Keith’s GoutPal Story 2020 Forums Please Help My Gout! What Next with my gout

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    Hi everybody,

    I am a 34 year old male from Australia. I have had gout from around 25 with the occasional attack. Of course as time went by, it has increased and gotten worse. Always used Colchicine and Arthrexin to fix the gout when it happened.

    These days I get it about every second week or so and was constantly on colchicine and arthrexin.

    I am overweight and eat and drink like 34 year old, meaning red meat, drink beer/wine and whiskeys every weekend.

    On the 23th of Jan, I had enough and started with allipurinol 100mg. Every week I increased it by 100mg and are currently on 500mg per day.

    Since starting it, I have had a big attach lasting a couple of days in my knee, where the gout always went first. Took a lot of colchicine and arthrexin to fix it and after a long while, it moved down into my left toe. It has been in my left toe now for another week currently, have been drinking colchicine twice a day with some arthrexin but it doesnt want to go away. It is better now but still not gone, my toe is still in pain and a little stiff.

    Since the 23rd, I havent had any red meat, and no alchohol. I only eat green vegetables and chicken, no coffeee etc, to loose weight and of course fix my gout.

    I bought one of the easy uric acid testers and monitored it with that. My levels were:
    30-01: 7.9
    31-01: 6.3
    3-02: 7.3
    4-02: 7
    8-02: 6.2
    10-02: 5.7
    11-02: 6.6
    15-02: 5.7
    26-02: 5.4

    So it would seem like it is going down (I hope). I havent had a blood test done yet with a doctor but want to try and get that done next week. I have since the 23rd also lost about 7kg with my new diet so thats goo, because I want to be lighter because of the way gout has destroyed my knee.

    Do I keep on increasing the allipurinol up to around 800/900mg per day? I have stopped at 500mg now and am on it for the second week now.
    Do I add colchicine twice a day (0.5mg) for now for another month or so, because initially I was just drinking the allipurinol on its own, nobody told me to drink the colchicine with it?

    Should I just keep strong, as you guys have mentioned on the forum about going through these flare ups, hopefully removing the gout crystals in my body over time?

    Does colchicine lower your levels or are the uric acid levels I am testing being changed because of just allipurinol?

    Thanks a lot for all the info and information people

    Ron Avery

    Hi Martin, I too have recently started taking Allopurinol after having struggled with gout the past 5-6 years and recently a stretch that saw it move from joint to joint to joint for 2 months. Getting control on the uric acid levels is key in stopping the pain and destruction that is occurring in our bodies.

    I don’t think you should continue raising the amount of Allopurinol until you’ve had your blood test. First and foremost you want to make sure your liver & kidney functions are normal. Then you want to bring your UA level to well below 5 so no new crystals form in the joints and old ones can start dissolving and go away. You need to work in conjunction with your doctor to monitor your levels and medicate as required when/if flare ups occur.

    It is not uncommon to have flare ups for up to a year or so after starting Allopurinol as the old crystals that are dissolving can trigger an attack. However these attacks will not last as long and be less powerful as time goes on.

    Colchicine stops inflammation from spreading. It’s the Allopurinol that is lowering your UA levels.

    I’m sure Keith will have a much better and more detailed response but know that you’ve started to take control of your situation and there are many others in the same boat who are here to help and to support.

    Good luck,

    Keith Taylor

    Wow! Wow! And thrice wow!
    1. Martin: Welcome to the forum and thank you for an inspirational first post. Your overall plan is staggeringly good. Some of the detail needs work.
    2. Martin: Thank you so much for putting useful gout facts in your Personal Gout Profile. You cannot imagine how much easier that makes it for me.
    3. Ron: You instantly homed in on exactly my concerns.

    There are lots of detail that I can add over the next few days. Here’s my problem:
    I have a real long working day today. I have a birthday party tomorrow (All welcome if you can get to Ilkley Weatherspoons 3:30pm Saturday ). I have a recovery day Sunday.

