Diagnosis and treatment of gouty arthritis.

The characteristic phenomena of acute gouty arthritis are acute arthritis in a middle-aged male, associated with serum uric acid above 6 mg. per 100 cc. and a satisfactory response to colchicine. Roentgenographically observable changes do not occur early. In recent years uric acid metabolism has been studied by means of isotope techniques utilizing labeled substances. Uric acid is excreted in relatively constant amounts by humans and is little affected by variations in dietary intake, except for purine or nucleic acid substances. Persons with gout have a greater total amount of uric acid and a lower turnover than normal persons. In the treatment of acute attacks of gout colchicine is still the most practical single drug, even though its pharmacologic action remains unknown. Benemid (probenecid) is a powerful uricosuric agent of low toxicity which has been subjected to extensive clinical trial for three years. It causes inhibition of the resorption of urate from the glomerular filtrate; the site of action is believed to be the tubular cells. The author's usual dose is 2 gm. a day. This has caused a lowering of the uric acid in the serum and an increase in the urinary output.