Question: I develop gout periodically, and was told that allopurinal 100mg would help control it. I also understand that I would have to take this medication for the rest of my life. Are there any other solutions?
Dr. Hibberd's Response:
Gout is characterized by the accumulation and deposition of uric acid crystals in tissue, especially in joints creating a painful inflammatory arthritis. It commonly presents as joint pain, usually of one joint with associated swelling and redness in predisposed individuals. It is associated with an elevated uric acid level, but a normal or low uric acid level is not necessarily protective.
Gout can be managed in several ways. Many attacks can be prevented by reducing the purine content of your diet, especially avoiding red meat, liver, kidney, anchovies, and alcohol which are known to precipitate attacks. Gout can be precipitated by illness, surgery, stress, various medical conditions, and many medications (especially diuretics). Gout has also been established as a risk factor for cardiovascular disease.
Treatment of gout usually involves the use of NSAIDs (anti-inflammatory medications, especially indomethacin), often with a short pulse of oral or injectable corticosteroid medication.
Allopurinol use has a double-edge sword attached. While allopurinol does increase the excretion of uric acid, lowering the LONG term attack rate, it may, if given for an acute attack, make it worse. It also has long-term side effects of neuropathy. Doses of allopurinol used to be standard at 300mg per day, but with the information on long term side effects a concern, doses have been lowered to hopefully reduce the chance of drug-induced neuropathy. Allopurinol use will need to be taken only on the advice of your physician. The trend lately has been to avoid its use where possible.
Cochicine used to be given for acute attacks with great effectiveness, but its safety profile is poor and some patients have ended up worse off, so it is no longer recommended for routine gout management. Colchicine has been associated with serious and unpredictable side effects including aplastic anemia (bone marrow toxicity) and neuropathies (loss of peripheral nerve function). The older FDA-approved oral dosing is no longer recommended.
All attempts should be made to correct for known triggers of gout, especially diet and medication sources before any chronic drug therapy is considered.
Underlying malignancies and lymphomas commonly precipitate gout as do many chemotherapy treatment regimens. These circumstances will often dictate use of agents to reduce uric acid levels to prevent other complications.
Consult your doctor for advice in your individual situation. If you need a second opinion, you may consider requesting a referral to a rheumatologist.
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