THE DIVERSITY OF GOUTY ARTHRITIS AND ITS COMPLICATIONS

Abstract

Selected items from the medical study of 8 patients with gout are presented. They serve to illustrate the diversity of gout and gouty arthritis. The onset of symptoms, i.e., the 1st attack of gouty arthritis, may appear in the 1st decade of life or as late as the 8th decade. At the time of the 1st attack X-ray evidence of osseous tophi or subcut. tophi on inspection usually is lacking. The passage of urate stones or urate gravel may precede the 1st attack of gouty arthritis. Urate stones may be passed by persons who do not develop gouty arthritis subsequently. Renal disease is the most important non-arthritic phase of gout. There appears to be no close correlation between renal involvement and joint involvement. The pathological findings in the kidney of gouty patients are a mixture of several entities. Rheumatoid arthritis and gout may be observed in the same patient. Each disease must be treated independently. This may be done without aggravating either condition. Col-chicine at the rate of 0.5 mg. per hr. is recommended for the acute attacks. This dosage should be maintained until onset of gastro-intestinal distress. From 10 to 14 doses are usually sufficient. Colchicine is then stopped and Tinct. Camph. Opii is given. Between attacks some colchicine is recommended. In patients with frequent attacks of arthritis, 1 or 2 treatments with colchicine each day is advised. Less severe cases may require but 1 or 2 tablets per week. A balanced diet with a liberal fluid intake seems to produce as satisfactory results in many patients as does rigid dieting.