Doc says to stop allopurinol due to gout flare?? HELP!

My husband is 37 and has just been recently dx with chronic gout.  His uric acid was 9.2 before starting allopurinol 8 weeks ago.  He has been doing well, but just a few days ago he had a gout flare.  He called doc and doc says to stop allopurinol and start back on cholchesine.  I thought he was supposed to keep taking the allopurinol even if he got a flare up (aren’t flares common when starting treatment)?  Why on earth would he stop and let his uric acid creep back up?

I am NOT happy with the way his doc is managing my hubby’s gout.  He hasn’t even had a repeat uric acid check since starting the allopurinol, and now he wants him to stop it?  I think he should stay on it and take cholchesine to manage the flare up.

What should he do (besides find a new doc)??

Thanks!

Jenny, wife of a gout guy

Hi Jenny,

I can’t believe that these schoolboy errors still occur. This is basic, very fundamental stuff.

Though starting allopurinol during an acute attack is not recommended, once started it should never be stopped unless serious side-effects occur.

Gout flares during the early stages of any uric acid lowering treatment are very common. They occur because old crystals are dissolving, and many doctors prescribe colchicine alongside allopurinol or febuxostat for the first few months.

Frequent uric acid tests are a must. They should be every 2 to 4 weeks until they stabilize, but then can move out to every 3 months, and even out to once or twice a year when you know the gout has been fixed.

Your doctor is being negligent, but if you cannot find a better one, you will have to take control. You are right to insist on colchicine whilst staying on the allopurinol. Then you need to arrange two-weekly uric acid tests with a view to stabilizing uric acid well below the 6mg/dL (0.35 mmol/L). The 3 to 4 range is a good target. Once allopurinol dose has been established to maintain this target uric acid level, stay on that dosage until your (lucky to have you) gout guy has gone without a flare for 6 months. Some people take daily colchicine for 3 to 6 months, just in case. Others only take it if they feel an attack come on. As you suggest, always stay on the allopurinol.

That marks the end of the urate deposit removal phase, and you can gradually relax the allopurinol dose to maintain the level around 6mg/dL. Move the frequency of uric acid testing back to two weeks during this (or any other) dosage adjustment to ensure your guy never goes near 6.5mg/dL.

After a few years, there is good evidence to show that an allopurinol holiday is OK, but that requires careful monitoring. I’ll be reporting on this soon, so keep an eye on my allopurinol pages.