Have you noticed something about GoutPal.com?
I tend to tell you why you should fix your gout, what you should aim for, but rarely exactly what you should do. Why is that?
Because gout affects everyone differently.
Basic Gout Principles
Gout is caused by excess uric acid.
Gout flares are caused by uric acid crystals forming or dissolving.
Gout is controlled by maintaining uric acid no higher than 5mg/dL (0.30mmol/L).
So if gout, and how to fix it, is explained in three sentences, why do we need thousands of pages about it?
Because everyone is different.
People have many different causes of high uric acid. People have different reactions to gout flares, and different levels of understanding. People have different reactions to gout treatments, and different needs and desires. Every gout sufferer has their own reactions, experiences, opinions, and interpretations. Hundreds of factors combine in different ways to give the millions of individual situations.
I do not want to teach a set method for managing gout - it could not be appropriate for everyone. I want to help you understand the basic rules so that you can work with your doctor to fix your gout.
Basic Gout Management Principles
Start with a competent diagnosis of your symptoms.
Develop a gout treatment plan to make uric acid safe, and deal with pain until you reach safety.
Assess gout diet to see if improvements will help your treatment plan.
However, I realize that, in the unfamiliar world of gout, a map can help you. An example of an individual treatment map can help you understand the big issue. That should help you and your doctor tweak the details to produce your own personal gout treatment map.
Best Gout Treatment Map
This is the best gout treatment plan because it suits most gout sufferers. It is a "default setting" that you can discuss with your doctor, or discuss on the gout forum. You can amend the details of the map to suit you, whilst ensuring that your gout compass still points in the right direction.
Best Allopurinol Treatment Plan
- 1. First 2 weeks
- 100mg allopurinol per day to rule out allergic reactions
- 2. Day 14
- Blood test for uric acid, liver function, and kidney function
- 3. Test results
- If no adverse reactions or blood test results, increase dose by 200mg allopurinol per day.
- 4. Repeat 2-3
- Test and increase until maximum 900mg dose. Yes, go large. Use the search box above with lower quicker. You will find several references here on GoutPal, showing how lower uric acid gets rid of old crystals quicker, and those references link to many similar investigations. Getting rid of old uric acid crystals quicker means a shorter period for the risk of another gout flare. Why settle for less than the best treatment for gout?
- 5. Monitor urate clearance
- Monitor every month until stable uric acid level achieved, then extend test interval to 3-6 months. Record any gout flares. Continue until six months have passed without a gout flare.
- 6. Dose adjustment
- Repeat test-dose adjustment process each month, reducing dose by 100mg per day until uric acid rises to around 4.5mg/dL (0.27mmol/L), and continue testing monthly until uric acid is stable in the 4.5-5mg/dL (0.27-0.30mmol/L) range.
- 7. Maintenance
- Extend monitoring period to six months or longer, but never less than once per year. Never allow uric acid to rise above 5mg/dL (0.30 mmol/L)
- Some authorities suggest that, once all uric acid crystals have dissolved, treatment may be relaxed, and allopurinol discontinued, for several months. This is something you can discuss with your doctor. I will report these investigations whenever clear recommendations are available. Common sense dictates that you must monitor uric acid levels during any break in treatment, and resume immediately if results approach 6mg/dL (0.36mmol/L). Do not rely on absence of gout flares - uric acid crystals usually start building long before they induce a gout flare. By the time you feel the pain, it is too late, and you are back where you started.
Stay On The Right Track
Planning your gout journey is important to me. You have the pointers to stay on the right track. Follow the pointers in the highlighted paragraphs above, and you can draw your own map to gout freedom. During 2012, I will introduce new tools to help you set your gout compass in the right direction. Stay updated with my free subscription service so you never miss an important development.