Gout treatment

[Aoki]

Would be grateful for any insight on this one. I suffer from gout which is probably due to my stage 3 kidney disease. I have recently been prescribed Allupurinol. But I am putting off taking it as I read that it can cause new gout flare ups when you take it at first. Having just emerged from a series of attacks I can't face another one just yet. I also read that people prescribed Allupurinol are often/usually also prescribed colchicine to treat such flare ups. I haven't been -- could this be because it's unsuitable for people with my level of kidney disease? I don't have any confidence in the new GP I have recently been allocated or I would ask her.

[orangecity41 NKF Ambassador]

Everyone is different. I am taking Allopurinol for hyperuricemia and it is working for me. I may not have high enough numbers of hyperuricemia to be classified as Gout. My CKD diagnosed at 3b. I am on a CKD diet.

[bumblebee_tuna]

I took Allopurinol for many years for high uric acid with no issue. I don't have a history of gout though so can't comment if it makes it worth. I would think it would make it better though since it's reducing the uric acid level?

[Aoki in reply to bumblebee_tuna]

Many thanks for your reply. I've responded in more detail below

[WYOAnne NKF Ambassador in reply to Aoki]

It's very important that you get your gout and high uric acid under control. Not only because of your gout attacks, caused by buildup of the uric acid and actually causes crystals to form...but it could also cause kidney stones. From one that has had both = stones can be excruciatingly painful and can damage your kidneys even more, to say nothing about gout pain. High uric acid needs to be controlled or you will cause more damage to your kidneys by doing nothing!!I was about to start dialysis when I was put on allopurinol. Never had any problems with the medication or stones. My uric acid was in the normal range and was fine while taking it. Shortly after my transplant I was able to stop taking the allopurinol and have had normal labs at 23 1/2 years post transplant.

TAKE the allopurinol!!!!!!! It can create a miracle in your life.

[Aoki in reply to WYOAnne]

Thanks very much for your encouraging reply. Allupurinol is certainly getting a good write up here. I shall start taking immediately.

[Bassetmommer NKF Ambassador]

Take the allopurinol. Gout is not caused by CKD, but from uric acid build up. Foods high in purine cause Gout. You can Google what they are. The uric acid build up will actually cause damage to your kidneys. Gout is the build up of uric acid crystals in the joints and guess what else.... your kidneys. They can form terrible kidney stones which in turn will cause more damage to the kidneys. Taking allopurinol is a known medicine to prevent gout and uric acid build up.

[Aoki in reply to Bassetmommer]

Many thanks to all for your replies. I do want to take the allupurinol and will do so when I can pluck up the courage as I'm so scared of having another attack riight now as I've a few things coming up I want to be well enough to tackle. That's why I'm interested in whether it is ok to take colchicine or not. There are very mixed messages about this online and as mentioned I have no confidence in my GP. and my next appointment with the kidney specialist is not until September. I think I will try the pharmacist.

[drmind]

It's my understanding that sometimes when you start allopurinol, it does cause a flare up because crystsks in the effected areas loosen up and cause trouble. So, colchicine is also given at the same time to treat any flare ups and inflammation that might occur.

However, I found this about colcolchicine:

"Is colchicine hard on kidneys?

However, in patients with CKD, nonsteroidal anti-inflammatory drugs are not recommended because their use can exacerbate or cause acute kidney injury. Also, colchicine toxicity is increased in patients with CKD, and dosage reduction is required based on level of kidney function."

So, I think you do have a dilemma because you have CKD 3 and just recently had gout flare uos. Sorry, you don't feel you can rely on your primary doctor. But, it's your call. There is no question that allopurinol reduces your uric acid level and reduces future flare ups so eventually it's best that you take it. You may want to take it without the colchicine and hope you don't get a flare up. Or, take it with low dose of colchicine for a very short period. Frankly, I've never understood why one would take colchicine in ADVANCE of a flare up.???

Having had one gout flare up a few years ago, I truly understand why you don't want another one after having recent flare ups. Yikes.

You don't mention your nephologist. Can you consult with him/her? Gout is definitely within their area of consultation.

Good luck

[Aoki in reply to drmind]

Very many thanks for your reply and sympathy! As you say I do feel in a bit of a dilemma as I have also seen info online that colchicine is not recommended for those with ckd but the messages are a bit mixed. I think it is often prescribed along with allopurinol so you've got it on hand in case of a flare up in the early days of taking. As mentioned above I am not seeing the kidney specialist until September and he is based in London though I see him at a local clinic and I don't know how to get in contact. I think I will have a go to try and find out how to do so.

