Joint stiffness with Allopurinol

[Sandeep]

Hi everyone,

My doctor switched me from Febuxostat to Allopurinol since I started experiencing insomnia when I took febuxostat for 1 month. I started Allopurinol just yesterday and I had very stiff left shoulder and elbow joints on my left side when I woke up today. I just ignored it and took the dose today but as the day progressed my right shoulder and elbow joints also got quite stiff and it seems that my stiffness is affecting my spine also now. from what I read many people take allopurinol for long term without any serious side effects but I am having achy joints on the second day itself. Would it go away gradually or should I revert back to febuxostat and search for solutions for my insomnia. ALso which medicine has adverse side effects when taken in long term. I am just 29 now and I am already struggling with terrible left knee after 3 surgeries on that one and now this gout diagnosis is preventing me from attending my office regularly. Please suggest how do I deal with this.

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[d q]

Is this joint pain related to Gout?

Hi Patrick / Keith,

I was just wondering as I’m now getting pain in various joints but more specifically my right elbow joint. The rest are all pretty much ok. I haven’t taken any anti-inflamatories as of yet as I seem to be dealing with the pain reasonably well despite it actually being quiet painful.

My question is similar to Mauri’s. I started on 100mg and my UA dropped from 580 to 555 after a month (not much). My rheumatologist increased my dose about 6 weeks ago to 200mg. I’ll be taking a blood test this week and should have the results early next week. As you say Patrick I also don’t think 200mgs will be enough so I think the dose will probably be increased further to 300mgs.

Could these joint pains be a result of crystals dissolving despite not yet finding a stable therapeutic dose? I mean will crystals still dissolve at lower then a patients usual UA (originally 580 in my case) but far greater then the 350 safe limit? Or are these pains completely unrelated?

Thanks 🙂

[Keith Taylor]

It’s hard to put exact figures on the crystallization point. Uric acid concentration is one factor. But, it can vary in different points of the body. So, you get an exact result of 555. But, that probably means “around the 540 to 570 range”. And, I’m being deliberately vague, because we never really know the upper and lower values. Then, we have several other factors that affect crystallization. Temperature, blood flow, and mysterious factors that some people have that give them very high crystallization points. So, we don’t know. But, the most likely explanation is, a normal gout flare because your uric acid is still too high.

I realize that’s not at all helpful. But it’s true.

Personally, I just rejoice in the fact that you know you need to get uric acid lower. Other than take pain meds, there’s little else you can do.

[Patrick]

Could these joint pains be a result of crystals dissolving despite not yet finding a stable therapeutic dose? I mean will crystals still dissolve at lower then a patients usual UA (originally 580 in my case) but far greater then the 350 safe limit? Or are these pains completely unrelated?

Thanks 🙂

James,

I’m not sure. I can tell you in my case specifically, I used to get severe Gout pain in my left ankle. Then it started to happen in my right ankle. Once I got my UA under 4.5 mgs, the pain in my ankles went away, and has been for over a year (knock on wood). BUT….in the last 2 months, I’ve developed pain in my left shoulder. Now, several things may be happening here. In my line of work (firefighter) I may have injured it on an incident. Or, as an active guy, I recently dumped my mountain bike on a trail, but I don’t recall falling on my shoulder. I fell hard on my back, so I’m not sure. ORRRRRRRRRR, it may be Gout related. I am scheduled for an updated blood test next week, so I’ll have current UA results.

Either way, I found it weird that all of a sudden I had pain in an area I’ve never had pain before. I’m leaning toward an injury, but I’m hesitant to go to the doctor because I don’t want to be put on injury leave at work, if indeed it is an industrial injury. I’m one of the lucky people who actually loves their job and loves going to work.

[d q]

Hi Patrick / Keith

Thank you both for your encouraging posts.
I did my blood test today and I’ll have the results on Tuesday. We’ll know were we stand then. It’s more then likely they will increase the dose but we’ll find out soon.

