Regimen of indomethacin therapy in acute gouty arthritis.

Though colchicine has been famed for centuries for its effect in acute gouty arthritis its relief of pain and inflammation in this condition is not invariable and may not be apparent for 24 hours or more. It was therefore not surprising that when phenylbutazone was introduced colchicine was largely replaced by this preparation, which was more certain in its action. High- dosage phenylbutazone therapy, however, was occasionally asso- ciated with marrow depression (Mauer, 1955). In 1963 indo- methacin was reported to be an effective anti-inflammatory agent in a number of rheumatic diseases (Katz et al., 1963; Norcross, 1963 ; Rothermrich, 1963). In acute gouty arthritis Hart and Boardman (1963) reported favourable results with the use of 300 mg. of indomethacin given in divided doses during the first 24 hours, with a gradual subsequent reduction to 100-150 mg. daily. The dose was varied from day to day according to the response, and treatment was continued for at least five days, or longer if symptoms persisted. Smyth et al. (1963) also obtained good results with indomethacin in acute gouty arthritis, using doses of 600-900 mg. on the first day and 400 mg. daily in divided doses during the next three to five days.