Recent Questions Asked:

Q: Do all patients having an acute attack of gout have elevated uric acid levels?
A: (Dr. Weaver) Approximately fifty percent of patients will have uric acid levels of less than 6.8 mg/dL during an acute attack. During acute attacks, the uric acid levels drop. Problems occur when the physician obtains a serum uric acid level that is < 6.8 mg/dL and assumes that it is "not gout."

Q: Why do we not want to lower uric acid during an attack?
A: (Dr. Weaver) If you use a urate-lowering drug during the attack then you will prolong the attack and increase the intensity of the pain. You should initiate appropriate prophylaxis therapy prior to starting urate-lowering therapy.

Q: Why did the federal government remove uric acid from the chemistry profile?
A: (Dr. Weaver) I am not certain who was responsible for removing uric acid from the chemistry profile but whoever was responsible did not have the data we have now. The major reason was there was a significant number of patients being treated for asymptomatic hyperuricemia.

Q: I have a patient with bony tophi and he is not responding to colchicine. I put him on 100 mg of allopurinol and he keeps having attacks. Only steroids seem to help. With the new drug, since it is so potent, would you expect it to precipitate attacks even though he is on prophylactic colchicine?
A: (Dr. Weaver) Any time you rapidly increase or decrease the uric acid level you will increase the likelihood of an attack, regardless of the cause of the uric acid flux. You really have to counsel the patient on this and make sure he understands that he will have to experience an attack in the short term to decrease attacks in the long term. To answer your question directly, yes you will cause attacks. What was his uric acid level?
Follow-up response: He was in the hospital for his attack at the time and the level was 5 mg/dL when he left the hospital. I don't know why it was so low; they must have had him on something in the hospital that affected the level. His level went up to 9 mg/dL 2 weeks later.
Follow-up answer (Dr. Weaver): Actually, during an acute attack the uric acid level often falls down well below the normal level. It takes around 2 weeks, as you saw in this patient, for the level to return to normal. Also, colchicine is a prophylactic agent to prevent acute attacks and has no urate-lowering capability. Likewise, it would be most unusual for 100 mg of allopurinol to bring the uric acid levels to below 6 mg/dL.