A paragrah in http://www.Icuredmygout.Org reads: "do not initiate allopurinol or probenecid during the gout attack. They will lower the blood uric acid level suddenly, and will worsen and prolong the attack. Start them gradually in increased dosages 4~6 weeks after gout attack is completely gone, preferably with indomethacin, colchicine, etc to avoid another gout attack. However, if they were initiated before the attack, do not stop and keep taking them."

That's interesting because I have used allopurinol for over 10 years and only take it when I feel an attack coming on. A tenderness in my big toe or ball of the foot usually. It has always stopped the attack from getting worse. And in a day or so the tenderness is gone and i'm back to normal for months, years at a time. Before I was first diagnosed and given allopurinol my attacks were so severe it felt as if my foot was broken.

It's very interesting. May I ask what are your blood uric acid levels over these years? Thanks.

sorry, but I have no idea. My doctor sent me for a blood test the first time I went to him with an attack. And he then diagnosed gout. But, I don't know what my u.A. Levels have been. I have no way of testing it myself. I haven't had a severe attack since I started taking allopurinal. But, even though they say you have to take everyday for the rest of your life I only take it when I start to feel a stiffness in my toe or ankle. Which is maybe once or twice a year.

Well I decided to take one fourth of a 100mg allopurinol tab while I still had some twing left in my toe but it was mostly gone....And it really caused a major reaction in my toe. That was two days ago and I still have pain so i'm taking indocin and it controls it pretty well. I had hoped the nominal dose and the previous gentlemans (michael macuser) comments would enable me to finish off the little I had left but obviously it didnt. My advice is to believe it when they say don't take allopurinol until its totally gone. I was forewarned and didn't comply with the advice...

Is anyone doing anything about this terribly common problem?

I have atrial fibrillation. My doctor has tried several medical remedies but we have concluded that I am best treated by keeping my heart pulse down and warfarin. This seems to be working fine but my question is what effect will all this have on mortality. I read that strokes are the principal hazard but are there any statistics I can refer to?

Gout is a strong indicator of underlying obstructive sleep apnea. The only stronger indicator is atrial fibrillation. Make sure you get tested for sleep apnea to lower your risk for its known life-threatening consequences. When I was finally diagnosed with sleep apnea and overcame it, my gout disappeared immediately. My atrial fibrillation disappeared after 6 months. It took a TIA (ministroke) before my sleep apnea was diagnosed.

This is very interesting. Thanks for the heads up. Is this common knowledge in the medical community. My primary physician knows of both conditions but has not connected the two.

No, it is not yet common knowledge among physicians. A paper in the journal Circulation in 2004 described the results of a prospective study showing that afib patients had a very high prevalence of obstructive sleep apnea. Other articles in the journal Sleep in 2005 and in Medscape in Jan 2009 discuss the connection of gout with sleep apnea.