Dave, thank you so much for digging out those test results.
Now, though you say you were first diagnosed with gout 6 weeks ago, uric acid crystals have been building up for years before that. It’s impossible to know exactly when. There are now advanced imaging techniques that paint a better picture of your uric acid burden. But, we can manage without those.
We just need to know what to manage. There are 2 things:
- Uric acid burden
- Gout Pain until uric acid burden has mostly dissolved
Your test results show your uric acid is well under control. You could go lower if you wanted to as a temporary measure for a few months. Most doctors will only agree to this if you have visible signs of tophi. I’m guessing this is not the case for you. So, all that’s left to do is to maintain regular tests. I recommend monthly tests, at first. As your results stabilize, you can extend the interval. Always test at least once per year. Uric acid tests should be accompanied by kidney function and liver function tests. That is usual for most doctors, but always best to check.
You might find fluctuations in uric acid test results. This is normal, especially if your appointments are at different times of day. However, you should soon see a natural average. Ideally, this will fall below 300μmol/L, but 309 is very close. If it does start to rise as you get older, you might have to increase allopurinol dose. This is fine, as you are well within the maximum dose.
For a few months, you are absolutely right when you say “I *think* this is normal and that this is simply the Allopurinol working and dissolving the crystals and whilst this happens, you can have further mini-attacks.”
For this reason, good gout doctors usually prescribe pain control for a few months. There are several different approaches to this. Some doctor prescribe daily colchicine for a few months as a preventative. Personally, I think if you are managing OK without that, then best to stick to naproxen.
All I would say, if you are incapacitated, is to speak to your doctor about paracetamol, or similar compatible painkiller, to take alongside naproxen. I think it’s important to stay mobile when you have a gout attack. That, at least for me, stopped gout attacks sticking around for many days.
All in all, Dave, I’d say you are well on the road to recovery. Your diet seems healthy, which will be good for other potential health problems that often run alongside gout. Of course, if I need to clarify anything, or you get other questions, just ask.
I’m sure your gout attacks will become fewer, and less intense, as you continue to bring uric acid under control. It amazed me how little gout hurt when I knew my uric acid was safe, and occasional flares were just a sign of old crystals dissolving. 🙂