Reply To: Probenecid questions

Keith Taylor

Hi Gary,

I think your doctor is right to take this seriously. 9.1 is far too high for uric acid.

Even though you can manage occasional pain now, it’s going to get worse. Untreated high uric acid means that crystals are developing in your body every day.

Some days, your immune system deals with uric acid crystals without you noticing. Other days, you get symptoms that range from a little itching or discomfort, through to full-blown gouty agony. It gets worse after that, as joints start to crumble. It’s especially bad if your prone to kidney stones. Untreated gout leads to kidney damage. And, skin and heart are other common targets. All organs apart from the brain are at risk.

I wanted to mention all that to underline the dangers. Also, to point out that your second gout attack was nothing to do with red wine. It was caused by crystals that started to grow many months, or years, ago.

But, your main question is about choice of treatment.

Probenecid is usually prescribed for patients who have low uric acid excretion rates. This is tested by measuring the amount of uric acid in urine over a 24-hour period. Have you had that test?

Allopurinol is best targeted at over-producers. However, it can be effective for some under-excreters as well. So, many doctors try allopurinol first. Then, they might introduce probenecid if allopurinol isn’t getting uric acid low enough.

After 6 months of safe uric acid levels, you definitely do not need colchicine.

If you’ve lost confidence in your GP, I think it’s best to see a rheumatologist. I guess it depends how easy it is for you to see one. Also, we might get to understand your GP’s reasoning better if we know about the urine test I mentioned.

It comes down to whatever you think is best for you.