Gout Pal Interactive

I'm sorry, but I do not know about this side-effect.

More importantly, what are your uric acid levels during the time you have been taking allopurinol?

And what dosage have you been on?

To make any guess about what is going on here, it is vital to compare changes in uric acid levels with dosage of allopurinol over the time you have been taking it.

If any other readers want to look at this, please start with my allopurinol side effects page.

Wow, it's not often I get praise for a quick response. You've just been lucky!

I hate trying to second guess a qualified rheumatologist who has access to all your test data, but something here does not seem right to my unqualified brain.

I have heard of the idea of an “allopurinol holiday” before (unfortunately I can't remember where). The idea is that, having carefully monitored uric acid levels over a number of years, and being certain that no uric acid crystals remain in joints or body tissue, then allopurinol may be discontinued for a while, subject to regular uric acid blood tests.

The crucial point here is that uric acid must have remained low enough for all existing uric acid crystals to have dissolved. There is no exact formula for this. On the scale that I think you are using (mg/L?) this would mean a level sustained below 55 for at least a year, possibly longer. Sorry , I can't remember the length of time involved. There may not even be a standard length of time, as getting rid of all the uric acid crystals will depend on how many crystals there are, how low your uric acid levels fall, and how long you sustain the low level.

Despite the common advice, purines from food are only a small proportion of the amount of uric acid in the blood. Most of it occurs from cell death that is a part of normal human metabolism. Conditions that can make this worse include obesity, starvation, dehydration and other trauma such as surgery. This over-production is the most common cause of excess uric acid, but kidney problems causing under-excretion of uric acid is also very common.

Allopurinol only lasts in the body for about a day, so as soon as you stop taking it, you are exposed to whatever uric acid levels your body naturally produces. As soon as you stop taking allopurinol, you run the risk of increasing uric acid level to the point at which crystals form. This point varies from person to person, and I do not have enough expertise to know if crystals have started to form in your case. The only way that I know to test for this is to analyze fluid from an affected joint - a process known as arthrocentesis.

This is normally done to diagnose gout in the first place, but I see no reason why it cannot be used to establish whether, or not, uric acid crystal have started to form again.

Quite frankly, I cannot understand how or why the medical profession do not make these simple tests more readily available. As far as I know, the results are fairly conclusive as to the existence of uric acid crystals. If you are not certain of the existence of crystals, how can you manage allopurinol dosage? Pain, numbness, swelling, redness or any other typical sign of gout are absolutely no measure of this. Why? Because uric acid crystals cause one or more of these symptoms when they form and when they dissolve. My article “Allopurinol Medication: The Gout Cure That Can Hurt” is crucial reading in this matter.

Unfortunately, this does not really answer your original question, but I do not see a way for anybody to answer that without clear proof that the discomfort you are experiencing is not due to uric acid crystal activity. Surely, with your history of gout, that is much more likely than RSI. Is there a reason why your rheumatologist is suggesting RSI?

I'm at a loss as to what to suggest next. I'll have a think about it and get back to you if anything else occurs to me.

Can any other readers suggest a way forward?