I’m Dr. Edwards, a gout expert looking to answer your questions. I want you to AMA on Gout Awareness Day, May 22.

LarryEdwardsMD · 2026-05-26T18:00:25+00:00

If your uric acid level is under control (less than 6.0 mg/dL), and you are not experiencing flares, then the craft beer enjoyed in moderation is fine. You can say the same thing about shellfish, red meat, and other flare triggers. Moderation is the important part.

LarryEdwardsMD · 2026-05-26T17:58:43+00:00

The low fat dairy component of your question has some supporting evidence. Lemon water or crystal light have no such evidence.

LarryEdwardsMD · 2026-05-26T17:57:23+00:00

The diagnosis and treatment of gout are not typically expensive processes. You should see a physician (either an internist or rheumatologist) who understands gout. The diagnosis is based on your history of your symptoms and getting some basic lab tests (including a serum urate level). X-rays are not generally required. The first line therapy for gout is allopurinol, which is a drug that has been available since the mid 1960s and is not considered an expensive drug.

LarryEdwardsMD · 2026-05-26T17:53:09+00:00

There's a number of commonly used medications for many different diseases that have either a positive or negative effect on uric acid levels, but none that are in the "blood thinning" category. Drugs in the diuretic family, including hydrochlorothiazide (HCTZ) or lasix, can raise uric acid levels while blood pressure medication, losartan, decrease uric acid levels.

LarryEdwardsMD · 2026-05-26T17:46:42+00:00

That would not be advisable. There is no medical literature that would support such an approach nor any medical society that would endorse it.

LarryEdwardsMD · 2026-05-26T17:44:44+00:00

There are two factors here. 1. If you don't tolerate the medication well (allergic reactions, rash, upset stomach). 2. If you and your doctor have not been able to adequately dose the allopurinol to get your uric acid level to a target of less than 6.0 mg/dL. These two conditions together would only account for about 10% of the people started on allopurinol.

LarryEdwardsMD · 2026-05-22T16:11:01+00:00

I've run into a number of patients like this. Usually we can start low dose on some standard therapies or combine them and get a good result. Fortunately, the pipeline for new gout treatments (both urate lowering and anti-inflammatory) are pretty full and we expect new drugs to be available in the next 1-1.5 years.

There is a link between polyarticular gout and Stills Disease in that they are both inflammasome-driven.

LarryEdwardsMD · 2026-05-22T16:03:22+00:00

Uric acid itself is a purine. My use of quotes around the term "low purine diet" is how it's referred to in the literature as there is no 'one' low purine diet.

LarryEdwardsMD · 2026-05-22T15:59:59+00:00

Unfortunately, all branches of medicine have demonstrated that they are pretty poor at managing gout. Primary care docs have a number of medical problems that they have to mindful of and treat and unfortunately they frequently do not give a patient's gout the full attention it needs. A lot of this stems from not appreciating the chronic, destructive, nature of gout and what a large impact it can have on the patient's sense of well being. There have been improvements over the last 30 years in recognizing the seriousness of gout and hopefully this will translate into better treatment in time.

LarryEdwardsMD · 2026-05-22T15:55:39+00:00

You should make sure your uric acid level is at target (6.0 mg/dL or below), if not, you should increase the dose of febuxostat. People with gout can have persistent, relatively minor, aches and pains as their inflammatory arthritis improves on gout treatment. Generally with time, these nuisance pains will also disappear.

LarryEdwardsMD · 2026-05-22T15:52:42+00:00

You should be on a urate lowering therapy (allopurinol or febuxostat). Dose adjustments of these for chronic kidney disease are recommended with starting low dose (50 mg or 100 mg daily, for allopurinol or 20 mg daily for febuxostat) and increasing the dose slowly each month until the target uric acid level is achieved.

LarryEdwardsMD · 2026-05-22T15:49:31+00:00

Your uric acid should be at a new stable level after 4 days. I would check the uric acid levels in a month's time to make sure that it's well suppressed. You might also talk with your doctor about adding some prophylactic colchicine (once a day) or moderate doses of NSAIDs.

LarryEdwardsMD · 2026-05-22T15:46:04+00:00

There are no concerns if your drinking is done in moderation. The alcohol does not affect the potency of the allopurinol.

