Reply To: Febuxostat and Colchicine dosing


More frequent attacks could on the contrary be a sign that the treatment is working more efficiently (as well as a sign your husband might benefit from beign constantly on colchicine for a little while).
Individual attacks being more severe and lasting longer however, I would not see that as a good sign. The thing is, you could easily get the impression that attacks are getting worse when they’re merely getting more frequent if you’re not taking into account numerous shorter and milder attacks.
The following might sound like reading tea leaves (I certainly can’t cite medical research to back it up!) but I think the duration of the average attack (taking even the mildest ones into account) matters more than the frequency of the serious ones.

I don’t know that there’s any treatment that can entierly prevent debilitating attacks during the “de-bulking” phase, especially after many years of untreated gout.
But one downside to febuxostat (as well as allopurinol) is that it does not directly help the body get rid of the uric acid which is released in the blood during attacks. Usually that is not a problem but with kidneys which are not working very well, I guess it could sometimes cause undesirable spikes in the amount of uric acid mixed in the blood. Tests done between such spikes would not show high uric acid.
80mg febuxostat should already be doing a very good job of preventing the body from producing much uric acid but maybe the doctor you’re seeing tommorow could determine if some other treatment in combination with febuxostat might help the kidneys in evacuating the uric acid which had formed before your husband started taking febuxostat. But I have no idea what if anything would be appropriate given your husband’s kindey problem.