Thank you for those numbers, nobody. They definitely support your notion of not getting tested often enough. We can see that January, February and March are all spent assessing allopurinol sensitivity, rather than controlling uric acid. And even if we allow for vagaries of testing accuracy, this seems too long to me.
So, we have a strong likelihood that d_q’s uric acid is only now getting low enough for old crystals to dissolve in any significant number. Therefore this sounds like exactly what happens to most gout patients during the early weeks of uric acid lowering. I.e. gout flares in unpredictable joints.
Now, to many people, that sounds like bad news. But, it’s only a temporary situation. As more crystals dissolve, attacks become less frequent and less intense. Also, it might be worrying if a patient is already on maximum allopurinol. But, even in that situation, gout patients have improved their rate of recovery by adding probenecid to their allopurinol. So, if my view isn’t obvious, I’d better state it:
Titrate allopurinol from 100 to 200 to 300 mg per day. With test and dose change every 2 weeks. Then, if there are no adverse events, increase to 600 ten 900 (800 in USA). Once you have no symptoms for 6 months, reduce allopurinol slowly to a maintenance dose. There is debate in the rheumatology profession if this maintenance dose should be 300 or 350 μmol/L.
I hope that we get enough data from DECT experiments to allow us to judge when all uric acid crystals have dissolved. I guess there should be an approximate formula based on how long a patient has had gout, and the level they get down to during uric acid treatment.