Ask An Expert: Gout and Medications

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Ask An Expert: Gout and Medications

Question:

I have gout and am taking allopurinol daily. I also am taking meloxicam daily for arthritis in the hip. Since gout is a form of arthritis, can I stop taking the allopurinol and use the meloxicam to treat both the gout and the hip pain?

Answer:

The answer to this question depends on why you are taking allopurinol and the type of hip arthritis you have.

Let's start with the allopurinol. This medication lowers the blood level of uric acid. Uric acid is a waste product ordinarily eliminated by the kidneys, but in some people, the kidneys cannot keep up with the amount produced. Because deposits of uric acid crystals in a joint cause gout, allopurinol can be helpful in preventing attacks of this type of arthritis. However, it is not necessary for every person with gout to take this medication. It is usually reserved for people who have:

• Frequent attacks of gout

• Severe attacks of gout that do not respond promptly to therapy

• Multiple joints affected by gout at the same time

• Lumps of uric acid crystals (called tophi) in the skin, joints or elsewhere

• Kidney stones (because uric acid can contribute to kidney stone formation)

If you take allopurinol for one or more of these reasons, it is usually best to continue taking the drug. If you stop taking it, the blood levels of uric acid will likely rise again and the gout will return.

Although meloxicam might reduce the pain and swelling from a sudden attack of gout, this medication has no effect on uric acid levels. So, if you take allopurinol for one of the reasons above, meloxicam is not a good substitute.

"Arthritis of the hip" could mean many things. The most common is osteoarthritis (also called degenerative joint disease). Acetaminophen or anti-inflammatory medications (including meloxicam) can be effective treatments for this condition. The hip is an unusual place for gout to attack, and gout in the hip would not be expected to cause pain every day, so allopurinol is unlikely to make your hip pain better.

Talk to your doctor about the reason you are taking allopurinol, the risks and benefits of continuing it, and the cause of your hip arthritis. If you have gout and osteoarthritis, and if the medicines are not causing any side effects, it may be best to continue taking both medications.

Robert Shmerling, M.D., is associate physician and clinical chief of rheumatology at Beth Israel Deaconess Medical Center and an associate professor in medicine at Harvard Medical School. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program and has been a practicing rheumatologist for over 25 years.

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Last updated:	January 24, 2007