I was just wondering and wanted to confirm, is it when crystals form and get stuck in joints or when crystals break away from joints does inflammation occur and the pain start? The reason I’m asking is because I was curious as to whenever it’s crystals breaking away from let’s say ankles and getting trapped in other joints (like my elbow) or if it’s just crystals breaking from the same plac and causing pain there?

How long or how many attacks did you have to endure until you got to your therapeutic stable doses?

Thanks!

[d q]

Patrick, following your last post, I just wanted to say I admire people like you (firefighters). It’s people like you that make a huge differences in people’s life let alone saving lives.

I’m constantly worried about doing any physical exercise in case I cause an attack whilst finding my optimum allopurinol dose. 🙁

My left toe has never felt right since the first attack and I’m really hoping in time allopurinol will fix that and I’ll regain complete flexibility.

[Patrick]

Patrick, following your last post, I just wanted to say I admire people like you (firefighters). It’s people like you that make a huge differences in people’s life let alone saving lives.

I’m constantly worried about doing any physical exercise in case I cause an attack whilst finding my optimum allopurinol dose. 🙁

James,

First off thank you for the nice compliment. I’ve learned a lot from working in the city of Los Angeles for 27 years doing this job. It’s a great job and a rewarding profession. My son has followed in my footsteps and he is also a Firefighter in Los Angeles, and has been for almost 5 years. Occasionally, we work together on the floor. I love that, my wife hates it.

As for the apprehension of physical exercise, I understand that, but physical exercise is actually beneficial for your condition. That is, if you are capable of doing it. I know that since I’ve been diagnosed with Gout, I have lost a lot of mobility in my left ankle. I try and power through it, but I can’t run long distances anymore because of it. Anything longer than 5 miles is painful.

Instead, I mountain bike and swim. Both are easier on the joints, and really beneficial for your overall health. Especially swimming. My advice is do what you can to stay active. Walk at a brisk pace, swim, bike, etc…as long as you do something. I take some ibuprofin and Glucosomine and it seems to help. Try that.

[Keith Taylor]

I’m constantly worried about doing any physical exercise in case I cause an attack whilst finding my optimum allopurinol dose.

My left toe has never felt right since the first attack and I’m really hoping in time allopurinol will fix that and I’ll regain complete flexibility

James, I don’t want to push you towards exercise that might make your toe pain worse. But, my experience is similar to Patrick’s. I found walking always helped me control pain better. Initially, boosted with ibuprofen. Then later, as allopurinol started to work it’s magic, it was a joy to realize I could walk bigger distances with increasing freedom from discomfort.

I know we’re all different. But I sense a similar tendency with you, James. Because, I believe we both sometimes overthink potential problems. So, if I’m right, it’s time to get those walking boots on. By the way, stout boots are always better for gouty feet. Because, they support your joints better, if they are fitted correctly.

[d q]

Thank you for your encouraging words Keith / Patrick.
I’ll definitely try and get those joints moving more.

Just an update, I got my UA results back yesterday!
We’ve gone down from 555 to 388..! I am shocked and extremely excited to say the least. My elbow pain has also reduced slightly but my left toe still feels a little painful when bending it far back (which wasn’t painful before gout). I’m hoping all these joint pains are crystals dissolving away rather then side effects of the Allopurinol. The only one thing that my haematologist wasn’t to happy with was my haemoglobin dropped by approximately 1 point so from around 7hgb to 6hgb. He asked me to come next week and do another blood test to verify if that is indeed case. I asked him several times if it’s the allopurinol that may be causing this hub drop and he feels reasonably confident that’s it’s not. In fact he felt increasing the allopurinol dose to 300mg to drop UA further is the a good idea.

My worry now is if allopurinol may be causing my haemoglobin drop?
I’ve done a little research on blood counts and allopurinol and that it may interfere with haematological counts (including the leaflet in the box). All other results seem normal enough though.

Any advice or test one can do apart from stopping allopurinol to see if my haemoglobin returns to my normal levels?

Thanks guys

[Keith Taylor]

I think the toe pain is most likely to be uric acid crystals dissolving. So, increasing allopurinol dose to hasten that process is a very good idea. If you want me to explain why you get pains where you never got them before, please ask.

