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Hi Paul,
Sorry to hear about your recent flare up. Flare ups within the first six months to one year of starting Allopurinol are not uncommon. Actually, I believe they’re almost expected as the old crystals lodged in the joints dissolve. In all likelyhood your consumption of alcohol is purely coincidental.
It’s encouraging that your flare up didn’t last as long before as that’s usually what happens as your old crystals dissipate.
Keep doing exactly what you have been, colchicine & Naproxen during flare ups and stay on the Allopurinol. The old crystals will eventually dissolve and no more flare ups as long as your uric acid level is below 5 mg/dl.
I’m sure Keith has much more useful information to contribute but based on my experience you are on the right course so keep at it !
Cheers,
RonHi Paul,
Sorry to hear about your recent flare up. Flare ups within the first six months to one year of starting Allopurinol are not uncommon. Actually, I believe they’re almost expected as the old crystals lodged in the joints dissolve. In all likelyhood your consumption of alcohol is purely coincidental.
It’s encouraging that your flare up didn’t last as long before as that’s usually what happens as your old crystals dissipate.
Keep doing exactly what you have been, colchicine & Naproxen during flare ups and stay on the Allopurinol. The old crystals will eventually dissolve and no more flare ups as long as your uric acid level is below 5 mg/dl.
I’m sure Keith has much more useful information to contribute but based on my experience you are on the right course so keep at it !
Cheers,
RonHi Bob,
Usually, exercising a joint during an attack is not advisable. It just increases the pain and can exacerbate the flare up.
Do you know for sure that your “usual uric acid reduction regimen” is working ?
What is your uric acid level? Are you taking any medication to reduce uric acid ? Are you taking and anti-inflamatories or pain killers to help deal with the pain ?
All are important things to know in order for people here to help you.
Cheers,
RonHi Paul,
Let me summarize my gout experience. I have had on and off gout attacks over the past several years, mostly in my left big toe. Very painful, very debilitating. However, the beginning of this year saw me experience excruciating pain in both knees and ankles as well as my toe that I have never experienced before. I was at wits end until I found this site and decided that Allopurinol was the way to go. As a side note, I have always tried to eat healthy, that is a lot of fruit and veggies and limiting my meat intake. However, I have always enjoyed my alcohol in somewhat moderation. ????
I started on 200mg allopurinol and my doctor refused to increase it. My last uric acid test in I believe was April was below 5mg/dl so since I’ve been with her for the past 25 years so I decided to stick it out.
Well I’m happy to report I have not had a major flare up since, and after having abstained from alcohol for the first 3 or 4 weeks I’ve been enjoying 3-4 pints a week as well as wine and the occasional scotch. I’ve also gone to Vegas twice since then where I have WAY overdone it both on the food and booze front including an abundant amount of oysters and mussels which I love.
My point is that if you get your uric acid level at an acceptable level and keep it there and the old crystals that have built up in your body dissolve so as to not cause any flare ups then you should be able to enjoy all foods and beverages as long as you don’t overdo it long term as to harm your overall health.
Gout does not need to define you. You can take control.
Best of luck,
RonKeith,
That’s an interesting comment you make about being on Allopurinol for 6 months and no gout flare means your pretty well cured. I’ve been on Allo for almost 8 months and no flare ups so that makes me feel real good !
I’m back to exercising and playing sports like I used to and I’m still enjoying my beer & wine and occasional scotch. My next visit with the doctor is the beginning of December so I’ll post my uric acid acid levels once I get them.
If I am indeed “cured” I owe a wealth of gratitude to you and this site for steering me in the right direction and giving me support I needed to get on the right track to beating gout.
Barry, I hope that your flare ups are behind you and you can start enjoying your Stella’s again !
Cheers,
RonKeith,
What a detailed and in depth answer. I’m always learning something new about gout on this site.
One thing you didn’t mention that you have before is how FFA’s (Free Fatty Acids) may actually cause the gout flare up while high purine foods and beverages increase uric acid which is the fuel.
