Reply To: Mini gout flare whilst on Allopurinol

Stopping Gout Together Forums Help My Gout! The Gout Forum Mini gout flare whilst on Allopurinol Reply To: Mini gout flare whilst on Allopurinol

#3652
nobody
Participant


Hi,
Curing gout is typically painful but it needn’t be that bad.
I wonder if you might suffering needlessly because of the dosing of the drugs you take. More on that later.

Diagnosis over a web forum is basically impossible and I can’t tell you what’s normal because everyone is different (you’re much younger than most gout sufferers, my SUA was never as high as yours used to be and so forth). But in answer to your questions:
-connections between gout and both recent and old trauma (the trauma need not be major) are possible
-it doesn’t seem uncommon to experience ongoing serious symptoms over several weeks when initiating ULT

You haven’t explained all your circumstances or the rationale of your doctor for prescribing the doses you’re taking but assuming you do not have unusual conditions or drug intolerances…
-this might be controversial but while guidlelines in many places would have you target a SUA below 6 with ULT, my opinion is that the target should be lower inasmuch as you are experiencing serious gout symptoms. On top of that, have you established how much your SUA typically varies? You aren’t testing it very often and for all you know it might be well above 6 most of the time. The lower your test results, the larger your safety margin against variations. And the maximum allopurinol dose is much higher than 300mg.
-0.5mg of colchicine is a much lower dose than 90mg of etoricoxib. I don’t know how large you are but chances are your colchicine dose was insufficient which is why your symptoms didn’t abate completely or came back constantly. Trouble is, if you’ve used colchicine every day for 2 months, now might be the time to think about discontinuing it rather than increasing the dose. The longer you take colchicine, the more pernicious side effects you’ll get (though your dose might have been low enough to mitigate that). There are alternatives to colchicine but they have their own issues.
In other words I think you might benefit from an appointment with an experienced rheumatologist who could review your medications.

The following is only an anecdote but when I started pharmacological ULT for real, I was initially testing every 2-3 weeks and got a result well under 4 the second time.
Not that I recommend you actually try to get your SUA that low. But 6 is probably still too high for your deposits to dissolve fast enough to spare you unnecessary misery (though that might depend on the temperature, your diet and the amount of water you’re drinking, how good your body is at excreting UA and so forth).