January 12, 2013 at 10:28 am #12927
I am a 42-year-old guy and have been fighting gout now for about 15 yrs. I have been taking mostly colchicine for treatment and it worked pretty well except for the nasty side effects. To make a long story short I have not got my gout problem under control and it is affecting my life and job badly.
Recently my uric acid level was 9.5 and I was having a severe attack in my foot and ankle. My Dr. gave me Uloric to lower my acid level and prednisone + colchicine for pain. It went away until the prednisone wore off and now it is in my middle finger and elbow. Extreme pain here!
My uric acid level is at 4.5 now and still having a lot of swelling and pain in my finger and elbow. I have another appt with the Doc in a couple of days so I guess I will see what he has to say now. I really hope I’m on the right track to getting a handle on gout.
January 14, 2013 at 2:15 am #12930
Hi Leonard, welcome to the gout forum.
If you’ve had gout symptoms for 15 years, you have at least 20 years of uric acid crystals lodged in your body. These are everywhere, but more in the colder parts of your body, hence the elbow and finger pain.
There is no easy way, at the moment, to tell how long it will take to get rid of these, but we do know some facts.
1. At 4.5, you will not get any new crystals forming, and old ones will dissolve over the next few months. After 6 months, the frequency, strength, and duration of gout attacks will be significantly reduced. You should consider daily colchicine for a month or two, supported by other pain relief as advised by your doctor if the colchicine needs some help occasionally.
2. You can reduce the period of time it takes to get rid of uric acid crystals by getting uric acid lower for 6 to 18 months. Personally, I’m around 2, and I have been attack-free for almost a year now, with most tophi gone. See Lower Uric Acid Gives Faster Gout Cure for the proof if you need to persuade your doctor.
Leonard, I think you are on the right track, but you can tweak it to go faster with less pain. Please make sure you get liver function and kidney function tests with your uric acid test at the next appointment. Recent Uloric prescribing recommendations have made those tests optional dependent on gout patient’s symptoms, which is too risky as far as I’m concerned. By the time you develop symptoms of organ damage (which I must stress is extremely rare), treatment is more difficult. Why take the risk, especially as you have to have the blood draw for the uric acid test anyway?January 14, 2013 at 8:47 am #12932
“…You should consider daily colchicine for a month or two, supported by other pain relief …”
Keith, I, strongly, disagree with you.
1) You have done an outstanding job in creating and maintaining this Gout Forum. While it is highly recommendable advising gouties a) to check their uric acid levels and keep them below 6mg/dL, b) to have their liver and kidney functions checked regularly, c) to make sure that they get the right doses for their uric acid treatment, however,
2) DO NOT ADVISE how long gouties should take a pharmaceutical medication. It’s bad enough that the medical industry keeps millions of patients unnecessarily on drugs and gets paid for it under the table! Please, don’t YOU do it, too. Especially, since you have gained the confidence of uncountable gouties who believe you probably more than they believe a representative of the medical industry, and rightly so.
3) Colchicine and pain relief medication should only be taken as long as the inflammation and the severe pain last. That duration depends on the severity of the inflammation and pain and varies also with each individual.
January 16, 2013 at 2:13 am #12936
By the way, @hansinnm, you should take credit for 1b, the function tests.
I agree with your point 3, but those who are new to Uloric usually need some clearer guidance than “as long as it takes”
I’m not saying my advice provides that clarity, but I’d rather discuss the specifics of duration of prophylactic colchicine with respect to @leonard01‘s specific needs. The guidelines from the American rheumatology profession, issued last year are a little long-winded. Hence the delay for me summarizing them. They appear to recommend that colchicine should be taken whenever you start allopurinol or Uloric for the longer of the following:
3 months after achieving target uric acid (5 or 6 as determined by personal case review) if you never had visible tophi
6 months after achieving target uric acid but where visible tophi have now resolved
I believe that the reasoning is as follows:
If a gout patient experiences a gout attack during allopurinol, Uloric, or other uric acid lowering treatment, they are less likely to continue that treatment. In the world of professional medicine, there is strong focus on compliance, so the small risk associated with colchicine for a few months is outweighed by the reduction in risk from failing to maintain uric acid control.