I’m sorry, I can’t comment on the iron blood test. I don’t understand the blood chemistry of iron enough. And, I can’t find anything to make me think it would be allopurinol related. But, I’m always happy to learn, if anyone has relevant information.

[d q]

Hello Keith,

I’ll be seeing my haematologist tomorrow to discuss the haemoglobin issues etc. I’ve personally decided not to start 300mg until we see what the latest results are. I’m currently taking 200mgs daily and sit at around 388 ummol. Let’s hope things are ok for me to increase further. He has no issues but I’m the one who is a little worried as my haemoglobin levels have come down a little since starting but thats necessarily allopurinol.

Keith I would really appreciate if you could explain why I’m getting pains that I never got before. It would really help me understand further.

Thanks mate.

James

[Keith Taylor]

OK, James, this is for you: Ouch! Why does Gout Recovery hurt?

Thank you for the inspiration. It’s been one that I particularly enjoyed writing. 😀

In fact, I got so distracted writing it, I’m late for an appointment. So, my other lovely gout correspondents must wait for my responses tomorrow. 😳

How will you avoid joint pain during gout recovery?

[d q]

Hi Keith, thank you so much for that fantastic article!
I’ll get started reading it and get back to you if I have any questions. Thank again mate 🙂

[Mark]

I have seen several comments stating that there is pain during debulking. My question is – does your UA% go up during debulking? I have previously posted an excel chart showing my almost daily readings. I was pretty happy that I was able to get down in the 5.5-6.0 range, just by going vegetarian and cutting out alcohol, with some supplements, etc. I had a recent ultrasound, where my UA stone went from about 9mm to 6.5mm. I was thinking everything was going in the right direction. My diet has been VERY consistent and out of the blue my readings started going 6-8 and I have some pain in my toes. It’s not bad pain, but it is definitely there. I have been OK by taking an Alleve before bed. It would make sense that if these crystals broke up and had to be eliminated, you could see a spike in UA%. Just wondering if this would be over about a week’s time?

Thanks in advance for any comments and I am very grateful for this forum.

[Keith Taylor]

Great question, Mark:

My question is – does your UA% go up during debulking?

To me, logic dictates that it must go up slightly, unless uric acid excretion rises to compensate. That’s the opposite of the phenomenon we often see in diagnostic uric acid tests during gout flares. By which I mean blood uric acid drops during gout flares. Because uric acid has gone from the blood into crystals.

Unfortunately, I can’t find any specific gout studies that show uric acid levels when crystals are dissolving. So far, the most useful report I’ve found is “Gout treatment: Should we aim for rapid crystal dissolution?”:

Monosodium urate crystal deposition in gout precedes the first attack and, while hyperuricaemia persists, it grows and expands to other sites. Fortunately, it is reversible and slowly dissolves when serum uric acid (SUA) is lowered below its saturation point of about 6.8 mg/dl [400μmol/L] and with certainty below 6 mg/dl. Crystals finally disappear from joints, taking longer in those patients with longer disease duration, probably because of a larger accumulated load of crystals. The SUA level achieved affects the velocity of crystal dissolution and tophi reduction. Accordingly, by deciding the SUA level cut-off point to be achieved by treatment we are determining the time of crystal disappearance and cure of gout. 6 mg/dl is the usual target level, but lower levels appear appropriate to us, particularly in certain situations.

So, that seems to be consistent with your gout recovery, Mark. In your situation, as a champion Gout Dieter, 5.5-6 should be effective. As nobody says (below), you may need patience. But, gout recovery is on your horizon.

In James’ case, I think it’s more borderline. 388 is too close to the 400μmol/L upper limit. In particular, as an allopurinol patient, there’s no need to settle for long periods of gout recovery that Gout Dieters may have to endure.

For readers confused by the scales, there’s a handy multi-colored chart in the sidebar. Or, use my Uric Acid Concentration Conversion calculator.

