Questions for Rheumatologist

Stopping Gout Together Forums Help My Gout! The Gout Forum Questions for Rheumatologist

This topic contains 6 replies, has 2 voices, and was last updated by  Sian James 3 weeks, 4 days ago.

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  • #8749

    Sian James
    Participant
    Ŧallars: Ŧ 10.49


    Hi Guys,

    Wondered if I could call on your experience once more? We are going back to the rheumatologist next week. She previously was hostile to discussion of whether or not febuxostat or allopurinol had a better profile in terms of side-effects.

    My husband, with extensive lifestyle and diet change, and meds, seems to finally have his flares under control. He is currently on 80 mg Febuxostat daily (he decided himself to lower the dose from 120 mg), 1 500 mg naproxen and 20 mg omeprazole in tandem with the NSAID. We dont have recent urate results, but will have after the appointment. This is the first time in a decade his gout has been under control.

    My question – is this a time to continue as we are in terms of meds, or to try and lower or alter doses? What questions should we be asking of the consultant at this point?

  • #8750

    nobody
    Participant
    Ŧallars: Ŧ 506.12

    Assuming 80mg febuxostat doesn’t result in alarming blood test results or more subjective unbearable side effects I see no reason to change your husband’s dose at this stage. It’s too soon to declare victory over gout even though any reoccurring symptoms ought to be less violent and/or shorter in duration.

    Prolonged NSAID use is dangerous however, especially when a PPI such as omeprazole is required.
    If it’s at all possible at this stage to dial down the NSAID dose and maybe take it only on the days when inflammation shows up, that’s what I would recommend. If your husband is ever told to abstain from NSAIDs because he took too much in the past (possibly damaging his stomach or what have you), he’ll be in trouble if he gets hit with serious inflammation again.

  • #8751

    Sian James
    Participant
    Ŧallars: Ŧ 10.49

    Thank you very much @nobody, that helps clarify my thinking. Good point on future usage of NSAIDS. I will see if there’s a way of dialling that back, and/or switching to a less potentially damaging med.

    Do you have a view re febuxostat re allopurinol and long-term safety? Or am I treading old ground here?

  • #8752

    nobody
    Participant
    Ŧallars: Ŧ 506.12

    In my opinion, febuxostat vs. allopurinol should be a matter of individual reactions to the drugs and individual vulnerabilities.
    Febuxostat has often been claimed to be preferable to allopurinol for patients who have kidney disease but I understand some people are arguing against this claim. I don’t have a serious kindney problem and so I know next to nothing about the issue.
    Allopurinol is of course better-tested and febuxostat is more dangerous according to some studies but the dosage is a confounding factor. People often compare stronger doses of febuxostat to weaker doses of allopurinol. Also, strong doses of allopurinol (like the one your husband would probably need) aren’t so well-tested. I wish less biased and better designed medical research would have provided us with more conclusive data but here we are…
    So assuming your husband is tolerating febuxostat well and you have no particular reason to be concerned about these elusive cardiac side-effects, I wouldn’t pick a fight with your husband’s doctor on this issue, especially at this stage. You’ll have a better picture of your husband’s requirements later on and a moderate allopurinol dose might become a long-term option at that point.

    I’m afraid effective alternatives to NSAIDs might be even more dangerous in your husband’s case. Hopefully your husband will simply have less need for anti-inflammatories in the future. But let’s see what your doctor (or doctors) think about that…

  • #8753

    Sian James
    Participant
    Ŧallars: Ŧ 10.49

    That is such a helpful response. Thank you so much for taking the time to write it, we are both very grateful for your time and your experience.

    Wishing you the best of health,

    Sian

  • #8754

    nobody
    Participant
    Ŧallars: Ŧ 506.12

    I just edited my previous post, mostly because I thought I needed to clarify “at this stage”.

  • #8768

    Sian James
    Participant
    Ŧallars: Ŧ 10.49

    @nobody

    I just wanted to feedback – my husband’s GFR was 46, and his creatinine 136 – the rhemumie said to stop the NSAIDS and PPI immediately, and that he couldnt
    use NSAIDS again. He had only been using them during flares – she was the one that told him to go to a daily dose. So, as you so presciently pointed out, that’s another med for inflammation that we can’t have any frequent recourse to.

    His urate level is now 140 (RR 200 – 400) so she was open to the idea of him reducing his febuxostat to 40 mg by dividing the tablet.

    Thanks again,

    Sian

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