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My Uric Acid Numbers article cites Hershfield's report, “Reassessing serum urate targets in the management of refractory gout: can you go too low?”, which is summarized:
PURPOSE OF REVIEW: Growing awareness of patients with refractory gout is prompting a reassessment of treatment strategy. This article reviews the current practice of targeting serum urate concentrations (sUA) in the mid-normal range (roughly 4-6 mg/dl) and considers the rationale for more aggressively lowering sUA in patients with poorly controlled chronic gout. Some hypothetical concerns with inducing hypouricemia are considered and relevant clinical evidence is evaluated.
RECENT FINDINGS: Recent studies confirm the benefits of modestly reducing sUA in many gout patients. However, tophi and tissue stores of monosodium urate crystals resolve slowly, particularly in patients with longstanding disease. Consistent with physicochemical principles, the rate of decrease in tophus size increases with a reduction in sUA concentration over a broad range. Reducing sUA to near or below 2 mg/dl can be achieved in some patients with current urate-lowering drugs, but new drugs now under investigation may be more effective. As a free radical scavenger, uric acid has been postulated to protect from oxidative stress. However, inherited disorders associated with profound, lifelong hypouricemia indicate that maintaining sUA near or below 2 mg/dl would probably be safe.
SUMMARY: Targeting low sUA could improve the elimination of tissue urate stores and achieve better control of disease in patients with refractory gout.So what is your uric acid number, and what are you doing to improve it?
Sorry I took so long to get back. I wanted to get my new UA test results which the doctor wanted to wait a month for. When I had my gout in August my UA was 8.6 if I remember correctly. I've been on Allopurinol since then and now I'm down to 7.6. Haven't had a bout of gout since August.
headusher
Headusher,
Refresh our memeories on how much allopurinol you have been taking since August. Of course, as you know, control to 7.6 is not good enough to prevent crystal formation in joints and ligaments. A minimum you should strive for is <6.0
zip2play said:
wes,
I mentioned that on another post. Do you CRUNCH when you walk?
Only on days when I can walk.
zip2play
I've been taking 100 mg of allopurinol for a month. Waiting for a new prescription to come in so I'll be out of the med for about a week.
headusher said:
zip2play
I've been taking 100 mg of allopurinol for a month. Waiting for a new prescription to come in so I'll be out of the med for about a week.
I sure hope your new prescription is NOT for 100mg. You need to be on 300. They did the same to you that they did to me – put you on 100mg to make sure you didnt have any of the bad side effects. Obviously its not strong enough to get your numbers where they need to be.
Therefore, I hope your doc bumped up the dose to 300 which should bring your numbers to somewhere in the 5's.
Keep us posted.
Unfortunately I think it's the same dosage. I'll know in a few days. The good news is that I haven't had a bout of gout in almost 2 months.
Also been watching what I've been eating.I agree with Tavery 100% here. Nobody with gout is going to prevent attacks with 100 mg./day and a months was long enough to determine that you can tolerate the drug (as is a WEEK.)
You need 300 mg. for a one YEAR trial to seee if that's enough; it usually is and that remains the dose that almost EVERYONE is on (that's why they make the 300 mg. tablet.
)Usher,
Beg borrow or steal some allopurinol so you are not without it for a fulll week, you might trigger an attack. Go to a pharmacist you know and ask for a “compassionate prescription” of 7 pills. They can do this in most states without breaking the law. In necessary they will call your doctor. Once you start allopurinol you can skip the occasional one or even 2 days because its metabolite, oxypurinol, remains active pretty long in your system but a week will deplete your system and if the body behaves like it does with most feedback systems, you'll produce even MORE uric acid than you usually do.
And tell your doctor to up your dosage ASAP.
headusher said:
Unfortunately I think it's the same dosage. I'll know in a few days. The good news is that I haven't had a bout of gout in almost 2 months.
Also been watching what I've been eating.
This is the medical equivalent of a game of chicken you are playing. You are betting that you can hold steady with your diet and 100mg of Allopurinol and have no more flareups.
Reality is that you are playing chicken against a train on railroad tracks. The train isnt going to blink first…
Here are my problems with sticking with 100mg.
1. Above a 6.0 means you are still building crystals in your body. Even if you go a while without an actual flareup – you are still causing damage to your joints with crystal formation.
2. Tophi can still develop even in the absense of a painful flareup.
3. When you finally do get another flareup it will be a truly nasty event. There is a reason why the first time is the worst – years of slowly building up until the dam bursts in an orgy of pain. The next time it is likely to be more than just a big toe…knees, elbows and other joints will flare also because they have had just that much more time to build up crystal deposits.
4. No one can be perfect with their diet forever. You will find it wont take much to push you over the line “accidentally”.
5. Even if you are perfect with your diet – your body is continally changing. Your attack threshold is a moving target depending on everything from what you ate recently to how much water you drank to whether or not you exercised. There are more factors than you can control.
These are the reasons why most of the regulars on this site advocate a sub-5.0 average. Less damage to joints via crystal formation and the freedom to enjoy a robust diet that allows a moderate consumption of the “bad” foods (red meat, beer, shellfish, etc).
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