Why do gout attacks become more frequent after starting to lower uric acid?

Nowadays, people’s lifestyle and diet are relatively rich, and many people have developed gout. After so many years of publicity and popular science, everyone knows that the real cause of gout is high uric acid. Everyone will go to the doctor to use drugs to lower uric acid, but some people have more frequent gout attacks while using uric acid-lowering drugs, and even more frequent attacks than when they did not take uric acid-lowering drugs. Then they become very resistant to uric acid-lowering drugs, and finally fail to lower uric acid. Today, let’s talk about the real reasons that lead to this phenomenon, so that everyone can have a full understanding of this special stage and build up everyone’s determination and confidence to fight gout.

Frequent gout attacks during uric acid-lowering treatment are medically called "crystal dissolving pain". Let me first tell you why it is called this way: Everyone basically knows that when the uric acid level in the body rises and reaches a certain level, uric acid will produce crystals. This is the same as drying salt in seawater. When the concentration exceeds a certain level, the salt will precipitate. The most common part of the human body where urate crystals are precipitated is the joints. When crystals appear in the joints, they will trigger the body's immune response, leading to acute inflammatory attacks, which is what we often call gout. When taking oral uric acid-lowering drugs, the process is just the opposite. It is a process in which the crystals are dissolved again in the blood and excreted from the body. At this time, someone must say, how can this cause frequent gout attacks? There must be something wrong with the uric acid-lowering drugs used by your doctor! In fact, the real reason is that after using uric acid-lowering drugs, when the uric acid concentration in the body drops rapidly, the urate crystals deposited in the joints may partially dissolve and fall off, and be released into the joint cavity, which will trigger the immune response again, leading to an acute gout attack. Because of this, our doctors use low-dose anti-inflammatory drugs (such as colchicine, nonsteroidal anti-inflammatory drugs or glucocorticoids) in combination in the early stages of uric acid lowering (usually the first 3-6 months) to prevent crystal dissolution pain. Some people stop taking the medicine on their own or take it intermittently, which will cause repeated fluctuations in uric acid levels, aggravate the instability of crystals, lead to more frequent attacks, and affect the quality of life. In addition, other diseases or drug interference such as renal insufficiency, hypertension (use of diuretics), obesity or insulin resistance may also affect uric acid metabolism. At the same time, I hope that friends with gout will improve their habits in the future, because high-purine diet, drinking, dehydration, strenuous exercise or joint injuries may still induce gout.

To sum up, frequent gout attacks in the early stage of uric acid lowering are only a stage. If you cooperate well with the doctor and alleviate it through standardized medication, combined anti-inflammatory prevention and lifestyle adjustments, then you can still reduce or even eliminate the recurrence of gout. Everyone should remain patient, avoid stopping the medication on their own, and manage long-term under the guidance of a professional doctor. We will enjoy a wonderful life together.