Reply To: Mini gout flare whilst on Allopurinol

Stopping Gout Together Forums Help My Gout! The Gout Forum Mini gout flare whilst on Allopurinol Reply To: Mini gout flare whilst on Allopurinol

Keith Taylor

Hi Rod,

It’s great to read your contributions, and I hope your latest message encourages Dave to discuss his allopurinol dose with his doctor. But I have to add some points of my own:

Anti-inflammatories and allopurinol are entirely separate. Anti-inflammatories, reduce inflammation caused by our immune system response to the presence of uric acid crystals. They act within minutes, though the full effect might take hours.
Allopurinol reduces uric acid. If the reduction is below 5mg/dL (300μmol/L), uric acid crystals will eventually dissolve. Allopurinol starts working immediately, but maximum uric acid reduction takes up to two weeks. The effect of reducing uric acid takes at least 6 months to dissolve most uric acid crystals, often longer.

Therefore, recovering gout sufferers often need anti-inflammatories for a few months, until most old uric acid crystals have dissolved. That is true for any uric acid lowering treatment, including febuxostat, or diet.

The recommended maximum dose for allopurinol is 800mg per day USA, and 900mg per day, UK. But, all doctors can prescribe whatever dose they think is best. Higher allopurinol doses might be justified, as long as they are medically supervised with frequent kidney function and liver function tests.

Purines might be in all foods, but, there are many different purines. Plant purines do not readily convert to uric acid in humans. Purine metabolism is complicated. But, the most important fact is that human flesh is the richest source of uric acid. Vegan diets need to be carefully managed, to avoid shortage of some essential nutrients. I need to do more research for the big picture. But, from a gout point of view, shortage of protein and calcium are big risk factors for gout in vegans. I’m interested in discussing vegan diet. However, Dave isn’t vegan, so I think it best to create a separate topic. (Now at Gout and vegans.)