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T HE beneficial action of phenylbutazone in acute gouty arthritis has been noted in many early clinical trials in various rheumatologic disorders.8*12~13,16 Further studies have confirmed and extended these initial observations and indicate that this synthetic pyrazolone derivative is particularly effective in controlling symptoms of acute gouty attacks.1,a,4,6,g,10,11 Table I summarizes reports from the American literature in which the clinical response of acute gout to phenylbutazone could be evaluated. In those cases treated within the first week of the acute attack, phenylbutazone relieved 82 per cent of the 315 reported attacks. Kuzell,’ Steinbrocker4 and Gutman have commented on the early subjective pain relief which precedes objective resolution of the other signs ofjoint inflammation. Our observations indicate that this early control of pain is a constant and significant advantage of phenylbutazone and may be obtained earliest with relatively large initial drug doses. Determinations of serum phenylbutazone level and serum urate concentration made at the time of clinical pain relief indicate that the drug’s effectiveness in relieving the pain of acute gout is related to the attainment of a relatively low but constant serum drug level and is unrelated to its uricosuric effect. This presentation describes our experiences in treating sixty consecutively observed acute attacks of gout with various doses of phenylbutazone administered orally.

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