[nobody]

Sure, your UA can go up and down for no obvious reason after you’ve lowered it modestly through diet. Whether the fluctuations might primarily be due to dissolving crystals or to metabolic variations I can’t say (I’ve never done frequent tests or owned a testing kit).
In my opinion, you may need to be very patient if you can’t get your lowest readings under 5.5. Don’t let more frequent (if less severe) symptoms discourage you but make sure the medication you’re taking is something that you’re going to be able to tolerate on a long-term basis.

[d q]

@nobody, whilst I totally agree that you shouldn’t let the severe or not so severe symptoms deter you from your goal of lowering UA levels some people might not actually have a choice but to tolerate the medication unless there is a medical interaction with another medication one may be taking, even then there are other UA lowering medications to try.

From all the research I’ve done and the fantastic source of information this site provides everyone will quickly come to realise what harm high UA levels can do to our bodies.

[nobody]

The medication in question is so far as I know not a UA lowering drug but an NSAID, a class which commonly does more damage than moderately high UA. Unlike UA lowering drugs, people should ideally not take an NSAID for very long.

[Keith Taylor]

I’m getting a sense that @d-q and @nobody are discussing 2 different meds here. James is talking about his allopurinol, and nobody is talking about Mark’s Aleve. Both make sense. But only if you split this topic into 2 different threads.

So, here’s a gentle hint. Instead of typing “the medication”, give it a name. Both the meds we are talking about have less characters. So, as well as achieving clarity, you save some finger energy.

You can use some of that saved finger energy to stick 2 of them up at me! 🙂

Please tell me you read the “at” in my previous sentence! 😀

[d q]

@Keith Great response!

By the way Keith I read your fantastic explanation of why the “road to recovery hurts article” and I’d like to thank you for it. Especially the sentance devoting it to me 🙂

I do have a few questions regarding it though, do you want me to raise them in this thread or start a new one?

Thanks again!

@nobody, I totally agree on the NSAID.. When I’ve had a flare up and start my course of them (Naproxen) the first tablet always causes me painful stomach cramps then things get a little better. I’ve managed to get my hands on the gastro resistant tablets which I will try next time (hopefully there won’t be a next time or a need for them though). 😀

[Keith Taylor]

Thanks James. If in doubt, start a new topic, unless it relates specifically to something we’ve already discussed here.

[d q]

Hi Keith, a few days ago I started taking 300mgs of Allopurinol every other day so that my body gets use to the higher dose rather then going straight to 300mgs from 200mgs (also hoping an attack won’t occur if going up slower). Unlucky for me I got caught up in a gout flare today.

I’m assuming I should not go back to 200mgs from tomorrow and stick with 300mgs going forward now correct?

Could it be that the increase to 300mgs caused the flare up and started dissolving more / older crystals?

I would have thought 388 ummol was reasonably safe and another increase wouldn’t “really” be necessary.

It’s the same left toe as before…

🙁

[Keith Taylor]

I’d say 388 is a kiss away from danger. It’s certainly very much in a range of Gout Hell. I’ve upgraded my article to try and make it clearer. See http://www.goutpal.com/9942/ouch-why-does-gout-recovery-hurt/why-does-gout-recovery-hurt-history/ and find the [*] explanation.

So, I believe you cannot tell if your flares are from new crystals forming, or old ones dissolving. And the sooner you get the right dose of allopurinol the better. There’s far less chance of a flare below 300. And, the lower you get your uric acid, the quicker your gout is fully recovered.

[Carroll Lee]

Uric acid crystal dispersment

i have had two distinct bouts in the last twelve yrs. am 65 yrs old, good health, probably eat too much pork, could do better on veggies and i drink around six light beers daily. went to my GP a week ago, had a blood test which was a 6.3. the inflamed joint is my big toe. he put me on the prednisone pack (1 week) and stated that if conditions improve to go another pred. round before starting allopurinol (300mg). upon completion of the first weeks tmt. (tapering off the pred. dosage as per instructions) pain/swelling have returned big time. have trouble sleeping because of triggers of SHARP pain the joint which lasts about one-two seconds all night for the last two nites. since the prednisone dosage has been decreasing could this renewed pain be an indication that the uric acid crystals are being expelled? it would seem that my white blood cell fighters have returned to my toe now that they are not being subdued by the prednisone. have been injesting 2 tbs acv/glass of cherry juice 2/ daily, no beer.