    Martin, I would definitely increase allopurinol, but as Ron says, stay on 500 until you get those 3 vital blood tests (ua, kidney function, liver function). Take one colchicine at bedtime. Repeat in morning if any twinges or signs of inflammation. Never more than 2 a day. Max safe dose of your anti-inflammatory Arthrexin (indomethacin). If needed, see pharmacist or doctor about helping the anti-inflammatory with a compatible pain-blocker. After a few weeks, you can probably drop the preventative colchicine and move to “as-required”

    Maybe back later – off to work now. Thanks Martin and Ron 🙂


    Hi Ron and Keith,

    thanks for the info, its so weird, in my left toe it is just getting worse, getting more red and more swollen, I took pictures of my toe a week ago when I had the normal “gout” type feeling in there, but what I am experiencing now is something else? Don’t know if its the allipurinol or what? Does the allipurinol bring on tophi, is it even tophi or what? It is a red circle and really painful, I had to drink another colchicine today midday because of the pain…

    What should I do, is this what happens as allipurinol starts lowering the uric acid, or is it something else 🙁

    Couple of weeks ago


    • This reply was modified 6 years, 9 months ago by Martin.
    • This reply was modified 6 years, 9 months ago by Martin.
    • This reply was modified 6 years, 9 months ago by Martin.
    • This reply was modified 6 years, 9 months ago by Martin.
    Keith Taylor

    A tophi is an obvious lump. It starts quite soft and jelly-like, then gradually hardens.

    Allopurinol will not cause tophi, but if they already exist, you might get a flare as the crystals within start to dissolve.

    Uric acid crystals grow very slowly, and you don’t always notice them. When allopurinol lowers uric acid enough, large quantities can start dissolving. It might hurt in a different way, but it’s a good thing because it means your body is recovering.

    Use my 3-pronged attack on pain, because colchicine alone is often not enough.

    Colchicine = stop inflammation spreading
    Anti-inflammatory = reduce inflammation
    General analgesic = block pain

    By general analgesic I mean something that your pharmacist recommends as compatible with your Indocin.

    Give it a few weeks, Martin. You’re doing most things right, and I’ll be back with more details next week. Please keep posting – it helps!


    Hi all, weird went to the doctor, and all they tell me is that I need to be on 100mg allopurinol or 300mg maximum 🙂 I will be doing my blood test at least after asking for it.

    Ron Avery

    It seems you were increasing your dosage of Allopurinol on your own which is never a good idea with any medication. Having said that I believe the upper limit is 800 or 900 mg depending on where you live however, dosage should only be increased after blood tests indicated that it is safe to do so and if your specific case requires it. Your doctor should also be on board. Some are reluctant to increase past the 300mg mark to help in the debulking of the stored UA crystals. If that is the case you may have to find a different doctor or a rheumatologist who’s up to speed on gout.

    Post your blood test results once you get them and I’m sure Keith can advise you on a suggested course of action.

    Keith Taylor

    Maybe what your doctor was saying Martin is that you should only be on 100 or 300 now, because you haven’t yet had an “official” follow-up blood test.

    Safe allopurinol dosing is:

    1. If Han Chines, Thai, or Korean descent, consider genetic screening test for allopurinol hypersensitivity risk.
    2. Start on 100mg.
    3. Get blood tests between 2 weeks to one month later. Tests must be at least uric acid, kidney function and liver function
    4. Adjust dose to achieve first year uric acid target
    5. Same 3 blood tests within 2weeks to one month of dosage change.
    6. After one year, gradually decrease allopurinol dose to achieve safe maintenance dose.

    This has to be a personal plan. First year uric acid target could be 3, 4, or ‘low as possible.’ Safe maintenance dose is normally 5mg/dL, but might be 6 if other health problems prevent the lower target.

    Personal plan should include pain control either preventative or as required for first few months. (Because your foot pain is typical)

    By increasing your dose to 500mg daily without corresponding blood tests, you risk adverse reactions. You will probably be OK, but why take the risk?

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