TREATMENT OF GOUT WITH ALLOPURINOLAND SULPHINPYRAZONEINCOMBINATION AND WITH ALLOPURINOLALONE

Successful long-term management ofprimary gout inthepresence ofnormalrenal function maybe achieved inmostinstances byagents whichdiminish tubular reabsorption ofurates, thuspermitting increased urinary urate excretion. Inrecent years the twomostwidely useduricosuric agents havebeen probenecid andsulphinpyrazone. Theeasiest longtermcontrol ofgoutwiththefewest untoward sideeffects hasbeenachieved withsulphinpyrazone (Gutman andYui, 1957a; Kersley, Cook,andTovey, 1958; Ogryzlo andHarrison, 1957; Kuzell, Glover, Gibbs, andBlau, 1964). Inspite oftherelative easeincontrolling goutwith sulphinpyrazone, anylarge groupofgoutypatients willinclude someinwhomtheuseofuricosuric agents maybeimpossible orinadvisable because of impairment ofrenal function ordrugintolerance. Somepatients, forreasons notyetunderstood, form tophi muchmorereadily thanothers, andquite large dosages ofuricosuric agents mayarrest theformationoftophiwithout rapidly diminishing those already present. Someformuratestones inthe urinary tract soreadily thatincreasing theurinary output ofurates maybehazardous. Finally, in secondary goutattended byexcessive uric acidformation, theemployment ofuricosuric agents maybe inadvisable because anyincrease inthealready high excretion ratemayleadtoobstruction ofthelower