Personally, I can see no logic in delaying allopurinol treatment at effective doses. Because, the advice to start at 100mg then increase, is mostly safety advice. It takes up to a month for serious (rare) allopurinol side effects to show. So, 100mg; test; 200mg; test; 300mg test is very effective with tests every 2 weeks. Also, the repeated testing, which must, of course, include liver function and kidney function tests makes for an extremely safe form of treatment.
Whereas, delays to clearing old uric acid crystals are dangerous. Because, in the worst case, crystal deposits can fatally damage your heart. But kidney damage, skin infections, and permanent joint damage, are all unnecessary common consequences of failing to control excess uric acid. So, you might think I’m laboring the point. But, excess uric acid is dangerous.
So, I believe high doses of allopurinol, within the bounds of side-effect safety checks, is the safest way for gout patients to recover. Also, Ruben has taken allopurinol before, so it should be safe to move forward quicker than the average gout patient. Assuming adequate safety tests were performed during earlier therapy.
Now, I move on to pain control.
Firstly, there is no guarantee you will get another gout attack, Ruben. As long as you get uric acid safely below 5mg/dL. Because, my mantra is: you might get a gout attack during uric acid lowering. But, you will definitely get a gout attack if you do not lower uric acid. Also, from my above, gout attacks are not your biggest problem.
Secondly, uric acid lowering therapy without gout pain control is like surgery without anesthetic. Because, it’s sadistic, unnecessary, and medically unprofessional. It’s easy to prevent gout symptoms for the six months it takes to get old crystals dissolved. Or, with enough experience, it’s easy to recognize the first signs of a gout attack, and stop it in it’s tracks. But, Ruben, I can assure you that gout laughs in the face of celery seed extract.
Finally, I’ve never seen any evidence to suggest that gout flares during early allopurinol will increase if dose is increased. Indeed, logic tells me that the opposite must be true. Because, we absolutely know that uric acid crystals dissolve faster when uric acid is at it’s lowest. Then, faster dissolution of old crystals has to reduce the risk of gout flares. Also, it must reduce the intensity and duration of gout attacks.
Of course, I’d love to be told if I’ve got this wrong.
Also, d_q, thank you for the links to my articles. I appreciate it.