Before you begin taking allopurinol, you must be aware that all uric acid lowering therapies can trigger a painful gout flare. This will diminish as you keep taking the medication. It is caused by uric acid crystals that have accumulated in your body tissue dissolving. It is vital that you get rid of these crystals to avoid crippling joint damage, so you must manage this pain for the few weeks or months that it takes to dissolve them. See my explanation of allopurinol medication for more details.

You will normally start with 50mg – 100mg allopurinol tablets, followed by a blood test. It is important to go straight back to your doctor if you notice any allopurinol side-effects. In a very small number of cases, you can have a strong reaction against this drug, and it is vital that this is picked up immediately.

The blood test will indicate if your dosage needs to be increased – common allopurinol gout treatment dosage is 300mg, but this will depend entirely on your particular circumstances. Repeat blood tests at the interval advised by your doctor to ensure this dosage is right for you.

Although allopurinol gout treatment is common, it is also commonly misused. As I reported in my December 2006 Newsletter (Retrospective Claims Analysis of Gout Drug Utilization, Compliance and Associated Serum Urate Levels), less than half of gout patients who start allopurinol treatment continue with it. Of those that do, only one person in three will take a sufficient dose to lower uric acid to the level that will dissolve all uric acid crystals.

For successful allopurinol gout treatment, remember:

• Take pain relief as a precaution, or as you need it
• Continue to drink water all the time to flush oxipurinol from your system
• Get uric acid tests to make sure levels are maintained below 6mg/dL (0.35mmol/L)
• Take allopurinol every day
• Do not stop taking allopurinol unless advised by your doctor

More Allopurinol Gout Treatment Information

There is in-depth information about all aspects of allopurinol gout treatment in the Gout Treatment Section. The information is spread over several pages starting on the allopurinol page within the uric acid lowering subsection.

Allopurinol Gout Treatment Spelling

Like many medicines, allopurinol is often misspelled. Though spelling is often overrated, it pays to take extra care with medicines, as a misunderstanding might cause treatment problems in the unlikely event of a similar sounding drug being taken mistakenly.

Allopurino

Missing final l.

Alluporinol

lupo changed to lopu.

Allupurinol

lop changed to lup.

Alopurinol

allo changed to alo.

Alopurenol

allo changed to alo, and purin changed to puren.

Alipurinol

allo changed to ali.

Alipurinal

allo changed to ali, and nol changed to nal.

Allipurinal

allo changed to alli, and nol changed to nal.

Alopurinal

allo changed to alo, and nol changed to nal.

Allopurinol

This is the correct spelling of allopurinol - the most common gout treatment for lowering uric acid.

Allopurinal

nal ending changed to nol. This is the most frequent mis-spelling of allopurinol

Alupurionol

Allo changed to Alu, and extra o added before nol.

All these spellings refer to the allopurinol gout treatment. If you are aware of other alternative spellings, please share them on the gout forum.

This article was first published prior to May 2008, and is reformatted here to suit the updated layout.

Leave Allopurinol Gout Treatment to read more allopurinol information.

As part of my research into this thorny issue, I was reminded of some comprehensive research into gout drug utilization. I have referred to this previously in a newsletter, so it’s high time I summarized this research as part of my forthcoming review of gout treatment compliance.

Gout Drug Utilization Research

This research was reported at the 2006 Annual Scientific Meeting of the American College of Rheumatology (ACR). I have paraphrased some of the language to avoid some jargon, though it is inevitable that some scientific terminology is required in this type of report.

Gout Drug Utilization Research Title

Retrospective Claims Analysis of Gout Drug Utilization, Compliance and Associated Serum Urate Levels [1]

Gout Drug Utilization Research Authors

R. Halpern; K.G. Saag; R.R. Mody; T.R. Mikuls; P.A. Patel

Gout Drug Utilization Research Abstract

PURPOSE:

Gout affected an estimated 8.4/1,000 people in 2002. Our objectives were to:

• Estimate the prevalence of gout in one of the largest US health plans;
• Examine drug therapy utilization;
• Determine the association of allopurinol compliance with serum uric acid (sUA) level.

