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Diet and exercise will not have a dramatic impact on your uric acid levels.? But just because you have high uric acid doesn't guarantee you'll have a second gout attack.? I doubt your doc will put you on Allopurinol until and unless you have a second attack.? A small percentage of people never have a second attack and you may fall in to that category.? I would ask your doc for Colchicine or, alternatively, Indomethacin and keep it handy in case you get another attack.? These are anti-inflammatories that will help keep the pain in check.? These are not long-term solutions but, in your case, having had only one attack, you may not need a long-term solution.?
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I went on Allopurinol after my third attack and a uric acid level of 8.3.? I went through the psychological stress of knowing that I would need pills every day for the rest of my life.? Before long, though, you grow accustomed to it and, for me, the 'rest of my life' anxiety was nothing compared to the stress of waiting for the next attack to come.? Now, after four months on Allopurinol, my gout is more or less under control and after about another year, once all the residual crystals have melted away, I'm hoping to be completely free.?
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300mg/day seems to the most effective dose for most people but because some people have allergic reactions most docs will start you at 100mg/day and work you up to 300mg over a period of weeks.? I think once you experience the benefit of the drug you won't want to stop.??
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Best of luck.
My rheumatologist has told me that my uric acid level at any given moment is 1/3 a product of diet and 2/3 the result of normal cell metabolism.? So until you control your uric acid levels using medication (like Allopurinol) increased intake of red meat, shellfish, beer, etc. could increase the likelihood of attack but completely cutting out these foods will not eliminate risk of an attack.? This is one of the many odd and perhaps counter-intuitive aspects of gout.
Stay on the Allopurinol.? Yes, it stinks that the medicine that will help you in the long-term can start out by hurting you.? Perhaps consider that without the Allopurinol you'd be having flares anyway and you'd be no closer to solving the problem long-term.? With the Allopurinil the pain is still the pain but it's also a sign that your body is healing.?
My experience after about three months on Allopurinol is that the food and drinks that trigger my gout (shellfish and beer) still do but with Colchicine and other anti-inflammatories the attacks never get a chance to go into full flower.? My rheumatologist told me that I'd still be susceptible to flares for 12-18 months after initiating Allopurinol so I keep the Colchicine handy and do not hesitate when I feel an attack starting.? My rheumy also pointed to recent studies that suggest relatively low doses of Colchicine are as effecitve as the 'pill every hour' formula without the stomach issues.? Every case is different but low doses (1.2mg a day or .6mg a day) have worked for me and I've had weeks where I've needed no Colchicine if I watch what I eat.?
I would solicit a second opinion from a rheumatologist.? Though many gout risk factors are lifestyle-oriented (e.g., being overweight, too much alcohol, etc) that does not necessarily mean that lifestyle measures are the best ways of controlling the disease. That seems to be the logic flaw in your doc's argument.?
I asked my doc similar questions.? He told me that the majority of uric acid in your body is a result of normal cell metabolism so a perfect gout diet will, by definition, only have a minor impact on your uric acid level.
My GP wanted me to have a second atttack before commencing Allopurinol because there are some people who have one attack and never a second.? That seems like a reasonable approach in that Allopurinol is a powerful drug that you wouldn't want to take needlessly.? But be sure to arm yourself with anti-inflammatory meds like Colchicine and Indomethacin so if a second attack does come you're prepared.?
Back with an update.? After six weeks on Allopurinol I tested again and my uric acid rate fell from 8.3 to 4.4.? I was extremely pleased with this result and so was my rheumatologist.? 300mgs of Allopurinol daily seems to be doing its job.? I'm down to one Colchicine a day and when I feel the tell-tale signs of a imminent flare-up (usually after eating shellfish) I take two a day for a few days.? The doc said I would remain at-risk for flares for about another year to 18 months as the old crystals dissolve in the low uric acid environment.? How much Colchicine I take is up to me and my plan is to stop it completely for a few days to see what happens.? But I'll always have it close by.? So far so good.? Feels great to be managing this condition and though I don't dount there will be some more bumps in the road it feels great to know the game-plan is working.?
I've found NSAIDs, Indomethacin in particular, to be moderately effective in controlling gout pain.? It takes the edge off but, for me, Colchicine works much better.
Interesting.? My rheumatologist told me during my last visit that,? in his experience, gout and eczema often show up together.? He did not indicate that one causes the other but did mention that he sees many patients with both.? My eczema is mild but I have noticed that it tends to worsen slightly during gout flares.
Two weeks for resolution for an acute attack, particulary if you let it go on for some time before taking meds, is not at all unusual.? Early intervention is absolutely critical.? I've found that Indomethacin alone only takes the edge off the pain and is not nearly as effective as Colchicine in knocking down an acute flare.? Try two 0.6mg pills/day of Colchicine for a few days and you'll notice a difference.?
It works extremely well.? Of course, it's not addressing the root cause of your gout –that would be elevated uric acid levels in your blood — but the colchicine will reduce your pain.? I take two 0.6mg pills per day for flares without any stomach issues, though your mileage may vary.? It can be used as a preventive measure but I wouldn't consider it a long-term strategy since all? it's doing is getting in the way of the imflammatory process, not doing anything about your uric acid.? Talk to your doc about Allopurinol as a long-term gout management approach.
I would ask your doc about colchicine.? It's really made a difference in knocking down a misreable month-long attack.? Two pills a day are really helping me without causing any stomach problems.
Quick update.? Saw the rheumatologist today for the first time.? Job number one is to knock down this flare that continues to kick my butt.? He wants me to take 1.2mg of colchicine daily until complete resolution and 100mg Indomethacin for another week.? He says that should do it.? My gout seems to respond well to colchicine so we'll see.?
Then we start the Allopurinol.? 100mg/day for two weeks, 200 mg/day for two more weeks, then 300mg/day for two weeks and then another blood test.? He wants me on colchicine for that entire time to prevent flares.? Seems like a reasonable approach.? I asked why we weren't starting with Allopurinol at 300mg/day and he said to protect against potential allergic reactions.? His perspective is that low initial dosing with proper flare-prevention meds is the best risk/reward ratio.?