Perhaps this is one more piece in the puzzle as to why Barry experienced another attack ?
Barry,
If I understand your previous posts you’ve been on Allopurinol for slightly over six months going from 100mg to 200mg. From what I’ve read it can take well over a year for all your old uric acid crystals to dissolve.
So, don’t despair eventually there will be no more flareups as long as you stay on the Allopurinol.
Ron
My 2 cents.
I too realy enjoy beer, wine and scotch in moderation with the occasional weekend of overdoing it. I have suffered from gout for many years and after my last REALLY bad flareup earlier this year and having read all the good advice on this site, I decided to get on Allopurinol. I abstained from all alcohol and once my Uric acid level got to below 5mg/dL I slowly started drinking alcohol again. I am now drinking the same as before and knock on wood have not had any major flare ups just a couple of really minor ones at the beginning which I believe we’re due to the old crystals being flushed out of my system.
Excessive alcohol, sugar, sodium, saturated fats etc. are bad for your health regardless if you have gout or not. However, I truly believe that if you get and keep your Uric Acid under control, you should be able to eat and drink as you please within moderation.
Again, just my 2 cents.
Cheers,
RonBarry,
Once your level is below 300 & stays there the old crystals will start to dissolve and that can cause flare ups. These flare ups will decrease in number & severity as time goes on. It can take up to a year for all the crystals in your body to dissolve so hang tough ! It will get better.
Ron
Hi Tom,
Under 300 is what you should strive for. The lower the better at the beginning so that the stored Uric acid crystals dissolve quicker.
As long as you stay below 300 all stored crystals will eventually dissolve and no new ones will form.
Please let us know what your blood test says and how it compares with home testing. I’ve thought about getting a meter but I not sure how accurate they are. Also, your Ua level fluctuates based on what you eat and I believe how hydrated you are.
Keep doing what you are doing and see if you can get your level below 5.
From what I understand you are not safe unless you get & keep it below 5. Although crystal will dissolve below 6 they can also be created especially when your body is colder. 5 & under is what you should strive for.
Also remember as crystals dissolve that can trigger a flare up and discomfort. Have anti-inflammatories such as Naproxen and pain killers such as Tylenol to deal with it.
As you lowering your uric acid by diet or are you on medication such as Allopurinol ?
Hi Dorian,
Sorry to hear about your discomfort. Until you get your levels to below 5 and keep them there long enough to clear out all the old crystals that are sitting in your joints you can never be sure.
whenever I’ve had attacks they are always worse in the evening so that could be what’s going on.
Are you on any medication to lower your acid levels or are you trying to do it through diet ? Regardless, until you get your levels below 5 I believe you will always be in danger.
Hi Parker,
Having high uric acid levels doesn’t necessarily mean you’ll have gout symptoms. However, and Keith will most certainly correct me if I’m wrong, high uric acid levels can lead to all sorts of health issues so you want to get your uric acid level down to below 5. This can be accomplished sometimes by diet and most certainly by medication such as Allopurinol or
Uricol.Since you are not having any symptoms I would have my level tested again as uric acid levels do fluctuate. If it’s high again then you have to decide how you want to proceed in order to reduce it.
Wether you decide to try to reduce it by diet or medication there is a wealth of information and advice on this site to help you.
Good luck,
RonHi Tom,
Sorry to hear about your ongoing attacks but do not give up on the Allopurinol ! It will get better. As the Allo helps reduce your uric acid levels in your blood old acid crystals that have accumulated in your joints start to dissolve and that can trigger attacks.
Have you had your uric acid levels tested as that is very important in knowing if you are on the right Allopurinol dosage. Typically, 100mg is just to see if you can tolerate Allo & then the dosage is increased at least until your uric acid level is at a safe level.
Also, you should have anti-inflammatory and pain medication at the ready in case of an attack. Colchicine will also help reduce the spread of inflammation.
