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Over the past year I've been experiencing issues with my feet which until the last 5 or six months I had no idea that I might have gout. After doing a lot of reading and trying various home remedies I was relatively certain I did have gout and scheduled a appointment with a rheumatologist.
Initial tests confirmed that my uric acid is high (about 7.2 mg/dl) and that given the symptoms I've been having they are pretty certain it's gout. I've adjusted my diet some with some success but the pain in the past couple months has been pretty constant. I think I've fallen into the gout hell range of dropping below 6 then rising above 7 and back and forth.
I'm not really overweight (6' 2″ Tall and 195 pounds) but in the last year I have lost about 10 pounds in attempting to change my diet and be more healthy (which Ironically looks like it triggered gout).
Just this week the doc started me on colchacine (0.6mg per day) with a prescription for Allipurinol (300 mg) to start in two weeks.
I have noticed an almost immediate relief with the colchacine and my feet after two days feel remarkedly better.
My main questions are what to watch out for and should I possibly start with a half dose of allopurinol and work may way up to avoid flare-ups. I'm not real keen on being on allopurinol for the rest of my life (I'm 35) but given how painful the past few months have been I don't like the alternative. I miss being able to be active and play with my kids.
Welcome, tmonter. My experience is with the other drug used to control SUA called Uloric. This drug was prescribed by my rheumatologist at 40mg daily. After a few months I realised this dose was not enough and I went up to 80mg daily which made a dramatic difference. It seems that the doctors often prescribe a lower dose to start in case there may be an allergic reaction. I think if you read more on these forums you will find that 300mg is the dose most find useful and some even start with 600mg allopurinol. 150mg may be a place to start if you are worried about an allergy but I think others will reply here to say 300mg is the way to go if you want to lower your SUA and you should get tested again in 2 weeks to see if your level goes down to below 6.0 then you can decide to stay at 300 or not. Good luck to you.
Hi tmonter,
I'll echo Richard's welcome, and his thoughts on allopurinol dosage. There's nothing to link higher doses of allopurinol with increased gout flares (at least, nothing I've seen), and the reverse is probably true. Certainly, the lower you get your uric acid, the faster old crystals will dissolve.
I have noticed an almost immediate relief with the colchacine and my feet after two days feel remarkedly better.
If there is any doubt about whether it's gout, that kind of a reaction is pretty confirmatory.
I feel strongly that diving right into the pool with 300 mg. allopurinol is the right way to start. Look for itching anywhere or any swelling of the lips or eyelids, both rare indictions of allergy and if you see these symptoms, stop the drug.
With no Tophi and only minor pain that started this summer, how long can I expect it to take for the Allopurinol to work? Additionally how long do people typically remain on the low-dose colchacine after starting Allpurinol?
I started AP 2 weeks ago this Friday coming up. When I started I had little pain but within two days I had another attack coming on. I am not on colchacine but prednisone for when the attacks happen and at this point I am pain free for the most part(I can put shoes on!). I test UA at home with a meter and after being sure to take very careful tests I find my readings in the low to mid 5's, prior to taking AP they were always 8+. Prior to this I had no Tophi but had major pain in all parts of my right foot and ankle at various times over the course the last 8 years. I hike/backpack frequently and have not been able to do so in the last 3 months, after this short time on AP I feel I will be back on the trail within the week. I will not have follow on lab work til May. So far that has been my experience on AP, I see others that have very different experiences.
rdavisiii said:
I started AP 2 weeks ago this Friday coming up. When I started I had little pain but within two days I had another attack coming on. I am not on colchacine but prednisone for when the attacks happen and at this point I am pain free for the most part(I can put shoes on!). I test UA at home with a meter and after being sure to take very careful tests I find my readings in the low to mid 5's, prior to taking AP they were always 8+. Prior to this I had no Tophi but had major pain in all parts of my right foot and ankle at various times over the course the last 8 years. I hike/backpack frequently and have not been able to do so in the last 3 months, after this short time on AP I feel I will be back on the trail within the week. I will not have follow on lab work til May. So far that has been my experience on AP, I see others that have very different experiences.
Would advise caution when resuming your hiking activities. Your low SUA levels (especially after such a short time on allo) do not reflect the level of crystaline deposits in your joints, which are just waiting for the right stimulus to kick off a flare. Walking around in the wrong shoes for a day can be enough, let alone stressing the joints on steep inclines and uneven terrain. I used to do a lot of coastal bouldering and all that toe grabbing flexion did for me on several occasions. Never been on any meds other than NSAIDs though, so maybe the prednisone will give you added protection.
Give my regards to Camelback, I bet it's real nice this time of year
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