Abstract
Spontaneous nucleation and growth of urate crystals require a high degree of supersaturation. Dissolution rates are rapid compared with those of growth, suggesting that periodic short-term reduction of urate might be effective treatment.
50 patients with gout were randomly allocated to one of two groups, receiving allopurinol either continuously or for 2 months every year. Patients with renal functional impairment or tophaceous gout were excluded. Duration of treatment ranged from 2-5 years. Of 24 patients in the continuous group 4 defaulted from follow-up. Of 26 patients in the intermittent group 6 defaulted, leaving 20 patients for study in each group.
Urate levels fell during treatment periods and rose after stopping the drug. Acute gouty arthritis occurred to a similar degree in the two groups during the first year, but thereafter attacks occurred with diminishing frequency in the continuous group compared with the intermittent group. 3 patients in the intermittent group were particularly troubled by severe gout occurring during periods of urate reduction. 4 patients in the intermittent group went on to continuous treatment at their own request because of recurrent attacks of gout. No significant change in renal function has occurred in either group during the period of study.
It is concluded that intermittent administration of allopurinol as given here is less effective in controlling symptoms of gout than continuous therapy.
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Bull, P., Scott, J. 137 INTERMITTENT CONTROL OF HYPERURICAEMIA IN THE TREATMENT OF GOUT. Pediatr Res 24, 134 (1988). https://doi.org/10.1203/00006450-198807000-00161
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DOI: https://doi.org/10.1203/00006450-198807000-00161