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Old 07-10-2013
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Question probenecid not in acute gout, WHY?

Why probenecid should not be given when a px is having an acute attack of gout?
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Old 07-10-2013
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a better question would be why the hell would you give him probenecid...

it's an acute attack, he is in pain, doesn't using high potency nsaids and colchicine make more sense?

there's probably a more scientific reason I guess
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Old 07-10-2013
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Allupurinol and Probencid are only used in chronic form to decrease uric acid level in blood to protect from formation of uric acid crystals
when you have an attack then gout crystals have already formed in your joint and you will not benefit from decreasing uric acid level in blood
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Old 07-10-2013
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Quote:
Originally Posted by drivenby View Post
a better question would be why the hell would you give him probenecid...

it's an acute attack, he is in pain, doesn't using high potency nsaids and colchicine make more sense?

there's probably a more scientific reason I guess
I appreciate and agree with what you were saying; probenecid is not doing much in relieving the pain in acute settings.....But the real question is WHY probenecid is "contraindicated" though !? Some literature says "NEVER give probenecid in acute gout"...... what is with the NEVER business? I understand probenecid most likely will not work in acute gout but will it kill the patient if we give it anyway? There must be a reason to use the strong word-'contraindicated' ? On a separate note: why cann't we give NSAID/cochicine & probenecid at the same time ? Why the text book keeps saying that you must control the acute inflammation first before you start a px on probenecid..... These textbooks never gave any explanation on this.
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Old 07-16-2013
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the thing is,,gout is precipitated in sudden increase or decrease in uric acid level in blood,,,many a patient can remain asymptomatic for years with high uric acid level,,,but when an attack is there u must not hurry in reducing the level....first give support,,then u can reduce the level,,,,unless the attack may become very severe and difficult to controll.....hopefully u got it........
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Old 07-16-2013
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As PROBLEM explained, acute gout is precipitated by rapid changes in uric acid levels. So, Probencid can worsen an acute attack of gout. It is, therefore, contraindicated for this reason.
Because agents that lower uric acid can precipitate attacks of gout, low-dose colchicine is typically used as prophylaxis for long term management of gout (usually for 6 months) when such therapy is initiated.
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Old 07-16-2013
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I think probenecid compete with uric acid for secreation.
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Old 07-16-2013
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Quote:
Originally Posted by Novobiocin View Post
As PROBLEM explained, acute gout is precipitated by rapid changes in uric acid levels. So, Probencid can worsen an acute attack of gout. It is, therefore, contraindicated for this reason.
Because agents that lower uric acid can precipitate attacks of gout, low-dose colchicine is typically used as prophylaxis for long term management of gout (usually for 6 months) when such therapy is initiated.
Thanks. sorry I was being dumb, but can you pls explain exactly (mechanism) how probenicid or allopurinol exacerbate acute gout attack?
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Quote:
Originally Posted by PROBLEM View Post
the thing is,,gout is precipitated in sudden increase or decrease in uric acid level in blood,,,many a patient can remain asymptomatic for years with high uric acid level,,,but when an attack is there u must not hurry in reducing the level....first give support,,then u can reduce the level,,,,unless the attack may become very severe and difficult to controll.....hopefully u got it........
I have trouble understanding why sudden decrease in uric level level will precipitate gout . I thought gout is crystal precipitated from over-saturated uric acid. Sudden decrease in uric level should help in dissolve gout crystal back into the solution. . . . Am I crazy ?
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Old 07-17-2013
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I appreciate there are lot of confusion regarding gout,,its mechanism and so on....I hv also some gray areas...still I am giving u people few concepts..


During acute gouty attack u must find these MSU crystals both intracellularly and extracellularly----it is always true-in gout serum urate level is almost always elevated at some time....due to these intra cellular thing during acute gout u can find ur plasma urate becoming lower sometime but the total body pool may become higher...........so these sudden increase or decrease in plasma level can tell u that msu invading intracellularly and an severe attack is coming......molecular level triggering starts and its time to work.....

the chance of nephropathy and the posibility of renal stone becomes very high this tym which is again a contraindication of probenecid use,,,


and yes cholchicine in any form is not useful for acute gout and not recommended now a days........

only thing u have to do.......nsaids or maximally steroids......

Acute gout not about depositions in ur joints its about inflammation......trigger is in the cell.........
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