METHODS:

We used medical, pharmacy, and laboratory claims data from a large, geographically diverse health plan (approximately 13 million lives) with commercial, Medicare, and Medicaid coverage. Gout patients were identified according to medical claims:

• 2 or more medical claims with a gout diagnosis (274.xx) on separate dates or
• 1 or more prescription claim for allopurinol, probenecid, colchicine, or sulfinpyrazone between 1/1/02 and 3/31/04;

The first relevant claim provided the “index date.” Claims were examined for 1 year before and after that index date.

Compliance was measured as medication possession ratio (MPR: days supply of drug from first fill through follow-up/days from first fill through follow-up, range 0-1). So if a claim for 30 days of allopurinol were followed by a 50 day gap before the second claim, then MPR = 30/50 = 0.6.

RESULTS:

25,226 gout patients were identified based on our selection criteria: 11,660 (46%) by prescription; 4,895 (19%) via diagnoses; 8,671 (35%) met both criteria. The mean (standard deviation (SD)) age was 54.6 (13.5) years. 82% of the study population was male.

Many gout patients suffered other health problems, known as co-morbidities. Prevalent co-morbidities were:

• Hypertension, high blood pressure, (affecting 49% of the population)
• Hyperlipidemia, high cholesterol, (41%)

4,901 (approx 19% – slightly less than 1 in 5) of gout patients had 1 or more sUA lab result during baseline or follow-up. The study reports that the average sUA level was 7.6 mg/dL (0.45 mmol/L), though this is largely meaningless, as it does not consider the effects of uric acid lowering drugs. Gout prevalence in the health plan population between 1/1/02 and 3/31/04 was 9.25/1,000. Prevalence was higher among men and increased with age.

60% of gout patients filled 1 or more allopurinol prescription during the 2-year study period, making it the most commonly prescribed gout drug therapy. Nearly 31% filled 1 or more colchicine prescription, followed by probenecid (3.1%), probenecid/colchicine (2.2%), and sulfinpyrazone (0.1%). About 16% used 2 or more gout drugs during the study period; most common were allopurinol and colchicine.

Average MPRs were: 0.64 for allopurinol; 0.23 for colchicine; 0.50 for probenecid; 0.41 for probenecid/colchicine; and 0.41 for sulfinpyrazone.

2,941 patients had an sUA result and at least 1 allopurinol prescription. These allopurinol patients 41% were “compliant” (MPR at least 0.8); however, only 35% of compliant patients had sUA below 6.0 mg/dL (0.36 mmol/L).

CONCLUSION:

The prevalence of gout in this health plan population is consistent with previous estimates. A high proportion had other chronic health conditions.

Although allopurinol was the most commonly prescribed drug for gout management, non-compliance with this agent was frequent. Moreover, a large proportion of patients compliant with allopurinol did not achieve target sUA level below 6.0 mg/dL, suggesting room for improvement in the current management of gout and gout medication compliance.

Gout Drug Utilization Summary

The accepted long term treatment of gout (a gout fix plan) is:

1. Take allopurinol (or other uric acid lowering treatment) everyday
2. Test uric acid in the blood at least once a month to establish the right dose
3. Be prepared to take pain relief in addition for a few months, as required or as a daily preventative.
4. Review treatment every 6 months to one year

If your doctor advises this, then follow this advice. If your doctor does not advise it, then either insist on this treatment, or seek another doctor. If any part of this is unclear, then discuss it in the gout forum.

Gout Drug Utilization References

1. AUTHORNAME. Retrospective Claims Analysis of Gout Drug Utilization, Compliance and Associated Serum Urate Levels . . 2011-01-20. URL:http://acr.confex.com/acr/2006/webprogram/Paper4307.html. Accessed: 2011-01-20. (Archived by WebCite® at http://www.webcitation.org/5vsWdew4k)

The gout remedies listed here come from an old version of the website. I now classify these treatments between:

• Anti-inflammatory medicines
• Other medical pain relief
• Herbal pain relief preparations
• Other non-drug treatments

I am moving all gout remedies, gout cures, etc. to the Gout Treatment section.

Gout Remedies For Pain Relief

This is the old page, updated for changed links, etc.

Many different gout remedies are applied in various treatments.
The remedies listed here deal with pain relief.
You can see more details of how and why these treatments work in the Gout Treatment section.
I list gout prevention treatments in the Uric Acid Lowering and Urate Deposit Removal pages.