[Keith Taylor]

It’s a very bad idea to start allopurinol at 300mg per day. The safe way to start allopurinol is 100mg. Then, 2-4 weeks later get blood tests for uric acid, kidney function, and liver function. If test results are OK, increase allopurinol to 200 mg. Then repeat until uric acid is safe.

The attacks that you are getting now are because your uric acid is too high. So, new crystals are forming.

Uric acid crystal dispersment – where can they go?

[Carroll Lee]

many thanks for any and all responses to my ques. have been on many gout forums in the last two wks., this one is the best. most/many people (myself included) are/(were) not aware of the many facets of gout treatment. how long should i wait after this bout has subsided before i start allip.?……….thanks again

[Keith Taylor]

My belief is that when you start uric acid lowering, you should have a good pain treatment plan in place first. Then, there is no need to wait for the flare to subside before you start. I believe this because of the work done by Taylor (no relation!) in 2012. Which, I reported in Start Allopurinol Quickly, But Carefully.

But, this only works when you have a supportive doctor. By that, I mean a doctor who understands gout pain. Which usually means a combination approach that the informed gout patient can vary according to their degree of pain.

[Keith Taylor]

Allopurinol and Joint Pain

Hi Sandeep,

I really need to know your uric acid levels. Because without that information, I can only give you guesses. So, my best guess is that allopurinol is working as it should do. By which I mean, it is causing old uric acid crystals to dissolve. Therefore, if the stiffness is too much, you should take anti-inflammatory medicine, as advised by your doctor. In fact, you need a good pain control plan for a few months, until allopurinol has caused most of your old uric acid crystals to dissolve. If your doctor cannot suggest a good plan for gout pain control, then I can help you.

Allopurinol Side Effects & Joint Pain

As for long-term side effects, I am not aware of any for allopurinol. But, there are concerns about long-term effects of febuxostat on the liver. For that reason, febuxostat patients should always insist on liver function tests at least every three months. You can use my search box near the top of each page to search for more information about febuxostat and liver.

Febuxostat Allopurinol Search Results. What will you search for next?

[Sandeep]

Can Allopurinol cause Joint Pain?

Hi Keith,

Thanks for your reply.

I am noticing a decrease in my joint stiffness now. It’s better than what it was a couple of days ago.

My uric Acid Levels are as follows
Feb 20-> 7.0 md/dl
After using febuxostat 40mg for 6 weeks
Apr 1-> 4.0 mg/dl
Discontinued the febuxostat and after 11 days
Apr 12-> 7.0 mg/dl

I am wondering if the uric acid lowering medicines just mask the symptoms of high uric acid level but they never get rid of the crystals that are deposited in the joints. So from my understanding the moment we discontinue the medicine the uric acid level rises again. And it keeps adding to the crystals that are already there. It looks like these crystals can only get bigger and more painful but they would perhaps never fully vanish from body. Also I notice these tinges in many other joints in my fingers and toes unlike many who only seem to have it at a single joint.

Indian diet is different from what western diet is and for us rice and pulses are our staple foods. I am an eggitarian but live with my family. It’s baffling really. I asked my doctor couple of times what to eat and what not for my gout diet but he just said I should stay away from meat and asparagus,mushrooms. I am already avoiding foods with high purine as per info on the internet. But in the South Indian context, that info is not all that helpful. There are many other oils, spices, pulses that we use in our diet. I am compiling a list of all food items that we use in our kitchen and hopefully you can help with some of the foods.

My doctor switched me to Allopurinol now but from my research on the internet both febuxostat and Allopurinol can cause serious side effects but I guess we do not have many options now. The natural or home remedies do not seem to do any good.

[Keith Taylor]

Sandeep, I’m sorry to say this. But, your doctor is a fool. Or, at least, he knows very little about gout. Asparagus is good for gout. Mushrooms are neutral. And small amounts of meat once or twice a month make very little difference.

