Been on Uloric and am really suffering…

[Greg]

I have suffered from severe gout for over 20 years….my feet, knees, hands………….I am allergic to allopurinol so have been “treating” my numerous gout attacks with NSAID’s……..finally, 3 months ago, I went on 80mg of Uloric……..it has lowered my uric acid levels but I am enduring almost constant gout attacks……how much longer should this last??

[Keith Taylor]

Hi @greg78

My doc gave me a colchicine (Colcrys) prescription for a few months when I started uric acid lowering treatment. Has your doctor said anything about this? Or has he said anything about pain relief until the Uloric takes effect?

There are two major factors that determine how long you are at risk of gout attacks when you start Uloric or allopurinol. One is the length of time you’ve had gout. The other is your uric acid level now. I know the first answer is 20 years, but what about your uric acid level now?

Has your doctor suggested a target uric acid level?

There’s a few things you can do to reduce the pain, and to reduce the length of time you are at risk of gout flares. Can you let me know your uric acid level so I can suggest the best things for you to do next.

[greg78]

I have been using Celebrex for inflammation reduction as I used to find Indomicithin hard on my stomach. My blood work done in mid-July showed a uric acid level of 258 but my doctor has not stated a target for me. Should I ask for one? Should I ask for a referral to a rheumatologist? I have been on the 80mg of uloric since June and read that my flares could continue for another 3 months…..my body seems to be moving from one spot to another where I have previously had gout. (right foot, to left heel, to left knee, back to left arch, etc.)

[Keith Taylor]

Thank you for the extra info @greg78. Just a minor point, but if you login before you post, your topics and replies get linked to your profile. This can be useful if you want to easily refer back to what you have written earlier. I guess it doesn’t really matter when you are adding replies to your own topic. I just thought I’d mention it in case you are having any problems logging in.

As for your uric acid level, 258?mol/L is a good result. Long term target should be no higher than 300. I got mine down to just over 200, and had no sign of gout after about 4 months. I had a doctor who was very responsive to increasing my dose, and I was on allopurinol. You might find a reluctance to go above 80mg Uloric, though in pre-launch trials it has proved safe at higher doses.

Doctors sometimes add probenecid to try to get old uric acid deposits out as soon as possible. Adequate fluid intake is important to allow uric acid to pass from the kidneys. Taking some of that fluid as skim milk might help, though this does vary from patient to patient, and I don’t think it’s been tested alongside uric acid lowering drugs.

I would talk about this with your doctor. If a rheumatologist can do more for you, that’s a good idea, However, as you have no complications, I’m not sure you will get much benefit.

As far as gout pain is concerned, some flares are to be expected. You are right that you might be looking at another 3 months, and you can only shorten that time by getting uric acid lower. On the other hand. the flares might stop next week. We don’t currently have easy access to the technology that can measure uric acid deposits in the body (DECT).

I know it seems hard to be still in pain when you are doing everything right. I found that the flares got less painful, and I could cope with ibuprofen after 2 or 3 weeks on colchicine. I did take colchicine later “as required” if I felt a twinge coming on, but gradually came to rely on occasional ibuprofen only. I was expecting to get pains where I’d not experienced them before, but also mainly in previously affected joints. This happens because uric acid crystals grow very slowly, and we often don’t notice. When they start to dissolve, they usually go quickly, and create flares as they are dissolving. I’m explaining this because I found it comforting. I knew that my uric acid level was safe, as yours is. Any pain therefore is part of the healing process. I know it’s not pleasant, but those thoughts helped me tolerate it more easily.

Greg, I think you are well on the way to recovery, but only you know how well you are coping with this. If you’d like to try and get uric acid lower, I’d see if your doctor can help, but if not, try for a rheumatologist. I had to discard 3 doctors in my group practice before I found one who agreed that 200 was a good target. The others thought 400 was good enough!

You could ask about colchicine. It’s only any use taken at the first twinge, before inflammation sets in, or daily as a preventative. It is associated with stomach problems, but some of that is because it used to be overprescribed. 1, or a maximum of 2 per day should be OK.

I hope that helps, and if you need any clarification, please ask.

[Terry Potter]

Hi i was also on Allopurinol and i developed an allergy. Colchicine helps me but upsets my stomach. Is probenecid the same generic drug as Allopurinol? Can anyone tell me?

[Keith Taylor]

Terry, probenecid and allopurinol are separate drugs, both used for lowering uric acid.

Probenecid encourages excretion of uric acid through the kidneys. It is only useful when the kidneys are not clearing uric acid fast enough (under-excretion). Allopurinol and Uloric both work by inhibiting production of uric acid. They are useful for over-producers and under-excreters.

For completeness, colchicine is an inflammation blocker. It should only be used until uric acid lowering treatment has removed the cause of inflammation, not as an alternative to uric acid lowering.

[greg78]

Thanks………..I really appreciate your speedy response and information.

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