Is it safe to continue allopurinol therapy during an acute gout attack, or does it risk worsening the flare?
Acute gout attacks are characterized by painful joint inflammation caused by immune cells attacking urate crystals. While chronic management to lower blood urate levels is crucial for preventing flare-ups, the approach to using urate-lowering therapies such as allopurinol during an acute gout attack continues to evolve. This blog will clarify some of the clinical considerations and evidence surrounding the use of allopurinol during acute gout episodes.
The Dilemma: Traditional Teaching vs. Emerging Evidence. Traditionally, initiating or adjusting allopurinol during an acute attack was discouraged, as altering uric acid levels can exacerbate symptoms. This concept led to a common recommendation of holding off allopurinol until the acute phase subsides. However, recent evidence has challenged this approach, suggesting that allopurinol, if already in use, should be continued during acute attacks to maintain steady uric acid levels and prevent rebound hyperuricaemia.