Keith’s GoutPal Story 2020 Forums Please Help My Gout! Alliopurinol doesn’t seem to help

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    Hi…I was first diagnosed with Gout about 25 years ago. I am now fifty eight years old. Since then I have had attacks of varying degrees on a fairly regular basis. Over all the years I have never  had a raised level  of Uric Acid whether tested before after or during an attack so Allopurinol was never prescribed. Last year was probably my worst year ever for Gout attacks. Not only were they extremely severe but they were quite frequent and prolonged involving both big toe joints. I took the usual drug treatments..Indomethacin and Colchicine with little relief. My joints became so swollen that my doctor injected both with Cortisone. He also took the pressure off the joints by extracting a white milky substance which gave me almost instant relief.  Although I still didn't show a raised Uric Acid leve during all this my doctor decided to put me on Allopurinol. It has been about six months since I started on Allopurinol and had the Cortisone treatment and I haven't had any gout symptoms since….until today.  I should say that I follow a very balanced diet, exercise regularly and consume virtually no alcohol…maybe a glass of wine a week. My coffee intake is not excessive either. So the question is….why am I still getting Gout? Is it more likely that I have Pseudo Gout and what can I do to minimize my chance of an attack? Thank you for your kind attention.


    Good to know about your experience. I've been on allupirinol and colchicine now for about a month and I think it's working.  I was hesitant because I didn't like the sound of medication forever, esp being only in my 30s.  But the unexplained pain in my ankle last October and November (back to back) and the twice a year attack prompted me to see an arthritis specialist. She immediately put me on allupirinol. I also started seeing an acupuncturist and that also seems to help.  It is at least relaxing. But careful starting that because any kind of “trauma” can cause gout.

    The allupirinol though makes me probably over-confident with my diet. I'm a little less vigilant with my diet. I still have to check my uric acid level this weekend and see if the meds actually lowered my uric acid. But I'm the same way-ok diet, exercise, 1 cup of coffee/day, and no alcohol. 

    What I'm curious about is that procedure you mentioned–the extraction of white milky stuff from your joint.  It sounds like it makes sense but I've never heard of it. What is that procedure called?


    goutanamo said:

     What is that procedure called?

    The procedure is called joint aspiration or arthrocentesis. It is commonly performed before a cortisone injection. By removing fluid from the joint the doctor reduces pressure, which can itself bring relief – the cortisone continues the relief by reducing inflammation.

    The joint aspiration is a vital diagnostic weapon. The fluid can be tested for bugs to illiminate septic arthritis – this should be done, as a matter of course, before administering cortisone. More importantly, for suspected gout sufferers, the fluid can be examined for crystals by technicians schooled in the science of polarized microscopy. Correctly analyzed, a competent person can distinguish crystals that indicate gout, pseudogout, or both.

    This test is important where there is any doubt about  gout, e.g. when gout-like symptoms are not supported by high uric acid levels.

    Speaking of uric acid levels, there are 2 important facts to bear in mind:

    1. Uric acid levels in the blood normally fall during a gout attack as uric acid has left the bloodstream to form crystals in the joints or other tissues.
    2. Tests described as “normal” may still be high enough to be indicative of gout. The actual value is important – not a description such as high or normal. Many labs include values up to 8 or 9 as normal. Whilst it is true that some people can have these levels without developing gout, anything over 6mg/dL is alarming, and for a gout sufferer, dangerous.
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