uric acid increase during an acute attack

[Lyndak]

Can anyone tell me the approximate amount to expect uric acid to increase during an acute gout attack?  Since my first blood draw was taken during an attack, my uric acid level has only reduced by 2 from 10.4 to 8, in 8 weeks taking 100mg of allopurinol.  I'm trying to figure out how effective the allopurinol at that level has been.  I know that most of you consider less than 300mg to be a waste of time, but I haven't had any further flares, which is a very good thing.  I have also had a kidney transplant and I'm not sure yet what effect higher does of allopurinol would have on my transplanted kidney.  I have an appt with my Nephrologist next month and I am preparing myself with knowledge for that visit.  Thanks in advance for your input.  Lynda

[zip2play]

Lynda,

That 2.4 drop in 8 weeks on 100 mg. allopurinol is better than can usually be expected and it is NOT enough to ward off further serious attacks. I doubt that taking more, as you must, will damage your kidney but rather benefit it. With a transplanted kidney and gout you dare not linger at 8.0. But you MUST get your nephrologist to make that call because it is too serious for internet boards.

From Medline Plus (NAtional Institute of Health…U.S. gov.)

Other uses for this medicine

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Allopurinol is also sometimes used to treat seizures, pain caused by pancreas disease, and certain infections. It is also sometimes used to improve survival after bypass surgery, to reduce ulcer relapses, and to prevent rejection of kidney transplants. Talk to your doctor about the possible risks of using this medication for your condition.

[Lyndak]

Thanks Zip, but I'm still curious about how much your UA increases during an attack.  I have read in here somewhere that it does go up.  If that's true, my UA may have started out nearer to 8 and the 100mg of allo hasn't helped at all….get my meaning?

I truely appreciate all the great advice I have read and received on this forum.  Keep up the great work!  Lynda

[trev]

I think the wisdom is that SUA usually, [or often] goes down, not up, during an attack Lynda.

Bearing in mind that daily variations occur then one [or so] readings aren't enough to gauge on.

They could also be wrong, but mostly on the home testing. I trust our NHS lab results.

The other thing is that from experience and reading here , 100 mg of AlloP can reduce SUA by up to 2 pts- so that seems fair enough, but you aren't getting enough to get clear of gout, but this depends on your kidneys capability. A routine blood test will show impact of this on the estimated GFR- that's what I watch.

200 mg of Sulfinpyrazone gets me [typically] from 8 down to 4 SUA [early test] anyway- but remember to drink plenty H2O as well, to assist in urate removal.

[cjeezy]

Wow Trev, your SUA is down to 4 now? Congrats!

[Keith Taylor (GoutPal Admin)]

Lyndak said:

Thanks Zip, but I'm still curious about how much your UA increases during an attack.  I have read in here somewhere that it does go up.  If that's true, my UA may have started out nearer to 8 and the 100mg of allo hasn't helped at all….get my meaning?

I truely appreciate all the great advice I have read and received on this forum.  Keep up the great work!  Lynda

---

Lynda, there is no definite answer to this. Studies may say that uric acid levels are usually lower during an attack, as they compare the uric acid level a few days after an attack with the reading at the time of the attack. On average it tends to be lower during the attack as during that time, uric acid that would have been in the blood was busy crystalizing in your joints, therefore lowering the blood concentration.

But many other factors come into play that cause changes to uric acid test results.

Only an average of a few tests, and analysis of the trend can determine what your true dose should be. As zip2play says, it is too important to be directed by Internet chatter, though we will all welcome a report back on what your nephrologist recommends, and more impotrantly, why.

[Lyndak]

Thanks everyone for all your expertise.  Trev, I will check out Sulfinpyrazone, and consider that.  I had some gouty twinges today and tonight and I'm hoping nothing comes of it.  I will report back after my Nephrology appt on 10/20.  BTW, I had another SUA blood test 2 weeks after my last, and it was still 8.  I may call instead of waiting another month.  Lynda

[trev]

Don't get me wrong Lynda- I was just emphasising that effective low dose SUA lowering is possible, I don't think my currrent med is recommended for those with kidney issues, but then- to be sensible, what meds don't stress the body, kidneys and liver in particular?

I think the wisdom is, that high SUA is the worst option though, and 'that' sneaks by without medication [or monitoring] for much of our lives, as we here have found out here, to our chagrin!

If you do get on the SulfP, it certainly has less intrusive side effects than other meds. Hopefully you will be abkle catch the Docs ear with a plea for lower SUA, whichever route is best for you!

One reason I dropped the Lasix/Losartan [though somewhat successful at  SUA management] was the discomfort in my L. lower rib and back area, which I think was possibly kidney related- and an ultrasound scan had shown some scarring from 'who knows what/when'. Unfortunately, urate does not show up well, if at all on these scans- so I never got any closer on that one!

Good luck- soon on your treatment quest .

[zip2play]

Lyndak,

Let me support and amplify what trev said. Your doctor WILL NOT sign off on any strong uricosuric like sulfinpyrazone or probenecid…the high excretion of urate is NOT good for anyone with kidney issues.

Far better to use an agent that causes less uric acid to be made, and that's allopurinol or febuxostat.

[Lyndak]

I agree, after researching sulfinpyrazone, that allopurinol would probably be best for me.  I have already learned that febuxostat would be way to expensive for an option…although my Nephrologist said it would be fine to use.

I agree trev that high UA is a sneaky devil.  I recently got my hands on a UA blood test from back in 2005.  At that time it was 10.9 and My GP, Nephrologist and transplant Hospital all got a copy, and not one of them told me it was high or suggested that it was a problem!  I have been getting a copy of all blood tests for the past 3 years, so that will never happen again.  What a bunch of bunk!!  If we don't watch out for ourselves, no one else will.  All the more reason that GoutPal is so important to us. 

[trev]

With 6mg/dl as a normal max SUA for a healthy woman- I fail to see how nearly double that figure is NOT worthy of note, unless they were protecting your worry function.

Then to ignore suitable treatment is inexcusable though, and Bunk is just about the right word for not addressing it earlier.

However, these are the same people you have to go back to and trust further- so, a bit of the usual bind, Hey!

Knowledge is Power, though….

[Lyndak]

Yes, I will be kind…..but also want to know WHY 10.4 UA wasn't high enough to do something about.  High UA is very bad for kidneys!!

[zip2play]

At that time it was 10.9 and My GP, Nephrologist and transplant Hospital all got a copy, and not one of them told me it was high or suggested that it was a problem! 

That's when you must be thankful that you don't have a machine gun in the house.

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