It’s very important that you know your uric acid levels and post them on your gout profile along with whatever pain/anti inflammation medication you are taking so that Keith can better help you manage your gout.
You are on the right path. You may need a little tweaking with your meds but stay the course and you will be gout free. It can take up to a year or more to be gout free once you start Allo.
Good luck and keep us informed. We all learn from each other.
Cheers,
RonKeith,
I read and re-read this like 3 times and now I have a headache and still can’t wrap my head around it ! The patience and dedication you have is amazing and I applaud you.
I did however note one thing you said which for me and I believe all gout sufferers is critical – “The main aim of proper gout control is to get rid of uric acid crystals. Once you do that, you can never get a gout attack.”
What I read into this, and please correct me if I’m wrong, is that as long as I get my uric acid crystals under control I can eat all the FFA’s I want and drink all the alcohol I want and I won’t have a gout attack. Not that I would want to do this as It would most likely kill me in the long run with a heart attack or liver disease – but no gout !
Is this correct ?
Hi Randy,
Don’t despair as it is quite normal to have a flare-up or more after starting Alopurinol.
Since you have had gout for 20+ years you have a lot of Uric acid build up. Since the Allo has lowered your blood level uric acid the crystals that have been accumulating in your joints, tendons etc. start to dissolve. This can cause the flare ups you have been experiencing.
I started Allo a few months back and just had my second flare up, this time in my left big toe.(last month in my knee) The good news is if you manage it properly with colchicine, anti-inflammatories and painkillers it won’t last very long. And they happen less often and with less intensity as time goes on. Eventually you won’t have any flare-ups at all as long as you keep taking the Allo. My latest flare-up latest 1 day. The shortest ever !
Stay the course and you will be fine.
Cheers Ron.
Hi DJ,
I am definitely no expert but I would have expected your UA levels to drop more than they have after 5 months on 300mg a day Allopurinol. Having said that, everyone’s body is different. While 200mg gets my UA to 4.5 it may take 500 or 600 for you. Don’t lose hope as it sounds like you are on the right track.
I do know that drinking plenty of water each day is critical in flushing out gout crystals so you may want to up you intake. I try to drink at least 2-3 litres per day and even more on days I do strenuous activity or exercise. And, I believe, that the recommended amount may be even more than that but Keith will let you know for sure.
As I said, it seems you’ve taken excellent steps in controlling your gout with medication and diet so keep at it!
Cheers,
RonThanks Keith !
The knee is still a little stiff but better. I’m happy with the fact that although it seemed like this was going to be the usual unable to move for a week flare up with pain at a solid 10 it turned out to be much milder and I was able to do most of my daily activities. (Albeit much slower).
I look forward to not having to worry about this in the near future as you state.
Thanks again,
RonIf it’s swollen and pink in color it could very well be. However, the only way you’re going to know for sure is to get your uric acid level checked. In the meantime I would take anti-inflammatories if you have them and some type of pain killer like Tylenol.
If it turns out to be gout then you can decide whether you want to lower your uric acid level by altering your diet or by taking a medication like Allopurinol. Sometimes diet alone is not enough. Keith will guide you based on your levels and your preferred method.Cheers,
RonHi Jason,
I too am new to Allo. I’ve been on 200mg for 2 months. It is normal to have attacks as the old crystals dissolve. I had a minor one in my ankle a couple of weeks back. From what I understand there flareups can occur up to a year after we started the Allo as the old crystals keep dissolving. The good news is that they will become less frequent & less severe.
The main thing, and I’m sure Keith will elaborate as he so eloquently does, is to have some type of inflammation & pain meds at the ready when a flareup does occur so it doesn’t interfere with life too much.
Hang tough & good luck,
RonThe ankle has been tender all week but manageable. I played hockey again last night and although it felt a little tender I was able to play through it. (I’m sure the 500mg of Naproxen and 2 extra strength Tylenol I took an hour before I played helped !)
