Uloric and Length of Time for Crystals to Disappear

[bryans]

First of all I want to thank all the participants on this forum – the information is invaluable. This is my first post and I have been suffering from gout for about 20 years. Initially I would simply take indomethicine when I had a flare and the symptoms would subside in 4 or 5 days and I would be gout free for months. This past spring, however, I had a major flare and have had constant attacks for the past 7 months. At about month 5 my GP and I decided it would be best to start Uloric and beat the beast back for good. The challenge I have is I have been on Uloric for about 40 days and I have had consant flares. The good news is that the Uloric has consistently lowered my uric acid levels to +/- 4 since I started taking it. Reading the posts on this forum I understand that it is going to take some time for the “stored” uric acid to be eliiminated from my system. The question I have is – is there any “normal/average” amount of time when the flares will stop? This attack is really putting a crimp in my giddy-up as I am a regular exerciser running/lifting weights/playing hockey.

[Keith Taylor (GoutPal Admin)]

Welcome @bryans, I’m glad you are finally tackling the uric acid after twenty years. I’ll work backward through your points.

1. Gout attack during uric acid lowering treatment.
Whether it’s Uloric, allopurinol, or anything else, including lifestyle changes, when uric acid levels drop, old crystals can cause flares. This is actually a good thing, though it doesn’t feel like it at the time. I was chatting with a lady yesterday about the pain of gout being worse than childbirth. After childbirth, you get a bundle of joy. After a gout flare, as long as uric acid stays at 5 or lower, you get the joy of gout freedom. The labor pains you are experiencing will be less if you get uric acid lower. More of that later, but I need to explain the epidural equivalent of gout treatment.
a) Take 1 colchicine every day for 6 months
b) At the first sign of a gout flare, take a second colchicine, but never more than 2 a day.
c) If inflammation is intolerable take gout strength (i.e. maximum prescription dose) of an anti-inflammatory such as indomethacin, ibuprofen or naproxen. Naproxen is highly regarded, but everybody has their own NSAID of choice.
d) If pain persists 2 hours after NSAID, take Tylenol or similar. Check with your pharmacist or doctor to be sure that the supporting painkiller of choice is compatible with chosen NSAID.

I call it Pain Freedom. If you can’t play hockey with that regime, you don’t deserve to be on the field.

2. Getting rid of stored uric acid deposits is easy but difficult (I feel like talking in riddles today).
It’s easy because the lower you get uric acid, the faster old crystals dissolve. This piece of elementary organic chemistry seems to have escaped most physicians. They treat you until they’ve got uric acid down to something they are happy with, then leave you to your pain. Insist on the maximum dose to get as low as possible for as long as you can.

It’s difficult because some crystals get bound up in masses of dead cells. These tophi can become pretty solid and might take years, or surgery, to get rid of. The good news is: they are unlikely to cause a gout flare, as the release of uric acid is slow.

The true answer to your question, after all my waffling, is that nobody knows. I can generalize and say the longer you have had gout, the longer it takes to get rid of old deposits. The higher your uric acid level before treatment, the more uric acid deposits you will have. As stated before, the lower you get uric acid with treatment, the faster you dissolve old deposits. That last one is the only one you can control.

I do not think a normal/average can ever apply because everyone is different. I had untreated gout for 17 years, got uric acid down to 3, and had no flares after about 3 or 4 months. I took daily colchicine for 2 weeks every allopurinol dose change, then as required, supported with other meds when necessary as per my Pain Freedom regime. No hockey, but plenty of pain-free dancing for joy 😀

[hansinnm]

Keith, you are out of your cotton-picking mind suggesting: …”a) Take 1 Colchicine every day for 6 months”…, if you don’t mind me saying so!!! It’s one thing telling people what YOU do and take, but it’s something entirely different to tell people what they should take. You know darn well that Colchicine doesn’t do anything for your gout except helping when you have an attack with resulting inflammation.
This comes from Hans in New Mexico with one foot in the grave (prostate and metastasized bone cancer), but still kicking and without a gout attack for 2 years and 9 months and a UA level of ~5 mg/dL.

[bryans]

Thanks for your responses. Just after I posted on November 8th the flare I was suffering from went away. Now – a week and a half later I am going through another flare. I had my Dr. send me my uric acid readings which are as follows June 11th 2013 UA level 7.6. July 29th UA level 4.7. October 16th UA level 3.7. Is it common to have flares with the uric acid level dropping so quickly? Also, how can I be having a flare with my uric acid level at 3.7? I am currently taking indomethicine 3x’s daily plus my 80 mg. Uloric. Will these flares ever stop?

[natesnathan]

The administration is right! Most rheumatologists will prescribe colchicine one a day for 6 months while starting UA lowering therapy. This acts as prophylaxis to gout flares. I just started lowering therapy and was taking colchicine and felt pretty good so I stopped and although my UA went from 7.3 to 5.1 in a month I got a nasty flare in my left knee and foot. I immediately started taking it and already feel better. I’m going to take it until my UA is under 5 and no flares for a few months. I’m also giving blood until my ferritin levels get below 125

[davidk]

2 weeks after I started on Uloric, my UA dropped from 11 to below 5. I had flare ups every few weeks for 6 more months before they stopped. I’ve been attack free for 3 years and my UA runs below 5. I take 40 mg uloric daily.

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