[Pontios]

Hi Aoki, I have been taking Allopurinol for about twenty years and have maybe only once or or twice had gout and not that severe. Before I started Allopurinol I had terrible pain from gout attacks. I would call the pain unbearable. I would definitely recommend from my point of view taking allopurinol as it has kept these attacks at bay for me. And as Bassetmommer has said you are only putting your kidney function at risk of further damage by not taking allopurinol.

[Aoki in reply to Pontios]

Many thanks Pontios. Yes I must take the allupurinol . Did you get flare ups in the early days? Were you precribed colchine to take in case at the start?

[Pontios in reply to Aoki]

Yes. I had a number of gout attacks before I was put on allopurinol. The attacks were extremely painful, almost always in the big toe. That was over twenty years ago. I have not had many incidents of gout since starting allopurinol and they were much less painful than those before allopurinol. I can't remember if I was given colchine for the original attacks. About 15 years ago I did have some milder gout and was given colchine which I took for a day or two. My eGFR was better back then at about 35. I am at 20 now. I have not had any gout attacks now for about 15 years

[Aoki in reply to Pontios]

Thanks for your v helpful replies. Allupurinol sounds like a miracle drug. I shall take it asap.

[Bassetmommer NKF Ambassador]

Just so you know, I had TERRIBLE kidney stones for over two years caused from high uric acid. I have a box of them in my dresser from ones I captured, and the doctors took the other one's because of the size of them. The damage they caused is irreversible. I have psoriatic arthritis and psoriasis, which changes your blood chemistry to very high uric acid. At the time, I had five stones wedged in my right kidney that were so large, they would never pass. One was 9mm, one was 6mm and the others over 3mm. The allopurinol got rid of them. I did not have any attacks, my joints improved, and although I may have had a gout attack once before I was on allopurinol, it was too hard to tell if it was from gout or the PsA flare. Either way, the stone production stopped, and I did not have a gout flare from taking the med.

[Aoki in reply to Bassetmommer]

Thanks that's encouraging . I'm sorry you had such trouble with kidney stones but wonderful that Allupurinol did the trick.

[kellyscats1 in reply to Aoki]

I started allopurinal last week after sevral gout attacks..I sake steroids for attack not colchicine..i also requested and got lab test for allopurinal hypersensitivity.. which although rare can be deadly.. est was good so i strted. Also I went t rheumatologist instead of nephrologist for gout as my nephrologist wanted me to start on too high a dose... grrrr. and yes the reason for the attacks when starting allourinal is because it causes the blood to clear uric acid and guess what...it makes more crystals in your joint so I go rx for prednisonone to take whan starting treatment..My rheumatologist is far more knowledgeable about gout and kidney disease than nephrologist...and yes.. it sure does hurt....lol

[Aoki in reply to kellyscats1]

Many thanks for your reply. I am about to atart the allopurinol now my latest gout attack has settled down and have decided not to ask for colchcine and just hope for the best. (I am pretty positive my gp will not prescribe steroids) So I'm crossing my fingers (and toes!!) that the initial allupurinol won't bring on another attack. How lucky you are to have a good rheumatologist -- I don't have one as have been pretty fortunate with arthritis until this wretched gout started up and my rather slow reacting GP has not referred me. Luckily I have a really good nephrologist and trust his judgement. You win some, you lose some!!

[Bert64]

I use tart cherry juice and you should watch your intake of acidic foods and drink.

[Aoki in reply to Bert64]

Thanks Bert24 . Yes I am a fan of cherry juice which I think really is helpful. I will keep a look out for acid food and drink -- I'm not sure what these are at the mo but no doubt the wonderful internet will tell me all!!

[Blackknight1989]

Certainly adding allopurinol will cause a new outbreak of gout and I get it. I had a great doc from 2006-2020 who had mine totally under control simply by starting me with the allopurinol at 150mg along with twice weekly (for about 3 months) colchicine and prednisone as prophylactic mediation against a new outbreak of gout…it worked like a charm. However, due to my illness progression I lost my ability to work which coincided with the pandemic onset. Thus, no treatment or doctors for a couple of years and now I have been referred to another rheumatologist who DESPITE being the partner of the doctor I had for those 14 years wants to “decide on proper treatment.” Cause you know, her partner’s plan worked so well she has to now show her medical expertise…sometimes those highly educated and skilled providers drive me crazy…so now again about 2.5 weeks out of every month I have severe gout in weird joints like most recently both wrist joints, all of my left hand finger joints and elbows.

If you have never suffered from gout, I hope you never do…I’ve had mutiple joints replaced, spent 8 months in the ICU in ‘96 post multi-organ failure and had an operation a year from ‘98-2020 wheather I needed those or not…lol and the pain from gout is worse than all of it…so of course new doc doesn’t believe the allopurinol is the way to go and wants to do the injections instead which will result in another case of severe gout and 10 days of pain but such is life for me!