I vaguely recall saying to you, in another topic, that you need not worry about purines. Just ensure you have a healthy diet. I know that Indian diet is different from Western diet. Which is why I directed you to an Indian nutrition website. I’ve never heard of an eggetarian diet before. But, I understand it is a vegan diet with eggs. If that means you avoid milk and cheese, it could cause gout problems. But, allopurinol will take care of that. So, stop worrying.

When uric acid lowering medicines (febuxostat, allopurinol, or anything else) is prescribed, a sensible doctor will also prescribe pain relief for up to six months. There are thousands of combinations of pain relief suitable for gout pain. I hope you can find a doctor, or pharmacist who can help you with a pain relief package. If not, I’ll try my best to advise you. I explain why you need pain relief in Allopurinol Medication: Why It Hurts To Get Rid Of Gout. But, although I focus on allopurinol, the same thing happens with febuxostat. Because gout recovery can hurt. But, if you keep your uric acid below 5mg/dL, any gout symptoms will get less frequent, and less intense.

In conclusion:
1. Stop worrying about diet. But, if you have specific concerns, please ask me for clarification.
2. Stick with one of your uric acid lowering therapies, and get blood tests every month for 6 months. Post your test results in your personal gout diary. Then, we can make sure you are keeping your uric acid safe.
3. Make sure you have access to good gout pain relief for 6 months. You won’t need it every day. But, it’s good to know it’s there when you need it.

I recently decided to celebrate my 60th birthday in India during February/March 2018. It will be great to combine that with celebrating your Gout Freedom! 🙂

[Sandeep]

Hi Keith,

Thanks for the link but India is a diverse country and the food habits are diverse as well. I searched extensively but couldn’t find any advice for South Indian diet. And I am not a vegan. I love cheese a lot and used to drink at least 1 glass of milk everyday with Protein supplment. Ultimately when I doubled for 4 months. At the same time I was taking certain biscuits as healthy snack alternatives and turns out they are protein rich as well. And I didn’t know that Peas are high on protein as well. So I believe it is this faulty protein-rich diet that led to my gout.

And I am seeing a rheumatologist this week for checking my uric acid levels two weeks after my allopurinol start and I would check with him if he has any dietary recommentations. In India we don’t get low-fat milk or low-fat curd. I get the Toned milk(first one in this link):
http://www.heritagefoods.in/product.html.
And Yogurt is prepared in our house through this milk. Since I have been told to stay away from sugar and Protein supplements, I am not sure how I should be drinking my milk now. Because without any sugar the milk tastes bland and for while I thought about a powder called Horlicks but my doctor said that it is mostly sugar and thst wouldn’t help my cause.

Previously I used to eat an omlette every now and then but now I am making a conscious effort to have at least 4 eggs per week. 4 soaked almonds everyday. Peanuts+Chickpeas paste in the morning. These are my protein sources.

I am going to stick with Allopurinol because I am not having insomnia as I did when I had febuxostat. Allopurinol causes mild joint stiffness every now and then but overall the symptoms have abated. It’s not as bad as it was for the first 2 days. I got to monitor my uric acid levels this week to see if Allopurinol has worked. I will ask my doctor about options in case I have a sudden attack midnight.

Thanks for your advice Keith.

[Keith Taylor]

Firstly, Sandeep, I’m planning to spend my 60th birthday next year, in Goa. So, if you know any places that you recommend visiting, please tell me in the General Discussion forum.

For your diet, protein is good for gout. That gets misunderstood, because most high protein foods are animal flesh. But vegetarian protein sources, and dairy products are good for lowering uric acid. However, you need to avoid too much protein. Because, it puts an acid load on the kidneys, which can reduce uric acid production.

Excess sugar isn’t good for gout. But, dairy fat shouldn’t be a problem. So, no need for low-fat milk or cheese. However, you still need to control calorie intake. Because too much fat can make you overweight, which is very bad for gout.

Generally, allopurinol should mean that you can eat anything you like. As long as you remember weight control and a good mix of healthy whole foods. But, it takes several months to work fully. So, it is usual to experience some gout symptoms at first. But, you are doing the right thing in getting uric acid checked. So, let’s hope you will soon be fully recovered.

