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December 20, 1958


Author Affiliations

Maurice Rich, M.D.; Miami, Fla.

Clinical Associate Professor of Medicine (Dr. Oren) and Clinical Assistant Professor of Medicine (Drs. Rich and Belle), University of Miami School of Medicine.

JAMA. 1958;168(16):2128-2129. doi:10.1001/jama.1958.63000160005010a

Chlorothiazide (Diuril) has been recently introduced into therapeutics, first, as an effective nonmercurial diuretic1 and, more recently, as a potentiating hypotensive agent in the treatment of essential hypertension.2 It apparently has proved to be quite effective in these actions but has a tendency to cause excessive excretion of sodium, potassium, and chloride.3

Recently, we noted that in some patients unexplained joint pains could occur, especially in the feet, during the use of this drug. Investigations show no organic cause for this symptom, but the uric acid levels in the blood were found to be elevated. Further investigation of a number of patients receiving this drug confirmed this observation, though joint and foot pain was by no means a uniform symptom. Indeed, some of the highest uric acid levels were associated with no joint pain whatever.

Two significant cases are reported below.

Report of Cases 

Case 1.—  A