gout flare up

[John McGovern,,,,]

Hi there,

Maybe I’m Just unlucky, I had my uric acid test results back on xmas eve they were 218umol so I allowed myself to have a 10oz fillet
steak on xmas day but I didnt stop there I had at least 10oz of cooked ham boxing day and the day after,I havent eaten anything since
last Saturday but here we are Tuesday night I have a flare up, I know i over did things a bit but I thought as it was just a couple of days I would get away with it, so I am not sure weather I should increase my allopurinol or take Arcoxia.

[Keith Taylor]

First, John, I think you are probably @john-mcgovern-543 – if you login before you post, you don’t have to wait for moderation, and it ties all your posts to your profile, so easier to find in future.

For gout treatment, you have to separate long-term uric acid control, and short term pain control.

Allopurinol is best for long term uric acid control. You are doing well with this, as the safe maximum level is 300 ?mol/L. At 218, you are dissolving old crystals. This is a good thing, but partially dissolved crystals can cause gout flares. You have to be prepared for that, irrespective of what you eat, so if Arcoxia is what works for you, then take it as required. This is to be expected for a few months.

Increasing allopurinol will surely reduce the amount of time you are at risk of gout flares, because lowering uric acid more will dissolve crystals faster.

When I was in your position, I persuaded my 4th doctor that maximum allopurinol for a year was my best solution. The other 3 thought that 400 was OK because it fell into the “normal range.” I lost faith in those 3, and haven’t seen them since. From memory, it took about 4-6 months to get rid of most of 16 years of uric acid deposits. During that time, I noticed attacks became less frequent, and less painful.

So, consider increasing allopurinol, but keep the Arcoxia on hand for a bit longer. Attacks in your circumstances are rarely caused by what you eat. If they are, it is nothing to do with purines, but everything to do with free fatty acids from saturated fats.

There’s a couple of relevant summaries at http://www.goutpal.com/the-gout/?q=joosten
I was inspired to write them after I read http://www.rheumatologynetwork.com/gout/gout-purine-rich-foods-and-red-herrings
They make most of what is written about diet and gout attacks obsolete. However, John, you can be proud to know that you are on the right road to full recovery. Go a little faster with more allopurinol for a few months if you wish. After 6 months without a flare, you can then reduce it to maintain uric acid no higher than 300.

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