[Tim]

Hi Barry,
I think it’s a good question that you’re asking.
I had a toe that was swollen and odd looking for a couple of years. It caused no pain unless i squeezed it, which of course I avoided. I didn’t know it was gout because even when i had the odd gout attack every year or more, it wasn’t the toe that was painful but somewhere else. Then, this year, i got an attack and the toe erupted with tophi. 3 months on it still hasn’t healed though is much better as my levels (on 200mg Allpurinol) have dropped below 5.
And here is my idea as to what the “old” crystals are.
Correct me anybody if it seems wrong, please.

There is some kind of tipping point and uric acid builds up, you have an attack or “acute gouty arthritis” that goes away as you have expelled some uric acid. The crystals are still in your joints waiting to build to the tipping point. When the next stage hits – the “chronic tophaceous gout”, the tipping point has been reached in several joints and it’s a big blast that is hard to shake. As the Allopurinol starts reducing the uric acid, the tipping point is reduced and so the flares occur.

Why the tipping point might be reduced by Alo, I don’t know. You would think if it lowered the level that the “old” crystals would just hang around waiting like they were before – I think that is the gist of your question, Barry.

So, my question out there is, if Alopurinol lowers production of uric acid, why don’t the crystals hang around until it is raised again?
Because if the lowering of the level creates flares, does that mean before an attack (pre- Alo) our levels were dropping, sparking an attack?

Seems a mystery, the whole damn thing.
Tim

[Tim]

Hi again, just new to this forum stuff, so i am replying to myself! I just read Keith and Barry’s exchanges (am i the only one laughing?). I see there is a lot of stuff about Allopurinol and I see Keith’s rant (his words) is about the very stuff I was worried about. Ok, I will wait for my Doctor’s advise but i do still wonder if i should be on anti- inflammatories at the same time.
I, like Barry, do look forward to being able to have a few wines and beers, and I see his point about monitoring oneself (previously not caring too much).
I don’t like the idea of being on Allopurinol for life, but …..
Tim

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