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This is my first post after finding this forum and spending the day reading through the great information here. This might be a bit long winded?so will try to keep it to the point. A little of my background first. I just turned 57 and just started taking AP on my birthday (just short of four weeks now). I need to say that my doctor seems to be pretty much right on in his diagnosis and recommended treatment when compared to what others have?posted here. My first attack was three years ago in my little finger. I was on a sailing trip and got to the point where I could not use my hand at all, let alone get any sleep. One week later I saw my doctor. He took one look at it and said with a smile, “your have gout'! He told me that this?was one of the most studied diseases over the years so?am somewhat surprised at reading about so many misdiagnosed cases here. Got the Cochicine and Indomethacin that took care of it right away. He wanted to put me on 300mg of AP right then because my blood showed slightly elevated levels of UA (don't remember the level and have not been tested since). He also told me that most likely I would have more attacks soon or possibly years latter and that even if I did not have any attacks, the UA crystals would continue to do their damage to my joints. Next bout was bursitis in my elbow about 1.5 years latter. Thought it was infection so started on antibiotics. When that did not help, I thought of?trying some of the colchicine that I had left over, which helped immediately. I should say that I do not have any medical insurance and am working in a business that is down about 2/3 income, so paying for any medical help is out of pocket and a luxury. Third attack was my big toe about 3 months ago so finally decided to go on the AP. The day after starting the AP, the toe flared up again?and my left knee got very weak, hot, stiff, and swollen (no real pain). Colchicine again helped within a couple of days. The next week, elbow pain started which put me back on the Colchicine. That is just now starting to subside. My question is if I should stay on the colchicine longer (I have been taking it just long enough for the pain and major swelling to subside) or continue as is according to the bouts. I am not sure if the colchicine helps with getting rid of the UA crystals or if that is strictly through the AP. These bouts are far more numerous than anything?previous prior to starting the AP. From what I have been reading here, it could take months for the AP to do its work.
The plus side of taking the AP?has been?an?immediate reduction?in a continuous dull shoulder pain. I have been a competitive swimmer for over 40 years doing workouts of 4,000-6,500 yards of interval training 4-5 days a week, intermixed with weight training every third day. I also bike and sea kayak on a regular basis. My lifestyle has been extreme physical activity for?all of these years. The recent bouts have kept me from any steady workouts, which is frustrating to say the least.?The shoulder pain has been part of my life for the past 15 years (and getting worse) which I blamed on age and overuse. The pain is not gone, but I can now feel sore muscles instead of?tight aching?tendons and joints. My doctor is also my swimming workout partner, so I brought this up to him. He?was quite amazed?and said that his typical gout patient was not the active type, so had never considered that this could be related. I just wanted to say that I am looking forward to working out in less pain than I have had in the past 15 years. In my case, I think that the?toe, finger, knee, and elbow?flair ups were just part of a body full of UA issues.
Hi Sailorboy,
This crops up fairly often when allopurinol isn't managed properly. Dosage should be set by reference to uric acid levels, with blood tests every month when dosage is being established, relaxing to once or twice a year when levels stabilize. Up to 800mg per day is recommended for adequate urate control, though some doctors have suggested that this upper limit can be stretched if necessary, and if monitored.
It is all too easy, with a “staandard” (frequently useless) 300 mg dose, to get into a bad situation where uric acid fluctuates around 6.5, with crystals partially dissolving, then reforming. Who knows if this is your situation? Only blood tests will tell.
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When to stop colchicine? Normally after a month or three with uric acid levels held below 4mg/dL, but that is a very general rule that I've just made up – the real answer depends on individual circumstances, which your swimming buddy should be a bit more concerned with.
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I am not sure if the colchicine helps with getting rid of the UA crystals or if that is strictly through the AP (allopurinol)
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No, colchicine just helps with the pain. It has no effect on uric acid. It works by stopping white blood cells reproducing, so it is important to keep dose down to one or two pills per day. It works best when taken at the first sign of pain, or as a daily preventative.
It stops inflammation increasing, rather than reducing existing inflammation, so I believe, if it does not provide enough pain relief, it is best to support it with an anti-inflammatory such as ibuprofen or naproxen rather than increase the colchicine dose (but I know others will disagree).
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