Treatment of Gout

To the Editor. — In a recent issue in QUESTIONS AND ANSWERS, there is a question concerning the treatment of recurrent gout in hypertensive patients. The physician who asks the question states that he has bowel irritability with diarrhea from colchicine, but he implies that this occurs only when he takes colchicine to treat an acute attack of gout. All patients with gout should take a maintenance or prophylactic dose of colchicine, 0.6 mg once or twice a day, to prevent attacks. If they are unable to tolerate larger doses of colchicine to treat an attack, they should take phenylbutazone or indomethacin. If his uric acid level is above 10 mg/dl, he should take with colchicine either allopurinol or a uricosuric agent. When one takes allopurinol or a uricosuric agent without colchicine, one is apt to precipitate an attack of gout.