prednisone or allipurinol

[jonpayson]

Like many, I am on multiple medications.  Ive been on allip for 6 weeks or so, while also being on prednisone (20 mg).  Ive got a lot better, and the majority of the pain is gone.  Ive been getting better slowely and consistancy over the last 6 weeks.  I have not fluctuated my prednisone, its been a constant.

My question is that now it is coming close to the time to ween of prednisone,

HOW DO I KNOW IF ITS THE ALLIPURINOL OR PREDNISONE THAT HAS BEEN HELPING ME?

thanks,

JP

[rdavisiii]

They are both helping you.  The Allopurinol is working on lowering your Uric Acid level, you will likely take this forever, it is just something you do now.  The Prednisone is for the swelling only, this keeps the swelling down and your doctor should have a plan to ween you off it, if you are unaware of it you should contact them directly and get a good understanding of the plan.  I was on the same combo and only used Prednisone on two seperate occasions, started at 90mg a day and over the course of 9 days I weened off it.  For me Prednisone basically elimanted my Gout symptoms.  The Allopurinol prevents Uric Acid from being created in your body for a short time(hours) after you take it.  The idea is to lower the amount being created so your bodies normal processes can process out what you do have, over time this will reduce the overall Uric Acid level in your body.  Once you get below a certain threshold(Typically 6mg/dl) the existing deposits you have will begin to disolve and over a longer time if dosed correctly those deposits wil go away and your Uric Acid levels will stay low.  The pain is not the most important item to focus on, the Uric Acid level is.  If you fail to get and keep your Uric Acid level below 6mg/dl you will continue to have Gout attacks and continue to accumlate deposits and you will just continue to get worse then you are now.  In the beginning of your Allopurinol consumption you will get additional attacks as your Uric Acid level drops, this is expected and you should not stop taking Allopurinol or you are simply setting yourself back in your treatment.   Continue to treat the pain and swelling with prednisone if that works for you until it is manageable without it, stay with the Allopurinol, get your Uric Acid levels checked every 4-6 months and know them and eventually you will be pain free. 

[jonpayson]

Thanks for the education.  I really do appreciate it. 

….but,

I was looking more specifically for how you know if the allip is working or not, if every time i try to get off the prednisone which i have been useing as a constant med at 20 mg i need to ramp back up on it when the pain starts.  In other words, is it normal to have pain while going off the pred, or do i need to stay on the allip longer?  My research shows that im probably not producing by myself anymore becuase ive been on it for weeks, so im not sure if the pain is inevitable until my body produces its own, or if i just need to stay on it until the allip has more time.

thanks,

JP

[rdavisiii]

You cannot judge the results of Allopurinol from the pain that you feel.  The only way you know if AP is working is by checking your Uric Acid levels.  If they are not dropping then you need more of it or AP is not working for your condition.  This process can take months, not weeks.  I had been on 300mg of AP for 3 months and my Uric Acid levels were hovering around 6, a very bad place to be.  Riding at the upper threshold for safe Uric Acid Levels can cause lots of pain because you never start disolving and your levels never stay low.  They upped it to 600mg and I had an attack within a few days of taking the increased dose, this was expected.  Went on prednisone and away it went.  I read some folks on here have endured months of pain before it got better for them, so I guess it is normal for some gouties.  I think I was fortunate to have so very few issues after starting AP.  Understand your Uric Acid levels and treat the pain as needed.  Prednisone worked best for me, no stomach issues but it did make me eat like a horse and display a little roid rage from time to time. There is other options if Prednisone is not working out for you but they all come with some sort of side effects.  

[jonpayson]

Thanks for the help

[hansinnm]

rdavisiii said:

… There are other options if Prednisone is not working out for you but they all come with some sort of side effects.

---

One of the other options is 1-2  0.6mg Colchicine, only, to fight the inflammation, if the pain is tolerable and 1-2 500mg Naproxen (Aleve) to fight unbearable pain.

[Keith Taylor (GoutPal Admin)]

jp, 6 weeks is not a long time for most gouties, but it depends on:

• How long you had gout
• How high were uric acid levels before lowering treatment
• How low are uric acid levels with lowering treatment

The only way you can be certain of progress is the same way you can be certain of gout – get a joint fluid analysis, unless you have access to Siemens CAT scan gout detector (not the official name).

A very rough guide is one month for every year of gout, but that is so rough you could almost call it a guess. If you look at some research on urate deposits, you can see some of the factors that affect the timescale for getting rid of old uric acid crystals, and some of the timescales involved.

Frequent monitoring of uric acid levels is vital to assess progress.

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