Both medical and alternative remedies are listed below.
Please note that even though an alternative remedy may not be as tightly controlled as most drugs, it can still have significant effects on your health, especially if you are also taking prescribed medication. As always, you should consult a qualified medical practitioner before starting any gout treatment.

To choose which remedies are best for you, study them and note any side effects. You should also pay attention to how remedies react with other conditions and with other remedies.

What are your best Gout Remedies?

This graph shows recent voting results for the gout remedies listed below.

N.B. Black Bean Broth added March 2009, so results are under-represented.

Remember, popularity is only a guide – you should study the remedies as they apply best to your own situation. In particular, pay careful attention to possible side effects and other conditions.

Remedies for Gout Pain Relief

2009 Update: GoutPal Moving

GoutPal is moving to a new platform and so voting is closed during the move.

Please share your experiences or ask questions in the Gout Remedies Forum.

2011 Update: New Gout Treatment Section

The Pain Relief pages of the Gout Treatment Section are organized as:

• Anti-inflammatory medicines and related articles tagged with gout cure.
• Other medical pain relief and related articles tagged with gout remedies.
• Herbal pain relief preparations and related articles tagged with gout relief.
• Other non-drug treatments and related articles tagged with natural pain relief.

The Gout Treatment section also includes vital information about removing the need for pain relief by choosing uric acid lowering treatments. I cover all pharmaceutical and alternative health options, and add new treatments as they are reported (e.g. from investigations such as orange juice in gout natural remedies).

Leave Popular Gout Remedies for Pain Relief to browse the Gout Relief pages

Dalbeth and Stamp, in Allopurinol dosing in renal impairment: walking the tightrope between adequate urate lowering and adverse events, recognize that:

Allopurinol is the mainstay of urate-lowering therapy for patients with gout and impaired renal function.

They note that deadly Allopurinol Hypersensitivity Syndrome (AHS) is a rare, but real, risk. A risk that increases with kidney impairment.

They are concerned that current dosage guidelines do not accurately reflect real life risks for developing AHS. Sometimes allopurinol doses below the guideline levels can induce AHS, and sometimes higher doses can be tolerated with few adverse effects.

Like many aspects of gout, particularly when complicated by other diseases, they recommend that each case is managed individually. Taking into account recent research data, they advocate:

gradual introduction of allopurinol according to current treatment guidelines, with close monitoring of serum uric acid concentrations. In patients with severe disease and persistent hyperuricemia, allopurinol dose escalation above those recommended by the guidelines should be considered, with careful evaluation of the benefits and risks of therapy.

Most importantly, they conclude that more work is needed to clarify the safety and effectiveness of increasing allopurinol dosage, especially with patients who have impaired kidney function.

Please note that this is a reformatted page from the old style website. See my allopurinol pages for more information about other effects of allopurinol.

Allopurinol Misspellings

Like many medicines, allopurinol is often misspelled. Though spelling is often overrated, it pays to take extra care with medicines, as a misunderstanding might cause treatment problems in the unlikely event of a similar sounding drug being taken mistakenly.

Allopurino

Missing final l.

Alluporinol

lupo changed to lopu.

Allupurinol

lop changed to lup.

Alopurinol

allo changed to alo.

Alopurenol

allo changed to alo, and purin changed to puren.

Alipurinol

allo changed to ali.

Alipurinal

allo changed to ali, and nol changed to nal.

Allipurinal

allo changed to alli, and nol changed to nal.

Alopurinal

allo changed to alo, and nol changed to nal.

Allopurinol

This is the correct spelling of allopurinol - the most common gout treatment for lowering uric acid.

Allopurinal

nal ending changed to nol. This is the most frequent mis-spelling of allopurinol

Alupurionol

Allo changed to Alu, and extra o added before nol.

If you are aware of other alternative spellings, please share them on the gout forum.

Gouty tophi are usually noticed under the skin, and are not usually painful until they burst through the skin, or become infected.

Gouty Tophi In Bone

We tend to ignore them in the early stages, and concentrate more on relieving the pain from acute gout flares.

But is this wise?

Probably not now that technology allows us to see tophi growing into cartilage, tendons and bones, leading to bone erosion and severe, painful, joint damage.

