The natural history of clinically overt gout is marked by explosive outbursts of acute gouty arthritis and by concomitant slow, insidious deposition of uric acid in the tissues, which in some instances progresses to disabling and deforming chronic gouty arthritis. Until recently, no clear distinction was made either in the immediate pathogenesis or in the management of these two manifestations of the gouty trait. Therapy in gout has, in fact, been almost wholly preoccupied with control of recurrent acute gouty arthritis; the most imperceptible accumulation of tophaceous deposits appears to have been accepted as inevitable and irremediable, save for what could be accomplished by surgical incision or amputation. The purpose of the present report is to describe the results obtained in the prevention and treatment of chronic gouty arthritis by a medical regimen combining uricosuric drugs and dietary regulation.
THE DICHOTOMY OF GOUT
Acute and chronic gouty arthritis both ultimately