I wonder what is the relative efficacy of allopurinol to febuxostat. The latter does seem better tolerated but I wonder if it has lower efficacy. And both I think work by reducing uric acid production while I think it would be better to have medication enhance excretion.

For chronic bouts, steroid injections into affected joints brings quick relief as well as prophylactic benefits. But injections should be done sparingly as they are not without side effects either.

Beer and peanuts seem universal triggers. Other purine sources are debatable and likely depend on the person. Dehydration is an enemy. Also, my understanding is that something related to gout is fat soluble and can be stored in fat. As one loses weight/fat, a bout could be triggered.

OP, hope you get that taken cared off before it becomes serious. Didn't know what it actually was until I went to Youtube. Couldn't make it through a whole video. I considered myself to have a very strong stomach but half way through I almost blew chunks on the keyboard.

https://www.youtube.com/watch?v=qH5x3h1y2uM

Thanks for the thoughts. Everything seems to be well under control with the Allopurinol 100mg.

quote:

Originally posted by konata88:
I wonder what is the relative efficacy of allopurinol to febuxostat. The latter does seem better tolerated but I wonder if it has lower efficacy. And both I think work by reducing uric acid production while I think it would be better to have medication enhance excretion.

1- Febuxostat (Uloric trade name) is more effective than allopurinol in lowering uric acid (UA) levels in patients with gout in a large retrospective study. However, it's unclear how that translates into clinical gout (i.e., flare-ups). Although one would be tempted to equate lower UA levels to less flare-ups, the study only addressed the UA levels, not the flare-ups frequencies.

2- The FDA has recommended that Uloric should not be offered as 1st line treatment of gout. It should only be offered if allopurinol is not doing its job (be it due to drug allergy, intolerable side effects, kidney disease, or still having frequent flare-ups). Reason is that the postmarket safety clinical trial found an increased risk of heart-related death and death from all causes in patients treated with Uloric. The FDA subsequently required this medication to have the so-called "Black Box Warning":
• Gout patients with established cardiovascular (CV) disease treated with ULORIC had a higher rate of CV death compared to those treated with allopurinol in a CV outcomes study.
• Consider the risks and benefits of ULORIC when deciding to prescribe or continue patients on ULORIC. ULORIC should only be used in patients who have an inadequate response to a maximally titrated dose of allopurinol, who are intolerant to allopurinol, or for whom treatment with allopurinol is not advisable.

3- Allopurinol has been around since 1966. Sure, it has potential side effects, just like all meds, but it is overall a very safe medication.

Allopurinol, Idon'tknowwhatthepossiblesideeffectsmaybebutitdoesn'tseemtohaveanyeffectonmeatall.

I've been on 100mg allopurinol for over two decades now and no more gout attacks. unknown if any side effects but i have gotten more assholey as i get older.

*******OLD THREAD REVIVAL***********

For all of the folks that I've seen over the years complaining about gout pain that I perhaps didn't take a seriously as I could/should have...

Each and every one of you has my deepest, sincere, heart-felt apology.

Holy crap!

I've had some mild symptoms over the years, maybe every other year or so, but never anything even remotely troublesome that some rest, fluids, and motrin didn't take care of. Woke up Monday morning and got up to take a leak. Took one step towards the bathroom and felt some goodly pain in the left toe. Throughout the day, I did the usual, and it slowly worked itself out. Tuesday, woke up completely back to normal. Zero pain, full range of motion. Went to bed Tuesday night and woke up at about 0400 in bad pain. Took some Motrin and tylenol, chased it with a lot of water, and muscled through the day. It was getting pretty sore around bedtime, but I had my fingers crossed.

Nope. Woke up at 0500 today in agony. Very swollen, and unable to bear any weight. Even trying to hop along with weight only on the heel was nearly impossible. I was able to make it into work and hit the pharmacy for some colchicine. Man, that stuff is a wonder drug. Within an hour, the pain was significantly reduced to tolerable. Still there, but only about a "5".

I had no idea that the pain could be that bad, and I have a very high pain tolerance. What I described as agony, was. I'll have some colchicine in the medicine cabinet going forward!.

Welcome to the club I guess! When are the meetings?

This message has been edited. Last edited by: Gustofer,

quote:

colchicine.

Yeah it's a wonder drug... gout is da debil

In Japanese, the word for gout kind of translates as "pain from the wind blowing" - meaning it hurts just if wind blows on it.

