago, after a number of weeks and a number of minor attacks and gouty sensations that wouldn't go away. I guess from what I've read on this site that the allopurinol is loosening up the crystals that have been building up over the years? Thanks again fo the advice, it's very much appreciated.
Just one addendum: the toe attack is usually at 5 AM not 5 PM. Probably has to do with low blood flow and a cold foot overnight. I would recommend when you go to sleep tonight to wear a couple socks over the offending foot. Keeping it as warm as possible is a wise way to spend the night because urate solubility is directly proportional to the temperature of the joint.
zip2play said:
(I think there is something to the gout attacks in early Fall but I have never seen anything about its seasonality in print. I've got a similar phenomenon…migraine attacks in April and October.
)
I've had a quick look at gout and seasonality. Some reports show slight increase in Spring (US and Europe). A recent UK study reports higher incidence in Summer. None of the variations are outstanding, though they are deemed statistically significant.
At the moment, my view is that the most likely explanation is an individual's changing eating and lifestyle patterns. Probably a complex set of factors such as higher risk of dehydration versus lower risk of cold triggering gout etc, etc.
I'll keep looking, and report back if anything significant emerges.
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