Gouty Tophi & Bone Erosion Revealed

It has been a few years since improvements in scanning techniques allowed us to view what is happening inside joints. Over 3 years ago, I quoted from Dalbeth [1]:

There is a strong relationship between bone erosion and the presence of intraosseous tophus. These results strongly implicate tophus infiltration into bone as the dominant mechanism for development of bone erosion and joint damage in gout.

Gouty Tophi & Bone Erosion Reviewed

A significant part of Dalbeth’s, and related research, is the observation that DECT reveals urate deposits much more effectively than any other technique, to the point that joints often show uric acid deposits prior to any physical or inflammatory indication of gout.

There is a commonly held belief that asymptomatic hyperuricemia (high uric acid with no gouty arthritis symptoms) does not need to be treated. This DECT research prompts me to believe that this policy needs to be reconsidered. As I said in my DECT review earlier this year [2]:

Lowering uric acid is more important than generally recognized. The policy of waiting for
several acute gout attacks before commencing urate lowering therapy is outdated, especially
given these clear indications that tendon damage takes place prior to acute gout flares.

Fortunately, this view is beginning to change amongst the more enlightened members of the rheumatology profession. Black and colleagues [3] note:

3D reconstruction clearly conveys uric acid quantity and distribution.

Utilization of imaging studies in order to accurately diagnose, monitor progression or treatment response, and assess clinical outcomes is increasing rapidly

Black’s review includes additional investigation showing benefits in over 50 cases. Note that this study has the diagnostic software to show urate deposits in green, rather than the red selected by most investigators. Many of their cases show clear diagnosis through DECT where traditional techniques have failed.

However, they do add a cautionary note:

Limited initial availability will likely continue the role of DECT to those individuals with diagnostic uncertainty or access to larger imaging centers.

Gouty Tophi & Bone Erosion Restrained

Perhaps the cautionary note is contagious.

It is disappointing to see that whilst recent professional advice recognizes the value of DECT it fails to acknowledge it’s importance as a diagnostic technique, and fails to recognize the implications on asymptomatic hyperuricemia.

Schumacher & Weaver [4] give with the one hand…

Recent studies show that DECT scans reveal signifcantly more areas of urate deposition than a physical examination. [...] But if these newer imaging techniques can identify MSU crystal deposition prior to bone erosion or joint destruction, they offer promise as a noninvasive alternative for diagnosing gout in the earliest stages of the disease. In addition, they may be used in the future to monitor the progression of gout and the effectiveness of ULT.

… but take with the other:

The consensus standard of care today is that asymptomatic hyperuricemia should not be treated.

Perhaps there will come a day when DECT, and other imaging techniques are common enough to dispel the myth that high uric acid is only dangerous when accompanied by acute gout flares. Until then, I recommend you do all you can to maintain your uric acid at a safe concentration below 6.5mg/dL (0.4 mmol/L).

Gouty Tophi & Bone Erosion References

1. Title: Mechanisms of bone erosion in gout: a quantitative analysis using plain radiography and computed tomography. Authors: Dalbeth N, Clark B, Gregory K, Gamble G, Sheehan T, Doyle A, McQueen FM. Published: Ann Rheum Dis. 2009 Aug;68(8):1290-5.
2. Title: DECT For Gout Diagnosis Author: Keith Taylor (GoutPal.com)
3. Title: Dual-Energy Computed Tomography for the Evaluation of Gout and Calcium Crystal Deposits. Authors: Black DF , Glazebrook K , Bongartz T , Matteson EL , Manek NJ , Leng S , Fletcher JG, McCollough C. File: Gouty Tophi Revealed With DECT
4. Title: Core Principles in the Diagnosis and Management of Gout and Hyperuricemia. Authors: Schumacher HR, Weaver AL. File: Gout And Hyperuricemia

Uric Acid Management

Though pain control is often the first consideration of gout management, long term uric acid control is the only way to prevent gout returning.

Gouty arthritis is a progressive disease. Left untreated, uric acid will continue to build up causing increasing, painful gout flares and joint damage. Many doctors realize this, and take care to manage uric acid with regular tests and medical or lifestyle therapies to manage uric acid levels in the blood.

Unfortunately, there are a significant number of doctors who either do not believe in uric acid management, or do not have sufficient training to ensure that uric acid is controlled to a safe level.

Do any of the following apply to you?

