If you are on allopurinol medication for your gout, you should be getting good advice and regular checkups from your doctor. Like myself, I know many of you look for more information on the Internet. That’s a good thing if it helps you, but beware of misleading lies and half-truths.
Experience tells me that there is a lot of misinformation about gout, and also opinion masquerading as fact. Sometimes opinions, including my own, turn out wrong, but that is the nature of gout, which needs much more research. Wherever I can, I like to give references for my information, so that you can check it yourself.
I’m so appalled by what I found today when searching for “allopurinol medication”, that I’m not going to refer directly to my source, though you can probably search for it yourself using the gout search form at the top and bottom of every page.
One page at the top, or near the top of my search for “allopurinol medication” purports to be an expert quiz. The quiz itself is largely banal, but worst of all, some of it is confusing if not misleading – not what I would expect from a gout expert.
The first question asks for the most common side effect from using allopurinol, and lists the possibilities as diarrhea, weight gain, coughing, joint pain. It’s got to be joint pain, yes? No – they reckon the correct answer is diarrhea. Now this just cannot be right. There are several side-effects to allopurinol, and diarrhea is one of them, but it is not the most common. Allopurinol causes joint pain in just about every gout patient that takes it – and if it doesn’t, it should! The only way to get rid of gout is to melt the uric acid crystals that can damage your joints. As they dissolve, chances are you’ll get a painful gout flare. That’s the way it works, and it’s why most doctors prescribe an anti-inflammatory, usually colchicine, to take at the same time.
The next question asks: what commonly prescribed antibiotic should not be used when taking Allopurinol? Choices are biaxin, pennicillin (yes, they stuck an extra n in penicillin), amoxicillin, or diflucan. Now this is just plain confusing. I actually went for biaxin, as I remembered it could be dangerous for some gout patients, though I didn’t remember why. When I got it wrong, I checked on my biaxin page, and realized I’d confused allopurinol with colchicine. So was it a trick question? Whether it was or not, it was confusing, and potentially dangerous to suggest to a gout sufferer that biaxin is OK to take, when the chances are that they will be taking colchicine. And why not take amoxicillin? Some studies have revealed that rashes are more prevalent when people take it with allopurinol, but nobody knows whether it is drug interaction, or some other factor of having gout that increases the chances of a rash.
I could go on, but I think you get the point. If you are taking allopurinol medication, you should be taking advice from a doctor, preferably a rheumatologist.
I too do searches on the internet and find some information very misleading. But the desire to find out and know things. Things that can really rule your life. For that I thank you for your web site.
I have been trying to find out the mechanisms behind the increase in attacks when first using allopurinol. Allopurinol lowers the uric acid. The crystals melt and loose the protein protection. To have another attack, the melted uric acid would have to crystalize. Right? But if the medicine is doing its job of lowering the uric acid level, then no crystals would form. The idea is that the fluid (blood?) would have to be saturated to form crystals. Or, does the metabolized chemical not bind with the melted uric acid crystals. Maybe there is a surge of melted uric acid crystals that overwhelms the medicine’s process. But, how could your blood be over saturated with uric acid when it is the under saturation which causes the crystals to be melted in the first place?
I have asked this question to my doctor and I left without being satisfied with his response. I probably didn’t ask the question in a way he would understand me. So, I gave up and picked up my prescription. It’s been a month and no major attacks – just minor to moderate joint pain. And, I am grateful that, as of yet, I have had no major attacks.
Great question.
Answer is – there is a missing factor. The reaction of your immune system.
The pain process is not:
Uric acid forms crystals. Crystals cause pain. Dissolving crystals removes pain.
I’ve described what really happens in my page describing how uric acid causes gout pain.
The crystals do not hurt – they are too small. What hurts is your immune system response when it attacks and tries to kill the uric acid crystals. It can’t kill them, because they are not alive, but it does coat the uric acid crystals in white blood cells and then they become invisible. The inflammation stops then, unless new crystals form.
After a few gout attacks, you’ve got millions of these coated crystals dotted around your body. These are often called the urate pool.
Allopurinol makes your body produce less uric acid. Other treatments (uricosurics) help you get rid of excess uric acid. Either way, uric acid concentration in your blood falls. If you do this right, it falls low enough so that uric acid crystals around your body start to dissolve.
Two things can happen.
1. Uric acid released from dissolving crystals goes back in your blood. If you are not excreting enough uric acid, either because your kidney function is impaired, or because you are dehydrated, the uric acid can form new crystals.
2. As the uric acid crystals dissolve, the protein coating from your immune system that hid the crystals will fall away. If the exposed crystal does not dissolve immediately, it will trigger another immune system response.
So there are actually 2 answers to your great question.
The good news is that gradually, the urate pool gets smaller. Eventually, it is all gone, and your gout is fixed. That does not mean that you are cured completely. If you stop taking allopurinol, and excess uric acid production resumes, then you risk starting over with the gout problems. Regular uric acid tests are vital to ensure that you keep uric acid below 6mg/dL (some recommend 5.5) until the urate pool dissolves (phase 1). Then you must continue regular testing, with appropriate allopurinol dose adjustments, to ensure that it does not rise above 7mg/dL (phase 2). Depending on your circumstances, and as long as you continue regular monitoring, it may be possible to reduce the dose to zero for a few months – as long as you get back on before uric acid rises above 7mg. For some people, it does mean taking pills for the rest of your life, but this is much, much better than gout attacks and the risk of bone damage.
Phase 1 takes around a year, possibly more, depending on how long you have had gout, and how well your body is responding to your allopurinol dose.
Phase 2 is the rest of your life, so let’s hope it’s a very long time.