[d q]

“Generally, allopurinol should mean that you can eat anything you like. As long as you remember weight control and a good mix of healthy whole foods. But, it takes several months to work fully. So, it is usual to experience some gout symptoms at first. But, you are doing the right thing in getting uric acid checked. So, let’s hope you will soon be fully recovered.”

This is exactly what my rheumatologist pretty much said. As long as it isn’t organ based foods then it only really contributes to 15% uric acid production.

(Although I am changing rheumatologist as he seems to be pretty careless in everything except that one statement when he first prescribed me allopurinol)

The 15% can be enough for some people to control by food only. Me on the other hand loves food too much to fuss around with that 15% for a tablet or two a day. I’ll never be able to get it low enough anyway as I have secondary gout. Rapid cell breakdown and release of their uric acid is what is causing my gout.

[nobody]

Assuming it’s even evidence-based, this 15% is only an average and only looks at half of the isse because food also affect how your body excretes UA.
My UA readings dropped by more than 15% after tweaking my diet and drinking habits (without trying very hard and without losing much weight). I had already eliminated organ meats and such before that >15% drop.

[Nadia Prescott]

Don’t know what to do about Allopurinol and Gout Pain

Quick summary. Had pains in my feet for a couple of months. Not debilitating, I’ve been able to work out and it doesn’t look like I have swelling. My doctor did your regards to test at end of September and my level was eight. I was prescribed colchicine 0.6mg For 10 days. I stopped after six days as I was so ill. I suffered nearly every rare side effect mentioned. Bloodwork redone after six days. Down to 6.6. Three weeks later with diet changes and cherry supplements, I am “stable“ at 6.6. I am working out at the gym but in the evenings I have burning pain in my feet. A little bit in my ankle.

My doctor is suggesting 100 mg of Allopurinol. He would like my level to be 6 mg. However I have a hereditary kidney condition which means I cannot take anti-inflammatories which is why I had the colchicine. Which I also cannot tolerate. My concern taking Allopurinol is what would I take if I had a gout flareup? But I don’t appear to get out like anyone else. It is the burning at night that is the biggest problem. But I am able to keep on bedclothes and looser socks.

I am on gene targeted therapy for lung cancer called alectinib. They do not know if the guy out is a side effect of this particularly as my father and grandmother had go out.

I’m uncomfortable more than in pain, but concerned about long-term effects of not doing anything as well as doing something! Advice would be appreciated from someone more knowledgeable and gout.

The alectinib Is not known to cause kidney damage but is known to cause elevated liver enzymes……

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Is 100 mg allopurinol OK?

[Keith Taylor]

Hi Nadia,

Unfortunately, I can’t see the real connections between your uric acid test results, your symptoms, and your longterm plans to stop gout returning.

For example, you ask: “My concern taking Allopurinol is what would I take if I had a gout flareup?”

But does that mean you are worried about uric acid treatment triggering a gout attack? If so, I hope you can understand the principles in: Allopurinol Medication: Why It Hurts To Get Rid Of Gout. Because the important thing to realize is:
Untreated uric acid will cause gout pain that gets increasingly worse. Until it kills you. But uric acid treatment might cause gout pain that gets increasingly less. Until it disappears forever.

As you are being treated for another medical condition, it is inappropriate to suggest what temporary pain relief is best for you. But the medical profession has a vast array of pain relief choices. So, ask your doctor about temporary pain relief that you might need for a few months until allopurinol has removed your risk of gout attacks. At the same time, you should ask about your concerns regarding allopurinol with alectinib. Because, though there is no reported risk in generally available literature, your doctor should have access to professional drug interaction databases.

[digital-warrior]

Dull pain in morning after allopurinol dose change

Hi All,

I wanted to reach out to the community and see if anyone had similar experiences:

Age: 34
First attack: 24, didn’t come back till 30
Allopurinol: Age30 – 300mg
First UA: 12 went down to around 4 after 3 months.
Kept at it for a year and another blood test came and it was 4-5
So the doctor put me on 100mg to see if that could be enough, I started getting dull arthritic pain after a while, not like a flare but just stiff, aching pain under the foot and just below the toes when I walked so the doc put me back onto to 300mg, and it was fine.

