Keith’s GoutPal Story 2020 Forums Please Help My Gout! Uric Acid low uric acid with tophi

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    About 20 years ago I had a bump removed from my elbow that proved to be gout. Since my uric acid was not high I was not put on medication. Of course the tophi slowly came back and is now rather large. My present physician put me on 500 mg probenicid which he has gradually increased to 4 per day as well as 300 mg of allopurinol in order to shrink the tophi, which has not happened. In fact my other elbow has joined in on the fun with a couple of unsightly bumps of its own, meanwhile my already low uric acid, as taken by my physician, has decreased from 2.5 to 1.5. I have never had a gout attack but wonder what the heck is going on here that these things continue with such a low uric acid count.
    Any ideas or suggestions would be greatly appreciated. By the way I am female and 59 years old.


    This does not make sense. I need more test result information to understand what is going on. Crucially, what is your uric acid history? One uric acid test result whilst you are taking uric acid lowering meds is hard to understand. All I can say is your uric acid is under control. If tophi are still growing when uric acid is down to 1.5dl/mg (assuming that is your test result scale), then you must have something more complicated than standard gout. In that case, only a rheumatologist can help.


    I thank you for your response. The reason why I came to this forum was to seek ansewers to this odd situation. My uric acid has NEVER been high and I have never had a gout attack which is why my original GP did not put me on meds sooner. In fact, if memory serves me correctly, my uric acid was about a 3 when I started taking medication. My present GP is scratching his head over these figures as well. I do not see a rheumatologist since the growth of these things are my only symptom, however I feel I may need to consult one in order to find answers. Thank you for your input.


    I still feel a bit confused about test results. If uric acid has never been over 3mg/dL with no medication, then I don’t see how it can be gout. If it has been over 5mg/dL (or over 4 with prolonged exposure to cold) at some time in the past, then it probably is gout.

    Uric acid crystals grow very slowly when uric acid is over 5, but should dissolve very quickly when uric acid is 3 or less. Once lumps (tophi) have become established, they can be very difficult to shrink without surgery, as blood flow is not reaching the center of the lump where it can encourage old crystals to dissolve.

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