Does Allopurinol Prolong a Treated, Acute Gout Flare?

Traditional teaching holds that starting allopurinol during an acute gout attack will prolong the attack. Recent expert opinion from the American College of Rheumatology Guidelines is that allopurinol may be started during an acute, treated gout attack. This study is designed to test the hypothesis that allopurinol does not prolong an acute, treated gout attack. Patients will either take allopurinol capsules or and identical capsule containing no allopurinol (placebo) over 28 days, starting within 72 hours of a gout attack that is being treated with other standard measures. During the study, neither the patient nor the examiner will know what pills are being taken. The time to resolution of the attack is the primary outcome measure. Pain level, serum uric acid level, and complications of therapy will also be monitored. A minimum of 32 patients completing the study are needed for a meaningful conclusion.

Inclusion criteria

requires both of:

• Crystal proven gout, and
• An acute gout attack within 72 hours of first treatment

Plus one of the following:

• At least 2 gout attacks in past 12 months
• Tophus
• Nephrolithiasis
• 24hr urine uric acid greater than 1000mg

Exclusion criteria

• Inability to return for examinations
• Glomerular filtration rate (calculated) less than 50 milliliters per minute
• Allopurinol use in past 6 months
• Ongoing cancer therapy
• Concomitant azathioprine or cyclophosphamide
• Any one of the following liver enzymes greater than 1.25 times the upper limit of normal:

• AST [Aspartate aminotransferase]
• ALT [Alanine aminotransferase]
• alkaline phosphatase
• Pre-gout pain in involved joint of more than 3 on a scale of 1-10
• Neurologic deficit around the involved joint