Reply To: Gout Victim Discussion

Keith Taylor

Rheumatoid arthritis is different from gout. You need a gout specialist. If you can’t find one, we’ll have to work something else out.

The main question is “What can we do about your allopurinol intolerance?”

I’ve searched GoutPal for allopurinol intolerance. You can do the same search using the search box at the top right of every page. I’m not sure if any of those results pages will help you. Please have a look, and let me know.

Normally, in cases of allopurinol intolerance, I recommend an alternative to allopurinol. Usually, I would suggest some kind of uricosuric, Krystexxa, or febuxostat. However, I know absolutely nothing about sourcing these drugs in South Africa. Certainly, I can see no obvious way to buy febuxostat or probenecid. However, there are many uricosurics that are used to treat other conditions. Your doctor might be able to supply these, but first you need a 24-hour urine test. I recommend arranging that urine test now. If you are a uric acid under-excreter, it makes treatment easier.

Remember, untreated high uric acid is dangerous. So, we have to do something to get your uric acid safe. The last resort is allopurinol desensitization. It has been shown to be effective. In most countries, febuxostat is an easier choice. But allopurinol desensitization might be exactly what you need, Tony.

Have a look at some existing information by searching GoutPal for allopurinol desensitization. If you agree with me that it might be useful, then I can help you and your doctor create a safe titration plan. Let me know what you think.

I haven’t addressed the colchicine point. Let me know if my colchicine guidelines need clarification.

Gout is often mistaken for Carpel Tunnel Syndrome. Or, gout causes it. Either way, we’ve got to get your uric acid safe. I can’t see your uric acid level. Do you have test results?