It’s great to have another new member from South Africa. You’ve made some great points.
It’s fantastic that you’re seeing positive results with Puricos. Am I right in thinking that Puricos is 100% allopurinol? It’s good to see your gradual introduction: 100mg rising by 100mg increments. To make this a perfect introduction to allopurinol, dose should be guided by uric acid blood test results. The only reason for taking allopurinol is to get uric acid to your target uric acid level. That means you have to have a target that is safe, and suits your personal situation. It’s usually below 5mg/dL. But, every Gout Patient should have their own target. And, Target Uric Acid should be reviewed annually.
We don’t know anything about your uric acid levels Johan, so I can’t comment on whether 600mg is the right dose for you. If tophi are shrinking, it seems right without considering anything else. But, if the aim is tophi reduction, then I’d usually recommend maximum allopurinol for at least six months. Everyone is different.
Finally, on allopurinol dosing, it’s usually better to review and change dose every 2 weeks. That’s because it takes 2 weeks for allopurinol to stabilize. 1 week is probably OK if you have tophi. I say that because tophi sufferers should be aiming low as possible, so weekly blood tests are really a safety check rather than a dosing guide. That implies you are doing blood tests right, and getting liver and kidney function tests with your uric acid tests.
I agree with your recommendation against long term use of diclofenac, but that’s the first time I’ve seen a warning for kidney damage. I thought the biggest threat from long term NSAIDs was heart attacks. Anyway, it’s best to limit NSAID use for a few weeks while uric acid lowering does it’s job. I also agree that steroids are a very bad thing, but I respect other views if cortisone is a necessary last resort. My beef with steroid use is when they are used as a lazy first option before trying other effective remedies.
Finally, Johan, I’m intrigued by your Bantang diet. I’ve never heard of it before. Please would you be kind enough to start a new topic about Bantang diet and gout? I’d love to know what Bantang diet is, and how is it beneficial to gout sufferers?