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Previous Volume 349:1647-1655 October 23, 2003 Number 17 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.

A 59-year-old man with bilateral olecranon-bursa tophi has frequent bouts of acute gouty arthritis, including three in the past year. His serum uric acid level is consistently above 9 mg per deciliter (535 µmol per liter). He is moderately obese and has mild, untreated hypertension. Allopurinol was discontinued after a maculopapular rash developed. How should this patient's condition be treated?

The Clinical Problem

Gout is . . . [Full Text of this Article]

Strategies and Evidence

Treatment of Acute Gouty Arthritis

            Corticosteroids and Corticotropin

            Colchicine

Long-Term or Prophylactic Therapy

            Approaches to Lowering Uric Acid Levels

            Pharmacologic Antihyperuricemic Therapy

Areas of Uncertainty

Guidelines

Summary and Recommendations

Source Information

From the Rheumatology Section, Department of Medicine, San Diego Veterans Affairs Medical Center and the University of California San Diego School of Medicine — both in San Diego.

Address reprint requests to Dr. Terkeltaub at 111K, VA Medical Center, 3350 La Jolla Village Dr., San Diego, CA 92161.

Related Letters:

Gout
Hepburn A. L., Feher M. D., Terkeltaub R. A.
Extract | Full Text | PDF  
N Engl J Med 2004; 350:519-520, Jan 29, 2004. Correspondence

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