Intermittent Control of Hyperuricaemia in the Treatment of Gout

  • P. W. Bull
  • J. T. Scott
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 253A)


Nucleation of urate crystals requires a high degree of supersaturation although it may be enhanced by various agents such as calcium, decreasing pH and mechanical shock1. Growth rate is also very strongly dependent on supersaturation and appears to be very slow at physiological degrees of supersaturation. In contrast, dissolution rates are very fast compared with growth, being limited by the rate at which the urate can diffuse away from the crystal surface2. This has led to the suggestion that periodic short-term lowering of serum urate in patients with gout might be as effective as constant treatment, a few days of normouricaemia every year being sufficient to eliminate small deposits3. Such a concept is attractive both with regard to financial economy (allopurinol costing approximately £300 per patient per year at a dose of 300mg daily) and perhaps to compliance, the idea of short intermittent periods of treatment being more acceptable to some people than long term continuous administration.


Serum Uric Acid Serum Uric Acid Level Serum Urate Gouty Arthritis Continuous Group 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    H.K. Tak, S.M. Cooper, W.R. Wilcox, Studies on the micleation of monosodium urate at 37°C, Arth.Rheum. 23: 574–80 (1980)CrossRefGoogle Scholar
  2. 2.
    C-Y. Lamerwin, G.H. Nancollas, The crystallisation and dissolution of sodium urate, J. Crystal Growth, 53: 215–23 (1981)CrossRefGoogle Scholar
  3. 3.
    R.W. Fiddis, N. Vlachos, P.P. Calvert, Studies of urate crystallisation in relation to gout, Ann.Rheum.Dis. 42: Suppl. 12. 15, (1983)CrossRefGoogle Scholar
  4. 4.
    T. Nishizawa, Y. Nishida, M Takehiro, I. Akaoka, Treatment of gout with alternate day hypouricaemic drugs, Rheumatol.Rehabil. 17: 143–9, (1978)PubMedCrossRefGoogle Scholar
  5. 5.
    W. Loebl, J.T. Scott, Withdrawal of allopurinol in patients with gout, Ann.Rheum.Dis. 33: 304–307, (1984)CrossRefGoogle Scholar
  6. 6.
    T.P. Kennedy, C.S. Higgens, P.F. Woodrow, J.T. Scott, Crystal deposition in the knee and great toe joints of asymptomatic gout patients, J. Roy.Soc.Med. 77: 747–750, (1984)PubMedGoogle Scholar

Copyright information

© Plenum Press, New York 1989

Authors and Affiliations

  • P. W. Bull
    • 1
  • J. T. Scott
    • 1
  1. 1.Charing Cross HospitalLondonUK

Personalised recommendations