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When should you take allopurinol for gout?

Q: I believe that allopurinol, which is the standard drug for preventing accumulation of uric acid in the body of persons with a tendency to develop gout should be used with caution as this drug in the early stages of an up-coming acute attack of gout can rapidly worsen the condition. I have been put on allopurinol twice a day; nimesulide twice a day and rantidine once a day. Should I continue with this medication or only dietary restrictions and exercise can prevent a future attack of gout. Also suggest who should be consulted for a second opinion (physician/orthopaedics/rheumotologist) and where in india?

A:In the absence of clinical details it is difficult to guess what is your disease. Regarding allopurinol, it is ONLY to be given if there are at least 5 major serious attacks of acute gouty arthritis in 1 year despite weight reduction and decreasing the total caloric intake. The only other indication for allopurinol is gouty tophi, that is, late stage of repeated attacks of acute gout. If you do not have any of these 2 situations then probably you do not need allopurinol. You need to be seen by a Rheumatologist-physician who knows about this and related conditions. Rheumatologists are available in AIIMS (Dr. Ashok Kumar and Dr. R. Handa), in Apollo Hospital (Dr. S. J. Gupta), in Indian Spinal Injuries Centre, Vasant Kunj (Dr. Sanjiv Kapoor and Dr. A. N. Malaviya).

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