There are several factors that determine when you should start allopurinol. The latest guidelines from professional rheumatologists say you should start allopurinol if any of these are true:
1. More than one flare per year.
2. Visible tophi.
3. Uric acid crystals in joint fluid.
4. Age less than 40.
5. Uric acid blood test result more than 8mg/dL (480μmol/L).
6. Also suffer from kidney disease, high blood pressure, coronary heart disease, or heart failure.
I’d say, the values in point 5 are high. So, I’d recommend discussing allopurinol if uric acid blood tests show more than 7mg/dL (400μmol/L). However, at this level, gout sufferers might also consider lifestyle improvements to lower uric acid. In any case, uric acid should be tested frequently to see if it’s getting worse.
Tom, I hope that helps. But, if not, please ask for clarification. Going forward, if you want better individual help, please post uric acid test results.