Personally, I believe that this should be resolved by clearer personal guidance and support from a doctor who has full access to medical records. In the absence of that access, I can only offer my view on the best compromise. Based on my experience, I suggest a month or two on colchicine to give the best chance of a pain-free transition from uncontrolled gout to controlled gout. I believe “month or two” is vague enough to constitute general advice, especially as this was given in the context of advice prior to full discussion with a doctor.
There is an equally valid view that says take colchicine only as required. I actually switched to this after about a month on daily preventive colchicine, but other people might not have the experience of pain control that I have.
One other point about colchicine before I get back to Uloric treatment. I strongly advise stopping colchicine completely if you have a bacterial or viral infection, or if you are likely to be exposed to one (e.g. if a family member gets infected). Under no circumstances combine colchicine with antibiotics.
What we all must keep focused on is the need to ensure that Uloric Treatment is as effective as it can be. That means maintaining uric acid at 5 in the longterm. During early months, I disagree with rheumatology recommendations that say you should increase dose until you achieve 5 or 6. I believe you should shorten the time it takes to “de-bulk urate” by maximum Uloric for a period of time agreed with your doctor. Your personal plan will have targets determined by the length of time you have had gout, together with your uric acid test results.October 15, 2014 at 11:15 am #17721
My name is Girish (Age 37yrs) of Indian origin from Philly. I had Gout in my big toe in July 2012 with an Uric acid level of 9.6 mg/DL.
I was prescribed Uloric (40mg) by my primary care physician and that reduced my Uric acid to 5.6 mg/DL. But I am having liver function side effects.
1. Was it right for my primary care doctor to have prescribed Uloric over Allopurinol?
2. I plan to Consult a Rheumatologist? Does anybody have a recommendation for Philly or Tristate area?
3. I was planning to avoid the pills for a month and try cherry juice? Now cherry juice is of 2 types ( tart and sweet), which one is recommended?
GirishOctober 15, 2014 at 10:02 pm #17732
1. I do not think it is right to prescribe Uloric before allopurinol, unless there is some specific reason. It begs the question: why prescribe an expensive licensed drug before cheap generics. The ethics are widely debated on many drugs, not just these 2. In the end, I think your doctor has to justify his choice to avoid the accusation of profiteering.
2. I hope someone local can answer this.
3. Both types of cherries have helped, but neither have been shown to lower uric acid from 9.6 to 5.6. Ideally, you need to get down to 5, so I would recommend cherry juice with uric acid lowering medication, not instead of it. A generally healthy diet is always good for gout, and specific improvements, besides a higher than average cherry intake, include alkaline diet, skim milk, and plenty of fluids.October 16, 2014 at 7:24 am #17747
Keith – Thank you. I really value the advice from the Guru himself.
My concern regarding Uloric is not the price but just one single factor and that is SIDE EFFECTS OF Uloric compared to Allopurinol. Moreso, because my liver is getting effected, I think I should not be on uloric.
GirishOctober 16, 2014 at 4:22 pm #17758
I agree with you, Girish. Though price is a factor, health is more important. It seems bad to me that your doctor prefers a medicine with no long track record. Also Uloric has a small risk of liver problems, which is why it is important to get Liver Function test at the same time as uric acid test.
I think you should ask your doctor to switch to allopurinol, and I would love to know why he did not suggest it in the first place.October 16, 2014 at 8:55 pm #17764
I am going to meet my primary care physician and ask the questions, will revert back with his answers. Also I got an appt(end of december) with a Rhuematologist with clinical experience in Gout.
I have got the EasyTouch Meter & have stopped Uloric and will be on Cherry Juice until my appt with the doctor.
GirishOctober 22, 2014 at 1:21 am #17934
@girish-kumar it would be great if you could share your experiences with your uric acid meter. It might help other gout sufferers who are thinking of buying a uric acid test kit.June 30, 2016 at 12:00 am #22530
There are concerns about the affects of gout medicine, Uloric, on liver function.
So we can get clearer guidelines, I started: Improving Uloric Liver Warnings Guidelines for Gout Patients.
Please share your views on liver function and Uloric gout medicine in that discussion. For any other questions about Uloric, or gout, please ask in the new gout forum.
Find more (see gouty search hints).