Reply To: Why colchicine with Allopurinol and Indomethacin?

Stopping Gout Together Forums Help My Gout! The Gout Forum Why colchicine with Allopurinol and Indomethacin? Reply To: Why colchicine with Allopurinol and Indomethacin?

Keith Taylor

Hi Maurice,

Thanks for all that information. I know it’s heartbreaking if this happens when you are doing everything right. You are lucky to have a doctor that seems to understand gout well. His explanation is correct. And, I refer to that uric acid crystal clearing process as “urate clearance”. Or, reducing the uric acid burden. But, it can’t answer your “How long does this process take” question.

Truthfully, nobody can. There are too many variables. But, I have made up a ‘rule of thumb’. Like all such rules, it is a little vague. I tell recovering gout patients, like you, to expect urate clearance to take about one month for every year you have had gout. Then, the only truth is “the lower your uric acid, the shorter the period for urate clearance”

Because of that, I personally chose to go for maximum dose allopurinol, in order to minimize the time at risk. My doctor gave me full support in that, but I had to try with 3 others before I found a doctor who understood the biology.

So, using my rule of thumb for your urate clearance period. I’m going to guess your gout started when you were around 30. But, I guess your symptoms started many years later. You started allopurinol in January 2016. But, your uric acid will not have got down to 5 immediately. I’m going to guess April 2016. Therefore, my rule of thumb says, 30 months of urate clearance takes you to October 2017.

Obviously, that’s all speculation. There might be a particularly well-hidden cluster of crystals that trigger a small attack on New Years Day 2018. We just don’t know. As I’ve said, you can reduce the risks of an attack. But, it’s always best to be prepared.

If you are the type of person who listens to your body, you’ll recognize the early twinges of an attack. In that case, there is no need for prophylactic gout pain therapy. That also applies if you are confident that you can control an attack quickly, once it starts.

If not, prophylaxis for a few weeks/months might be the answer. But, you have to weigh up the pros and cons with your doctor. Personally, if I was opting for prophylaxis, I’d also insist on an allopurinol dose increase. That might raise the risk of a flare in the short term. But, it would reduce the period of time that prophylaxis was required.

Again, there are no rules for how long it takes. So, I’m going to make up another rule of thumb, on the spot. If you get uric acid down to 2, change the rule to one week of risk for every year of gout. It’s very hard to be precise, but I hope this explains the controllable elements.

That should give you the information you need, Maurice, to improve your gout treatment plan. But, if you need me to clarify anything before you see your doctor, just ask. In particular, I’ve had to guess at things like current allopurinol dose, uric acid test dates and values, etc.

I’m here to help you make the right choice for you. And, we can discuss it whenever you feel the need.