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Hi guys
I had my first gout attack two months ago and have had four more since.
I have had my uric acid levels tested and was above the normal range at 0.56.
My Doctor has given me some nsaids but they don't seem to do much except to give me a bad stomach.
My question is
” is there any way I could expect to bring my uric acid level down to the normal range 0f 0.42 via a change of diet and weight loss ( I am about 2 stone over weight ).
Or is Allopurinal my only hope?
p.s I am 45 and 4 years ago I had a kidney stone and my uric acid level was the same then as it is now but this is the first time that I have had gout which was in the ankle and not my toe.
chacho, as I’m sure the others will point out shortly, your only hope is lowering your uric acid level. How you go about doing that task is mainly up to you and your rheumatologist. Allopurinol has been a successful method for some here. In my case, Uloric is the drug of choice. The common denominator for us all though is getting our uric acid level down and keeping it down.
chaco,
In metric terms you want to be looking at a steady <.35 (which is equivalent to <6.0 mg/dL) rather than the top of the “normal” range. Once we have had a gout attack we are no longer normal. I think it is highly unlikely that good living can get you down far enough and I recommend a drug regimen…usually 300 mg. allopurinol.
Your .56 corresponds to the conventional 9.5 mg/dL and that is very high.
Hi chaco,
I concur with zip2play – you must get your uric acid below .35.
I believe tht you should view this with some urgency. At the moment, you are depositing uric acid crystals everyday. Your joints will become increasingly eroded, together with serious cartilage and ligament damage.
If you assume for the moment that excess weight is to blame, losing two stones (28 pounds) in a short space of time will increase your uric acid load. It is far better to take allopurinol at the same time as you lose weight, then review the situation.
I recommend 6 months on enough allopurinol to keep uric acid in the.20 – .30 mmol/L. This will protect you while you lose weight, and perhaps improve exercise if necessary. You are then in a much better position to review your alternatives.
It is a good idea to get a 24-hour urine test before you start the allopurinol. That will give you good information about your urate clearance rate, which will play an important part in planning long term approach.
This does not mean that you will not be dependent on allopurinol in future, but it is your best chance of eventual control through lifestyle changes.
Thanks for the advice guys.
I will make an appointment to see my GP to discuss taking allopurinol and then buying a uric acid meter to keep an eye on my levels.
Can I ween my self of the tablets say after 6 months to see if the levels return to a high level after weight and diet changes or will that be too much of a yo yo effect.
Chacho: I always hope to ween from allopurional but until I get down to my BMI (which is rediculious) and change my eating habits. I wouldn't take the chance. I learned that starting alopurional can bring on nasty attacts. ( GP told me this could happen and it did) I don't want that pain again.(it was the worst Ive had so far) I still have pain in my hip from walking with a cane. I believe some where there is a natural cure. It seem nature always has a ying/yang effect for everything. What works for one doesn't always work for another.
When you are starting allopurinol, the weaning-on process MIGHT trigger an attack, but the chances are less than if you did nothing. The only way you can increase your chance of an attack when starting allopurinol (compared to doing nothing) is to get the dosage wrong (i.e. you take enough to start exposing old uric acid crystals, but not enough to get rid of them).
Best to start at 100mg just to see if you are one of the extremely rare people who has a bad reaction. Weaning-on can then be as fast as you like to get to your target uric acid level. Doctors often suggest increasing by 100mg at a time, but quite often a bigger increase is justified. The sooner you get to 3 or 4 mg/dL the less chance you have of triggering an attack.
Many gout sufferers who start allopurinol never get a gout flare. All gout sufferers who do not reduce their uric acid to a safe level WILL get another gout flare.
The weaning-off process comes after you have kept your target uric acid level for 6 months without a gout flare. You can then be almost certain that all old crystals have gone, unless you still have signs of tophi (in which case, wait longer).
Your target is now 6mg/dL (forever), and you can slowly lower allopurinol dosage. Proceed with extreme caution. Wait at least 2 weeks between each reduction, and get uric acid levels checked before you reduce the dose. If you are well below the 6mg/dL mark, you might drop by 100mg. Between 5 and 6, you should go for a pill-splitter and make smaller reductions. Also, as you go above 5, you should make sure that at least 2 consecutive tests confirm that your level has not risen to 6. That will ensure that you do not get a gout attack ever again.
If excess weight was causing your gout, and you have managed substantial weight loss, then you might get the dose down to zero. If not, you might have to continue with a smaller maintenance dose of allopurinol – I hope it is for a very, very long time.
Can I ween my self of the tablets say after 6 months to see if the levels return to a high level after weight and diet changes or will that be too much of a yo yo effect.
Short answer to that is an empatic NO, you cannot ween yourself off allopurinol!
If one's goal is the eventual drug-free treatment for gout it is best not to start allopurinol. If one is going to commit to allopurinol it should be a life's committment. Gout does not go away!
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