Medication

[Keith Taylor (GoutPal Admin)]

Hi,  After about 10 years of intermittant gout attacks my Dr has at last considered putting me on Allopurinal.  At the moment I'm on Prednisolone to clear up the last prolonged attack.  She has prescribed Allopurinal (100mg) 1 xdaytogether with Colchicine (500mg) 1x3times aday.  It seems strange to take Colchicine when I'm free of the gout. I would have thought that it was a medication for use in an attack. What do you think?

[Keith Taylor (GoutPal Admin)]

Gout flares happen when your immune system senses uric acid crystals in your body and attacks them like a virus. Unlike a virus, you cannot kill a uric acid crystal, but once your white blood cells have coated the crystal, it no longer triggers the immune response, and so the gout attack fades. For more information, see Uric Acid Crystal Meets White Blood Cell – And The Winner Is …..

When you take allopurinol (or reduce uric acid by other means), uric acid crystals start to dissolve, and the protein coating from your white blood cells falls away. This can lead to renewed gout flares, as the crystals are exposed to the immune system (unless they dissolve immediately). For more information see Why It Hurts To Get Rid Of Gout.

Anticipating the risk of gout flares when allopurinol is started, many doctors prescribe colchicine at the same time as a preventative (often described as prophylactic) dose. The colchicine itself has no effect on lowering uric acid, and so some gout patients decide to only take it (or some other pain relief) if and when they have an attack.

If in doubt, it is always best to discuss your choices with your doctor. The most important thing is to get the right dose of allopurinol to lower your uric acid level below 6mg/dL. To be sure this is happening, you must have frequent uric acid tests. This monitoring process is often overlooked which can lead to inappropriate allopurinol dose. If this happens it can prolong the period of time you remain at risk of gout flares.

Please keep returning and let us know how your uric acid levels are going and how you are coping with the treatment. In the UK, doctors often use a different scale of μmol (AKA umol or mewmol). It's OK to quote these values. To convert uric acid in mg/dL to μmol/L, multiply by 59.48.

[zip2play]

Mary,

I'm surprised your doctor has waited so long because a LOT of joint pain can occur in 10 years.

I agree with everything GoutPal has stated but let me add that you must mean 50 mg. x 3 per day, becasue 500 mg colchicine x 3 would probably kill you by day's end.

You can almost certainly discontinue the colchicine after a few months when the allopurinol has done its work and kept your uric acid at suitable levels and any tophi (often hidden) at stable or nmonexistent sizes. If you jump the gun and have an attack then you can always go back on the colchiciner for a while longer.

I was lucky! In spite of a couple visible small tophi, from the very first day of allopurinol (300 mg./day) I didn't have another acute attack dewspite taking NO colchicine. But I would never be without a bottleful in the medicine chest. I'll take 2 or 4  if I suspect any “suspicious” foot pain in the morning.

Over 10 years, my tophi, never big,  shrank almost to invisibility…only the teeniest on my right thumb and another teenier one on my right little finger.

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