The thing is my gout attack was never on my big toe its be always behind the back of my foot, near the Achilles area, it was hard to also bend the ankle.

Over the next 3 years, I had been pretty lazy sometimes taking allopurinol. But sometimes not taking it. Then in the last 5 months, it has gone to the point where I was taking it and getting weekly flares so decided to stop and see a rheumatologist in April who said I was probably misdiagnosed years due to the fact my gout was never on my big toe and that I have had psoriasis near in the groin area (I showed this to a second doctor and he said it’s not enough to be wanted Psorotoic arthritis), its been 2 months and no flares but I’m back to that same dull arthritic pain under the foot, would rather this pain then a full-blown flare but I’m not sure if it’s because of gout or what as it comes and goes, but recently staying longer and longer. I’ve been eating pretty clean, low purine diet. He told me to stop taking it as well and that only we can find out if its “gout” if I have a flare so he can extract fluid out. At this point, my UA is 7.7 as I had done a blood test for him.

I did ultrasounds and x-rays and they all look fine no bone damage, slight bursitis

It’s now May, I currently have a home test and my UA is 8.4 increased in the last 2 months. It wasn’t a lab test but I might do one in the next month. I worry that if I don’t get flares but UA level is still high it is will doing damage internally, making it worse. Like I get people who have high UA might not get gout but I’ve had a history of these attacks. even tho it’s not in the typical joints.

So here are my questions:

Since I haven’t had a flare-up do you think:

a. Just not go back on allopurinol (I’m actually taking this time to see if diet and herbal supplements like celery seed [Celery Seed for Gout Forum linked above] and cherry tart will work).
I really don’t want to take it for life.

b. Go back on Allopurinol but start off slowly again? since it has been 2 months since my last major attack would it be fine?

c. how long should you wait to retake allopurinol again to limit the flares since allopurinol exacerbates flares.

I’m just lost and don’t know what to do and it starting to affect my everyday life. and starting to worry it’s becoming super chronic. Any advice would be appreciated.

[nobody]

I do not have a similar experience but I don’t understand why, after taking allopurinol for so long, you have become so hesitant.
Did you have a bad reaction? Is your doctor worried about side effects?
You know your UA is high enough to cause gout symptoms without allopurinol and you know you can get your UA to a safe value with allopurinol. Therefore all you need to do to determine whether your symptoms are caused by gout is to take allopurinol regularly long enough to cure gout (5 months isn’t long enough). This is actually a more reliable way to tell whether you have gout than the joint fluid test. Your doctor’s “only way to tell” is actually the cheapest way to prove that you have UA crystals. Another way to prove it would be a DECT scan. That’s more expensive but it doesn’t produce false negatives like the join fluid test. And if you have access to allopurinol anyway, why do you need a proof?
If your doctor has a different therapy they want you to try, fine. But if the choice is between a drug you’ve already taken for years without issues and doing nothing, I’d go with the drug.

If you can cure your symptoms with allopurinol, then you’ll be able to quit taking it briefly in order to try celery seed and what not. Your UA will rise when you quit the drug but once you are cured the symptoms shouldn’t come back immediately so you should at that point be able to perform such experiments without damaging your joints and your quality of life.
If on the other hand allopurinol doesnt cure these symptoms, you’ll know that trying other ways to lower your UA would be pointless.

[nobody]

As I was going over your post again, I realized I had failed to understand one of your questions so here is the answer: you don’t need to wait to take allopurinol. The recommendation to wait until your symptoms have gone away is probably not baseless but it is kind of old-fashioned.
If you had a proper attack, you could wait it out but since you seem to have something chronic you could end up waiting forever. Better take a regular anti-inflammatory drug or colchicine for a little while along with your allopurinol. Obligatory warning: if you aren’t familiar with these common gout drugs, do not take them without discussing them with your doctor first!

[Author]

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