Today it actually feels pretty good so if it was a flare up it was minor and manageable which is great ! Hopefully this is one of the last I experience as the old crystals dissolve and leave my body.
Update.
Got my blood test results yesterday. Liver & kidney functions are normal. UA is at 303 which is down substantially from 503. My Dr. is happy that I’m in the normal range and refuses to increase my Allopurinol dosage to help with the debulking phase. She attended a conference a few months back where they specifically addressed gout and said doctors should prescribe to treat to a point where UA levels are within the normal range which is below 360 here in Canada. Since I am well below “normal” range and I haven’t had any more flare ups she doesn’t want to increase the dosage as it goes against “Canadian Standard Guidelines”. So I’m stuck at 200mg/day and she’s discontinued the 2 x .06/day Colchicine. She said if I do feel an attack starting I should treat immediately with Naproxen 2 x 500mg/day and Tylenol for pain until it goes away.
She’s been my doctor for over 20 years and she’s great so I am hesitant to push the issue and request to see a Rheumatologist.
Should I insist or stay the course knowing it will just take longer to dissolve the older imbedded crystals?
I have an appointment to see her in a month once this prescription of Allopurinol is finished. Not sure if she’ll want another blood test or not. On a good note, still no more flare ups (knock on wood) but I have stopped the Colchicine as of yesterday so we’ll see.
Just a quick update.
I left for Vegas last Thursday and came back last night. While there I can safely say I overdid everything ! I drank excessively (mostly alcohol & wine) and I ate whatever I wanted including many high purine foods such as red meat, crab, mushrooms etc. I was diligent in taking my Allopurinol and Colchicine and I am happy to report that I had a great time with no flareups or twinges at all.
Now that I am back I will return to moderate consumption of alcohol including several days a week of abstinence and will be back to healthy eating with the occasional indulgence.
I am scheduled for blood work on March 17 and will report my UA level when I get it.
Thanks again Keith for the support and encouragement you’ve given me and all others on this site who come for info and help.
It seems you were increasing your dosage of Allopurinol on your own which is never a good idea with any medication. Having said that I believe the upper limit is 800 or 900 mg depending on where you live however, dosage should only be increased after blood tests indicated that it is safe to do so and if your specific case requires it. Your doctor should also be on board. Some are reluctant to increase past the 300mg mark to help in the debulking of the stored UA crystals. If that is the case you may have to find a different doctor or a rheumatologist who’s up to speed on gout.
Post your blood test results once you get them and I’m sure Keith can advise you on a suggested course of action.
Hi Martin, I too have recently started taking Allopurinol after having struggled with gout the past 5-6 years and recently a stretch that saw it move from joint to joint to joint for 2 months. Getting control on the uric acid levels is key in stopping the pain and destruction that is occurring in our bodies.
I don’t think you should continue raising the amount of Allopurinol until you’ve had your blood test. First and foremost you want to make sure your liver & kidney functions are normal. Then you want to bring your UA level to well below 5 so no new crystals form in the joints and old ones can start dissolving and go away. You need to work in conjunction with your doctor to monitor your levels and medicate as required when/if flare ups occur.
It is not uncommon to have flare ups for up to a year or so after starting Allopurinol as the old crystals that are dissolving can trigger an attack. However these attacks will not last as long and be less powerful as time goes on.
Colchicine stops inflammation from spreading. It’s the Allopurinol that is lowering your UA levels.
I’m sure Keith will have a much better and more detailed response but know that you’ve started to take control of your situation and there are many others in the same boat who are here to help and to support.
Good luck,
RonKeith, I should be thanking you for providing the wealth of information and support that set me on the right path to conquer this beast.
To anyone reading this who has recently been diagnosed or has been sitting on the fence not sure what to do the best advice I can give you is read, read, read and ask questions. Knowledge is power and the more you have the better you will be able to understand how to beat gout and that you don’t have to live in constant fear. I realize that there may be setbacks with the occasional flare-up as my body cleanses itself of UA crystals but I know there is a flare-up free light at the end of the tunnel as long as I stick with it.
