Relapse Rates after Stopping Uric Acid Treatment chart

Review Is Allopurinol A Lifetime Drug

Stopping Gout Together Forums GoutPal Suggestion Box Review Is Allopurinol A Lifetime Drug

This topic contains 1 reply, has 1 voice, and was last updated by  Keith Taylor 6 months, 2 weeks ago.

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  • #2464

    Keith Taylor
    Keymaster
    Ŧallars: Ŧ 1061.11
    GoutPal Scholar Badge Rank: Scholar


    As I attempted to answer a question about allopurinol vacations today, I referred to Is Allopurinol A Lifetime Drug.

    I believe this is an important principle for Gout Seekers. Because many gout sufferers veer away from uric acid lowering therapy. I’ve had this myself. In the prime of your life, you see the specter of lifelong medication. Pictures of Grandad and his daily ritual of pills make you run for the hills.

    Of course, that’s ridiculous when you stop to analyze it. But, I still remember the same fear of having to wear spectacles for life when I was a boy. These are real fears that produce Gout Victims.

    And, the truth is, when you take control, you do not have to take gout medication for life. As long as you understand exactly how you can start and stop it so that you are in control.

    In the report attached to “Is Allopurinol A Lifetime Drug” there are detailed criteria for managing uric acid lowering therapy properly. I don’t think I represented those ideas very well in my original article.

    So, if you think I should stop dragging my heels, add your comments below. Constructive criticism, or simple “get on with it” comments are all welcome.


  • #6496

    Keith Taylor
    Keymaster
    Ŧallars: Ŧ 1061.11
    GoutPal Scholar Badge Rank: Scholar

    Following another question about this topic today, I have looked for more recent research. Although there are some interesting studies, there are still no definitive guidelines about the temporary withdrawal of uric acid treatment. So, it seems it is still a matter for individual decision making between you and your rheumatologist or other doctors.

    In 2011, Perez-Ruiz built on the 2006 report I used to create Is Allopurinol A Lifetime Drug. Because he published:
    Perez‐Ruiz, Fernando, Ana Maria Herrero‐Beites, and Loreto Carmona. “A two‐stage approach to the treatment of hyperuricemia in gout: The “dirty dish” hypothesis.” Arthritis & Rheumatology 63, no. 12 (2011): 4002-4006. 2-stage Uric Acid Treatment (Dirty Dish) PDF.

    The unusual “Dirty Dish” term is explained:

    A figurative analogy to a dirty dish may help in visualizing the issue: the initial effort to clean the dish (serum urate therapeutic target) would depend on how dirty it is (urate deposition burden) and, once it is clean, light daily wiping may be enough (serum urate preventive target) from then on to avoid dust (new urate crystal) accumulation and keep it clean (no recurrence).

    Last year, Beslon and colleagues reviewed all similar uric acid studies:
    Beslon, Virginie, Perrine Moreau, Annabel Maruani, Hubert Maisonneuve, Bruno Giraudeau, and Jean-Pascal Fournier. “Effects of discontinuation of urate-lowering therapy: a systematic review.” Journal of general internal medicine (2017): 1-9. Relapse Rates after Stopping Uric Acid Treatment PDF.

    So I used that report for the image you see above. But they conclude:

    Relapse of gout is common although delayed after discontinuation of ULT. Short-term prognosis after ULT discontinuation appears favorable if the serum urate level was low before ULT discontinuation. The results of this review are limited by the paucity of existing studies and their low quality. Further comparative studies should consider larger primary care populations and discontinuation of febuxostat.

    As I noted earlier, if this topic interests you, please encourage me to update the relevant resources on GoutPal.com by adding your comments below.

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