I do not initiate allopurinol until the attack is fully controlled with colchicine or NSAID, and usually cover increases in allopurinol dose (until at the 0.3mmol/litre or 300umol/litre urate/uric acid target) with colchicine or NSAID.

I would now initiate allopurinol on the basis of a single episode of gout as it is my understanding of the guidance, especially with a uric acid level of 0.7mmol/litre (700umol/litre).

I would consider this and any possible lifestyle changes as lifelong. If I could not get below the 0.3mmol/litre target I would be referring to a rheumatologist, but usually with repeated testing and persistence I can.

You need to consult a GP in person to go over an agreed plan suitable for you in full possession of the facts. Unfortunately, the stretched GP service is already giving you problems in service, so you will need to keep following up on this to protect your joints.

I tend not to comment too much on individual cases on the internet now due to potential problems, so would say that the above is what I would encourage a trainee GP (if there are any left) or a junior doctor or medical student I was teaching to do. There is no substitute for seeing this through with your own GP despite access difficulties.

 

Thank you John.


You said "I would now initiate allopurinol on the basis of a single episode..."


Did you mean to say not?


Cheers David

 

You don't usually start Allopurinol until a flare episode has settled down. The recognised process is to take 100mg for a month then jump upto 300mg. That's what my research found. If you take Allopurinol whilst having a flare it can in some instances make the flare worse.

I found after 2 months of taking Allopurinol all my aching joints had cleared up. I've not had any issues at all taking the drug daily for 6+ years

 

I think OP's GP's policy is to 'use' allopurinol to lower urate levels, reducing the trigger

While I can see this logic, allopurinol 'flushes' out uric acid, increasing the likelihood of a flare...

Interesting

 

I would now as in this would be my present practice, but it wasn't previously. I would not during the acute flare. Sorry if that was ambiguous.

 

NICE say after two or more attacks in a year, but it is a developing area. If you don't get it down from 0.7mmol/litre, it is very likely happening again.

 

OK, so the elephant in the room is why is the Uric acid so high?


I take a moderately high dose of diuretics but GP made no comment when I asked. Should I think about reducing dose?


David

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104583/

There are hazards from reducing diuretics depending on the reason for taking them, so needs further discussion. The worst risk is exacerbating heart failure if being used for that. Problematic can be swelling of the legs which can be difficult to manage.

 

Too much w*nking, that's what it is.

 

Psoriatic arthritis ... treated with Methotrexate, the sooner the better as I left mine too long and it's crippling.