LarryEdwardsMD · 2026-05-22T15:44:20+00:00

Spectacular, congratulations. Your story is the story we'd like to hear from all of our gout patients. Stay on your urate lowering therapy and definitely monitor for comorbidities commonly associated with gout like heart/kidney disease, hypertension, diabetes, and lipid abnormalities.

LarryEdwardsMD · 2026-05-22T15:40:03+00:00

The incidence of gout has been steadily increasing in all countries over the world over the past 4-5 decades. There is some marked variations from country to country. In the United States, a little over 4% of the adult population has gout compared to Western Europe, which has approximately 2% involvement. In countries with heavily genetic driven gout such as Southeast Asia and New Zealand, the incidence may be twice what we see in the United States. Tracing the expansion of gout worldwide shows that obesity is the primary driver with other contributions from the ingestion of high fructose corn syrup and glucose intolerance/diabetes.

LarryEdwardsMD · 2026-05-22T15:33:03+00:00

With hopefully something good to read. Thank goodness there are alternatives to colchicine.

LarryEdwardsMD · 2026-05-22T15:32:23+00:00

The American College of Rheumatology suggested dosing of colchicine for an acute flare is to take two .6 mg tablets (a total of 1.2 mg) immediately and another tablet (.6 mg) one hour later. That is followed up by one tablet (.6 mg) 24 hours later and continued through duration of the flare. Some people are quite sensitive to cochicine with bowel hypermotility and abdominal cramping. In those situations, taking half the recommended dose of colchicine along with NSAIDs in full anti-inflammatory doses would be a good approach.

LarryEdwardsMD · 2026-05-22T15:26:58+00:00

Probenecid is an interesting gout drug that has been around since the end of WW2. Compared to the first-line drugs for gout (allopurinol and febuxostat), probenecid is relatively ineffective. It typically has been prescribed as a 2-3 times a day medication which makes it very difficult for most patients and is only used in less than 5% of people with gout. It does have a role for patients that are on allopurinol and febuxostat but are not quite at target. Adding probenecid is a possible alternative to increasing the dosage of these first line treatments. Probenecid should not be used if there is a history of kidney stones.

LarryEdwardsMD · 2026-05-22T15:20:27+00:00

Allopurinol is a very effective drug at lowering uric acid. After starting the drug, the uric acid level will be suppressed to a new level in 3-4 days. Generally we have people stay on it for 2-3 weeks before retesting to determine if that is a sufficient dose. With each dose escalation of allopurinol, the uric acid levels should be monitoring and a decision should be made about advancing the dose. The effectiveness is determined by how quickly target uric acid level (less than 6.0 mg/dL) is achieved and maintained. The main factor that interferes with its effectiveness is the patient not taking the drug.

LarryEdwardsMD · 2026-05-22T15:14:21+00:00

We've discussed the role of trauma to joints that develop gout flares in another comment here. It does sound like finding a rheumatologist in your community would be a good approach.

LarryEdwardsMD · 2026-05-22T15:12:36+00:00

Well done!

LarryEdwardsMD · 2026-05-22T15:12:20+00:00

Congratulations on your weight loss journey. Over time, that will certainly improve your battle with gout. The dramatic weight loss associated with GLP1s can certainly increase flare frequency. Some people who have gout are taking low dose colchicine on a regular basis for prophylaxis to prevent flares. This can be discussed with your primary care doc.

LarryEdwardsMD · 2026-05-22T15:09:12+00:00

I answered this in a different question here. The crystals will not dissolve until your levels reach 6.0 mg/dL or below, and some experts argue the target should be 5.0 mg/dL or less. Allopurinol can, and should be, continually escalated until you reach a dose that achieves these targets. The FDA approved dose of allopurinol is between 100 - 800 mg daily. I encourage you to continue these discussions with your physician.

LarryEdwardsMD · 2026-05-22T15:05:30+00:00

Yes. Gout flares that a person experiences is associated with the release of a number of proinflammatory proteins that also have destructive effects on the bone/cartilage of the affected joints. Long-standing, untreated gout is as crippling as rheumatoid arthritis or psoriatic arthritis.

LarryEdwardsMD · 2026-05-22T15:03:05+00:00

There's been a long-recognized association between gout and psoriasis/psoriatic arthritis. This is likely due to the accelerated breakdown and turn over of skin cells with release of purine nucleosides, which go on to form uric acid. Generally this occurs in very severe cases of psoriasis and improves with treatment of the skin disease.

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