Those who know, understand.

Tip for tart cherry juice fans: I buy the powdered extract, and mix it up like a soft drink with a little sweetener at home. More economical, and avoids all that lugging of big jars from the grocery store.

quote:

Originally posted by konata88:
In Japanese, the word for gout kind of translates as "pain from the wind blowing" - meaning it hurts just if wind blows on it.

Those who know, understand.

That sounds crazy but it's true. 40mg generic Uloric a day has made me almost forget that I even have gout.

quote:

Originally posted by 12131:
My friend, welcome to the Gout fraternity. Several years ago, when I was approaching the half century mark, I started experiencing my 1st attack, at the Achilles tendon area. I thought at the time it was just tendinitis from too much running. But then, subsequent attacks appeared all over, from the most common joint (the great toe), to the ankle, knee, elbow, even the wrist. My uric acid level was sky high, almost at 11. I had attacks almost every other month, the longest bout lasted almost a month, the shortest a week. I skipped all meat, sea food, and the greens that suppose to trigger the gout. NSAIDs, cochicine, and steroids were useless. I refused to be near any narcotics and just suffered through these attacks. Even with strict dietary restrictions, my level never came lower than 9.

I finally got fed up with these frequent attacks and got on a low dose of allopurinol 150mg a day. And life has been sweet ever since. My attacks now are down to maybe every other year, and are no longer severe like before.
Unless you're allergic to it, allopurinol is a great med for preventing gout flare-up. It's been around forever. I'm glad your doc put you on it, instead of prescribing one of the newer and more expensive drugs.

Since this necro thread was resurrected, I figure I would give an update on my gout. After having been on allopurinol for several years w/o side effects or further flare-ups, I thought, "Why not stopping it and see what happens". I firmly believe in not being dependent on any meds, if you can. And, I'm pleased to report that, after 17 months w/o allopurinol, I've had zero event. And, during this time, my uric acid levels have all been in "normal" range. All this with no dietary restrictions whatsoever. Just goes to show, one doesn't really know jack about his body.

I cut beer out entirely. I also forgot to take my allopurinol regularly enough that I stopped entirely. I have not had an attack since the initial 2 in 2009. I feel lucky.

My nephrologist got rid of it 20 years ago,
I do what he says and no gout for me.

It amazes me that people refuse to see a nephrologist.

Proof positive that people are the worst decision makers on the planet.

I finally figured out that my trigger is beer

I now only have one or two beers a month, no problems

I've had gout for about the last 50 years. Allopurinol, by itself, didn't keep the attacks from occurring. Docs said, once in a while, someone needs both Allopurinol and Probenecid.

I don't know if they were right, but, for the last half century, I've taken both daily and haven't had more than a couple-three flare-ups in all that time.

Bob

My trigger was NUTS!! I love frozen Snickers bars, but they are a thing of the past. So far, have not required any meds(Rx).

quote:

Originally posted by straightshooter1:
I've had gout for about the last 50 years. Allopurinol, by itself, didn't keep the attacks from occurring. Docs said, once in a while, someone needs both Allopurinol and Probenecid.

I don't know if they were right, but, for the last half century, I've taken both daily and haven't had more than a couple-three flare-ups in all that time.

Bob

You must have had a bad case of very high uric acid that doc recommended both allopurinol and probenecid. They work independently at different targets to lower uric acid level. Allopurinol acts to decrease uric acid production in the body, while probenecid works to decrease the reabsorption of uric acid from the kidneys so more uric acid is eliminated in the urine.

I see that back in 2019 I recommended lifelong allopurinol.
Now I'm a huge fan of Uloric (febuxostat). Why?
Because I also have kidney stones. Not uric acid stones, but calcium oxalate stones.
My kidney stone urologist (as opposed to my bladder cancer urologist) did repeated 24-hour urine levels for stone prevention. I had low urine pH (acidic urine) and pretty high uric acid levels in my urine.
The urologist said that the uric acid crystals are like "seeds" for calcium oxalate crystals to form stones.
After switching to fubuxostat, my urine pH is closer to neutral; uric acid in the urine is almost nonexistent; and I seem to have stopped making new kidney stones.
Also: on allopurinol I still had low-grade gout at times in my big toes. On febuxostat there is no evidence of that at all.

So I have now upgraded my recommendation to Uloric if you have any problems on allopurinol.

Check out some of these articles:

https://www.lifeextension.com/...40832&sort=relevancy