Allopurinol (xanthine oxidase inhibitor) in the treatment of resistant gout

Allopurinol was given to 24 patients with gout resistant or intolerant to uricosuric drugs; in each case a substantial fall in serum uric acid level resulted. There was a sensitive relationship between the dose of allopurinol and the level of serum uric acid. There was no relationship between the severity of gout or degree of renal disease and the dose of allopurinol required to maintain a satisfactory level of serum uric acid. Response to treatment was satisfactory in all patients except one. Benefit was confirmed by adequate control of hyperuricemia, improvement in well-being, relief of joint pain, increase in joint mobility, decrease in joint swelling, subsidence of recurring attacks of gout, decrease in size of tophi, and reossification of bones. Long-term treatment with allopurinol was found feasible and troublesome recurring gout was not a problem. Colchicine was given simultaneously in only one case; a long-term trial with this combination was not carried out. Allopurinol is indicated in patients who have troublesome gout not responsive to treatment.