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May 21, 1982

Management of Acute Gouty Arthritis

JAMA. 1982;247(19):2660. doi:10.1001/jama.1982.03320440012011

To the Editor.—  The article "Acute Gouty Arthritis: Special Management Considerations in Alcoholic Patients" by David J. Nashel, MD, and Mahesh Chandra, MD (1982;242:58), brought up a common and perplexing problem in the treatment of acute gouty arthritis in patients who, because of other medical problems, are poor risks for orally administered colchicine or nonsteroidal anti-inflammatory medication. As stated in the article intravenous administration of colchicine, although not irritating to the gastrointestinal tract, is not without hazard, especially in patients with renal or hepatic disease. This drug treatment also must be performed as an inpatient procedure.So what can be done on an outpatient basis for the patient who would not tolerate colchicine or oral nonsteroidal anti-inflammatory agents? When dealing with a monoarticular inflammation, which usually presents itself as podagra, the use of a chemically produced, transient sympathectomy proximal to the involved joint will change a state of passive hyperemia