I am on day 4 of 200mg Allo and 2x.6mm Colchicine and so far so good. Right knee is almost 100% and my left knee is at about 70%. I will try to post weekly as to my progress, side effects, flare ups, blood results etc.
If anyone has any questions for me as I begin UA reduction journey feel free to ask. Once again, read all the information that’s on this site and tap into Keith’s wealth of knowledge. He’s done all the leg work for us.
Thanks Keith !!!
Once again thank you Keith for such a detailed and informative response. I feel honoured to have a “theory” named after me on GP!
My biggest fear when it was confirmed that I had gout was that I’d have to live a rigid life when it came to food and alcohol while all my friends and family were enjoying themselves at parties, restaurants, get togethers etc. it seems this is not the case. As long as one eats and drinks in moderation and makes healthy choices say 70-80% of the time then binges that occur occasionally whether food, alcohol or both should not be of concern once debulking of UA has taken place and your level is safely below 5.
Knees are feeling even better today(about 70%) so I am going to try and ride the stationary bike for 10-15 minutes (lightly) just to get the blood flowing. I haven’t been able to exercise in a good 3 weeks or so so I’m feeling like a slug. Also, I haven’t had any alcohol in over 2 weeks but friends are coming over tonight so I’ll probably have a couple of cocktails or glasses of wine. I’ll let you know how both affect me if at all.
Cheers !
That’s very comprehensive, thank you. It’s how I try to live my life (for the most part). I believe the more a food is processed the worse it is for you. The more it’s in it’s natural state the better. Living day to day and adhering to good eating and drinking ( no more than 2 units a day and at least 2 days a week no alcohol) practices does not concern me.
I’m more worried about the occasional weekend where friends come over on Friday night and we have 4 or 5 units to drink, Saturday night it’s out to dinner with other friends to a steakhouse where not only is the smallest steak 10oz but a couple of Martinis and 2 bottles of wine are consumed between the four of us. Then we’re invited to a family bbq on Sunday where 8-10 beers are consumed that afternoon/evening. Don’t get me wrong, this is not the typical weekend for me but they do happen 4-5 times a year with that type of consumption. Throw in a 4 day trip to Vegas with my buddies where drinking in the norm 24/7, a yearly one week trip to the cottage where there is daily consumption and I wonder…
1) Will this all lead to a spike in UA level that causes a flare up or will the Allopurinol keep it in check ?
2) From what I understand flare ups occur because of the deposits of UA in the joints that have accumulated over many years. Since theoretically a big bulk of these crystals that have been deposited in the joints should be cleared out after about a year of being on Allopurinol, and having your UA level below 5, there should be plenty of “room” to hold any new crystals that may temporarily form after a binge and spike in UA until the Allopurinol can catch up and get rid of it. Therefore there shouldn’t be a flareup. Does this make sense or is it wishful thinking ?
3) I don’t want to live in fear that a crazy weekend once in a while is going to result in a flareup. I’d rather take an extra 50-100 mg of Allopurinol to guard against that. Makes sense ?
Again, I want to reiterate that the bulk of the time will be normal eating and drinking.
I’m not sure I quite understand what you mean by inflammation in the context you are using it in. You say that drinking can cause inflammation. Is this inflammation of the joints or some other kind ? How do you quantify it ? In terms of measuring UA levels I have to rely on Drs. visits so they can only happen at best once a month so I wouldn’t be able to gauge immediately what a week or two of abstinence vs drinking does to my UA levels.
My knees are both feeling a bit better and I can walk without a cane…slowly and have been pushing myself to do so. They’re both still quite swollen and stiff with limited flexibility and going up & down the stairs is a chore but I can tolerate the pain now so no more Tylenol for now.
Thank you again Keith for all your help !
