RAPID progress has been made in recent years in the management of gout, one of man's oldest diseases. Today the patient with gouty arthritis can be effectively relieved during acute attacks and protected from recurrent bouts, and if tophi exist they can be reduced in size. This optimistic outlook depends, first, upon the physician's knowledge of the therapeutic measures available and, second, upon the patient's willingness to submit to uninterrupted life-time therapy.
Few illnesses follow such a set clinical pattern as does classical gout. Hench has described two stages—that characterized by recurrent episodes of acute joint inflammation followed by complete, but temporary, remissions (intercritical periods) and that of chronic gouty arthritis, or tophaceous gout.1 Because asymptomatic hyperuricemia (larval gout) precedes for some time attacks of acute joint symptoms, it is proposed that this part of the total disease be designated as the first stage of gout. For the purpose