• Your doctor fails to provide frequent uric acid tests, or
• It is inconvenient for you to travel to a blood testing facility, or
• You want extra data to help micro-manage lifestyle changes.

In those cases you need to seriously consider buying your own portable uric acid test kit. But what about cost?

Uric Acid Tester Costs

I am currently researching costs of “official” uric acid test kits. USA costs are around $30 to $60, though much depends on how much is covered by insurance. UK costs are covered by the National Health Service, though travel costs and inconvenience may also be factors.

Test strips for portable uric acid testers are less than $2 each, but there is an initial outlay of around $75 for the testing unit. This implies that you can make savings after very few tests, though much will depend on what you currently pay for tests.

I am researching the costs in more detail, along with insurance implications. I would appreciate your input in the Gout Forum – please let me know what you pay for your uric acid tests. Once I have the information, I will update my uric acid test kit reference page.

Gout Food: The Good, The Bad & The Healthy

Gout food means the world to gout sufferers, but there are two different approaches.

Some gouties look for good foods to help their gouty arthritis. Others look to avoid foods that will raise uric acid, or increase inflammation.

I need to teach you how both these concepts are based on gout myths. The best approach to gout food is a healthy, balanced diet.

Good Gout Food

Good gout food is anything that helps reduce uric acid, or helps reduce inflammation.

I frequently update the Gout Diet Section with specific examples of these, but you need to be aware of the dangers.

It is wrong to think that just eating good gout foods will fix your gout. Over-reliance on a small group of food items usually leads to poor general nutrition. The last thing you need is adding other health complications to your gout.

Bad Gout Food

Avoiding bad food is vital, both to gout and your general health. This is a great idea when it is based on a firm understanding of how uric acid and inflammatory or acidic conditions affect gout. It is a very bad idea to avoid certain foods because of Internet hearsay, or outdated nutritional advice.

Adequate nutrition is a big subject, but for practical purposes, it’s enough to eat a varied diet where meat and fish are always balanced by twice as much fruit and vegetables.

Purines are rarely significant.

The only truly bad gout foods are trans-fats, iron, and flesh binges.

Trans-fats are common in processed foods to prolong shelf life. Look for hydrogenated on the label – even partially hydrogenated means poison.
Iron is only required by growing children and menstruating females. For everyone else, it just causes gout.
Flesh binges are excess meat or fish meals. 4oz on a plate balanced with other food items is enough. Any more is a binge. If you cannot make a tasty, satisfying, healthy meal with 4oz meat or fish, join the GoutPal Cookery School (actually, there isn’t one yet, but you only have to ask).

Healthy Gout Food

Gout is not an eating disorder! It is a uric acid metabolism imbalance. Stop obsessing about gout food, and start planning how to manage your uric acid levels.
Healthy gout food does not rely on consulting lists of good or bad foods. It is is anything, and everything that forms part of your gout diet, that in turn forms part of your gout management plan. You do have a gout management plan, don’t you?

More Great Gout & Uric Acid Info

I will leave you with the latest list of popular gout and uric acid articles – a short selection of the best from the hundreds of pages of great GoutPal gout support information.

Top Seven Gout & Uric Acid Articles

Allopurinol        (Main Gout Treatments, Cures & Remedies Page)

Allopurinol is more than just a gout beating drug - it is a lifesaver. But is your dose right, or is it making gout worse?

Best Tophi Picture        (Main Gout Treatments, Cures & Remedies Page)

The best tophi pictures are the ones that show them disappearing. See before & after photographs of a remarkable gout treatment.

Privacy Policy

All good sites need a privacy policy. This is a gouty one. Nothing much about gout - it's just a privacy policy for a gout site.

Uric Acid Test Kit        (Main UDRP1: Uric Acid Page)

A uric acid test kit is easy to use, and keeps you in control. Do not waste time and money. Get the best uric acid meter today.

What Causes Uric Acid?        (Main UDRP1: Uric Acid Page)

Want to know what causes uric acid? The simple answer is purines, but where do purines come from? The biggest source is not food

Uric Acid Answers        (Main UDRP1: Uric Acid Page)

Here are all your uric acid answers. If the answer to your uric acid question is not here, it soon will be.

Uric Acid Levels        (Main UDRP1: Uric Acid Page)

All gout sufferers must know their uric acid levels. Learn how to arrange your uric acid blood test at home then fix your gout.