Finally started allopurinol. Not happy with uric acid

[Alexander Petrowski]

Finally, faced the reality. So far not liking some details

Hey y’all,

I was first diagnosed with gout some ~8 years back. Pretty much it went like: “you have a gout, you will be taking allopurinol daily for the rest of your life, next!” I did not like that much, so I took matters into my hands, switched diet, lost ton of weight, and never went down the Allopurinol route. Didn’t have any problems anymore for ~4 years either.

Then some years back I switched jobs, regained all the weight back (and then some?), and a year after that I started getting occasional problems. The sore thumb, generally in the morning. So popped some Ibuprofen, drank a bit more water, and it went away.

Unfortunately this year, I already managed to have 3 minor attacks. So after the last one I bought a uric acid meter. Started getting results like 9.9 mg/dL to 8.x mg/dL. So — panicked — I switched diets (went vegetarian), and expected to get some relief. My values seemed to go down a bit (high sevens, eights). But, 3 months after that I got a major attack. Couldn’t walk for a few weeks. Tried to treat it with occasional Ibuprofen, rest, cherries. Not much help.

So, I went to a doctor. Was point-blank (without even getting a blood test done) put to 300 mg Allopurinol and 3 Ibuprofen (3×400 mg) daily (till the situation clears, he said). Also got the blood drawn.

Seems a bit weird, but okay. Then got the pre-allopurinol blood test back, 7.0 mg/dL (417 μmol/L). Plus elevated triglycerides (but the rest well within parameters).

But even after being on 300 mg Allopurinol for a while now, my blood meter insists on uric acid (UA) values around 7.0 mg/dL.

So a few questions, if I may:
– Is that level of UA in blood normal, even after allopurinol? Or could it be that the meter is confused?
– Is there rough estimate when the UA level should stabilize and I should go for a blood test proper?
– Is the point-blank zero-to-300 mg actually a good thing?
– Given the symptoms (sore thumb, worse at night [f’kin 3am blues], elevated UA levels for ~years), should I actually insist on synovial fluid test?

The reasons I’m asking is because I read on the forum here that allopurinol is slow acting, and rule of thumb is ~1 mg/dL per 100 mg, which would probably put me around the 4-5 mg/dL target, so I can start the dissolution (and maybe a diet, without risking another major flare). But not really sure what’s with that.

Also, when having a flare, did anyone tried some of the pain-relieving gels that you can get in a pharmacy? Is that any good? Or are the NSAIDs and maybe the cherries basically the gold standard?

Thanks for any info.

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Without a Gout Treatment Plan Uric Acid is Chaos

[nobody]

Hi!

I don’t know if you can trust your meter. The meter itself might be fine but the blood you feed it might not be representative of what’s running in your larger veins/arteries.
I assume you’ve been taking allo for a few weeks if not a few months. So get another lab test done and try to test with your meter immediately before or afterwards. The meter might be getting the changes right while reading too high.
In any case you should get a lab test to see how your body lives with the allo (you want to watch the kidney and liver values in particular). If you’re doing fine, you could take a bit more than 300mg/day. Note that if you’re taking ibuprofen every day, that could also explain bad liver values in particular (allo isn’t always the problem).

Going from zero to 300 isn’t recommended but what’s done is done. Now it’s just another reason to do get a blood test done!

In your situation, I wouldn’t bother with sinovial fluid and simply stick with allo for a bit.

I’ve used a gel containing a NSAID. It works better on some joints (the smallest ones) than others but the pills are more effective anyway, assuming your body doesn’t react badly to prolonged use of NSAID pills.
If you have inflammation that won’t go away, you could try combining colchicine and a NSAID.
For a serious attack, you could try a larger NSAID dose first (get your doctor to approve the dose you’re planning to take). You don’t want to take a huge amount every day for too long but if a large dose ends your attacks quickly, that might be the best course of action as long as your body is doing OK on NSAIDs.

[Steve]

Colchicine for 3 days works for me together with Arthrotec if necessary.

[Author]

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