Keith: I was diagnosed with gout in June of last year, with a UA of 10.9, sed rate 79. DIP joint in my hand, but in retrospect, I probably had at least two flares earlier. One in the classic big toe maybe six years ago, one in a foot a year later following surgery on the other big toe,x and in a knee one year ago. Started allopurinol in June, last UA was 6.0 in December. My rheumy targets 6.0 and doesn’t feel the side effects of most medications warrant shooting for 4 type levels. As I get an annoying skin rash from allopurinol, I concur. Started at 50mg/day, then 100, then 150, then up to 200 by late August. UA at that time was 7.9.
I had a lot of flares over the past summer as I ramped up the allopurinol. Right ankle/foot three times, left ankle/foot once. Treated with 30mg Predisone for a week, then taper. Relief was considerable in every case after about 5 hours. Just had a flare last week in a middle toe, but it was relatively minimal. This was the first flare since August, so I was ‘flare-free’ for 5 months on allopurinol. I take 400mg of Celebrex daily for OA, and that was enough for my toe so I could walk; didn’t need Predisone.. I can’t take colchicine..GI symptoms are horrible.
Almost forgot..started probenecid 1/2 tab at the beginning of January, ramped up to one tab after two weeks. The toe flare occurred after I was taking the combined allopurinol 100 mg, probenecid one tab for two weeks. My worry is that the action of probenecid isn’t enough to stay ahead of my production of purines.
I wouldn’t have changed medications except that I’ve lost half my hair since I started on allopurinol last July. It’s a known side effect, but still rare. Lucky me…