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Why am I still getting attacks of gout?

Q) Help! I'm just recovering from yet another attack of gout. During the past six years I've had attacks of gout approximately once a year but from January 2009 have had frequent attacks, occurring every three weeks, in the big toe, ball of the foot joint and other parts of the foot. In January my doctor prescribed a daily intake of allopurinol 300 mg, and in mid-August they increased the dosage to 600 mg. Can you shed any light into why I'm still getting attacks? Blood tests have shown lower levels of uric acid. I'm 84 years of age.
Mrs Collins, Essex (Winter 2010)

A) This is a difficult one. Allopurinol lowers the level of uric acid in the blood and tissues. This clearing of uric acid may take some time to happen and can be associated with new attacks of gout while the clear out is occurring. This is well recognised and usually stops after about three months. However, in some people, and particularly those people with large deposits of gouty crystals in their tissues, called tophi, this process can take longer. If you have these tophi, this may apply in your case, but don’t despair, things will improve eventually.

There are other reasons why you might be getting more attacks of gout. Even while you're taking allopurinol certain other drugs can work against it. These drugs include low-dose aspirin, which is commonly prescribed nowadays. A high alcohol intake will also work against allopurinol, as will kidneys that don’t function too well (also common in the elderly). So plenty of reasons there, and best to discuss with your doctor which may apply in your case.

This answer was provided by Dr Philip Helliwell for the Winter 2010 edition of our magazine, Arthritis Today, and was correct at the time of publication.

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