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(recommendation is for patients to be treated for 6 months)Tj
0.00121 Tw 0 -1.2 TD
(after allopurinol is started. Recommendations beyond the 6-)Tj
-0.0239 Tw T*
[(month time period cannot be made on the basis of this study)64.8 (.)]TJ
0.00101 Tw T*
(It is reasonable to consider continuation for a period of time)Tj
-0.0081 Tw T*
[(if flares persist or if lar)17.7 (ge tophi are present. Chronic, contin-)]TJ
0.31441 Tw T*
(uous use of colchicine prophylaxis should probably be)Tj
0.2018 Tw T*
[(avoided due to the potential for side ef)17.7 (fects. )17.8 (The use of)]TJ
-0.0022 Tw T*
(colchicine in any setting needs to include a thorough patient)Tj
0.02499 Tw T*
(discussion about its risks and benefits.)Tj
0.21581 Tw 1.2 -1.17 Td
(The colchicine was well tolerated. One subject had a)Tj
-0.0078 Tw -1.2 -1.17 Td
(mild, self-limited, subjective muscle weakness that resolved)Tj
0.0564 Tw 0 -1.17 TD
[(with discontinuation of colchicine. )54.8 (A)-251.5 (significant number of)]TJ
-0.0126 Tw T*
(subjects developed diarrhea that resolved with a lowering of)Tj
0.1017 Tw T*
[(the dose \(to once daily\) in all cases. )17.8 (This likely led to the)]TJ
0.189 Tw T*
(trend toward QD dosing compared to BID dosing in the)Tj
0.0416 Tw T*
[(colchicine group. )17.7 (The time at which subjects changed from)]TJ
0.00571 Tw T*
[(BID to QD dosing was not recorded, and the relative ef)17.7 (fica-)]TJ
0.01579 Tw T*
(cy of QD versus BID dosing was not studied. If explored in)Tj
0.0043 Tw T*
(such fashion, this could have given support to consideration)Tj
0.13989 Tw T*
(of QD versus BID colchicine therapy to potentially mini-)Tj
0.02499 Tw T*
[(mize side ef)17.7 (fects.)]TJ
-0.01981 Tw 1.2 -1.17 Td
(The data may be limited in that the acute gout flares were)Tj
0.04539 Tw -1.2 -1.17 Td
(recorded retrospectively and subjects were not examined at)Tj
-0.0266 Tw T*
[(the time of each flare. )54.8 (Also, the relatively high percentage of)]TJ
0.18829 Tw T*
(subjects with tophaceous gout may make the results less)Tj
0.1701 Tw T*
[(applicable to those with no tophaceous involvement. )17.7 (The)]TJ
0.00301 Tc 0.3719 Tw T*
(relatively high proportion of subjects with tophaceous)Tj
-0.00011 Tc 0.1257 Tw T*
(involvement in our sample \(62%\32064%\) is possibly due to)Tj
0.0533 Tw T*
(referral bias to our rheumatology practice for complex/pol-)Tj
0.0363 Tw T*
(yarticular gout cases or cases associated with advanced age)Tj
0.12399 Tw T*
[(and chronic renal insuf)17.7 (ficiency)64.8 (. )54.8 (Another possibility is that)]TJ
0.1263 Tw T*
(many patients were screened with radiographs to look for)Tj
-0.0067 Tw T*
[(tophaceous changes. )17.8 (The higher rate of baseline diuretic use)]TJ
0.0219 Tw T*
(in the colchicine group, if anything, strengthens the conclu-)Tj
0.0013 Tw T*
(sions, as diuretics are known to elevate serum urate concen-)Tj
0.02499 Tw T*
(trations and make patients prone to acute gout flares.)Tj
0.0036 Tw 1.2 -1.09 Td
(Chronic gouty arthritis is a common and markedly debil-)Tj
0.01469 Tw -1.2 -1.09 Td
(itating illness and allopurinol therapy is commonly used for)Tj
0.02631 Tw 0 -1.09 TD
[(longterm therapy)64.8 (. Prophylactic use of colchicine upon initi-)]TJ
0.1828 Tw T*
[(ation of allopurinol will decrease the frequency)64.8 (, severity)64.8 (,)]TJ
0.13049 Tw T*
(and incidence of multiple acute gout attacks. It should be)Tj
0.0378 Tw T*
(given for 6 months after initiation of allopurinol, and could)Tj
0.0845 Tw T*
(be considered for longer periods of time in certain clinical)Tj
0.03329 Tw T*
(scenarios. Prophylactic colchicine was well tolerated in our)Tj
0.11189 Tw T*
(sample. Our study is the first to provide objective clinical)Tj
0.0705 Tw T*
(data supporting the common clinical practice of using pro-)Tj
0.00591 Tw T*
(phylactic colchicine therapy during initiation of allopurinol.)Tj
/T1_2 1 Tf
0 Tw 0 -2.2 TD
(ACKNOWLEDGMENT)Tj
/T1_1 1 Tf
0.3493 Tw 8 0 0 8 53.5 171.5266 Tm
[(W)79.9 (e thank )54.9 (Anneke C. Bush, ScD, MHS, Epidemiologist/Biostatistical)]TJ
0.1299 Tw 0 -1.25 TD
[(Support, 59th Medical )17.7 (W)39.8 (ing, Clinical Research Squadron, for assistance)]TJ
0.02499 Tw T*
(with statistical analysis.)Tj
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(REFERENCES)Tj
/T1_1 1 Tf
0.02499 Tw 8 0 0 8 60.5 117.5266 Tm
[(1.)-875.1 (Rundles R)54.8 (W)91.9 (, Metz EN, Siberman HR. )54.8 (Allopurinol in the treatment)]TJ
1.675 -1.25 Td
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-1.675 -1.25 Td
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34.675 79.8959 Td
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-1.675 -1.225 Td
[(3.)-875.1 (Paulus HE, Schlosstein LH, Godfrey RG, Klinenber)17.7 (g JR, Bluestone)]TJ
1.675 -1.225 Td
[(R. Prophylactic colchicine therapy of intercritical gout. )54.8 (A)]TJ
0 -1.225 TD
[(placebo-controlled study of probenecid-treated patients. )54.8 (Arthritis)]TJ
0 Tc T*
(Rheum 1974;17:609-14.)Tj
-0.00011 Tc -1.675 -1.225 Td
[(4.)-875.1 (Emmerson BT)73.9 (. )17.7 (The management of gout. N Engl J Med)]TJ
0 Tc 0 Tw 1.675 -1.225 Td
(1996;334:445-51.)Tj
-0.00011 Tc 0.02499 Tw -1.675 -1.225 Td
[(5.)-875.1 (Thompson FR, Duf)17.7 (f IF)79.7 (, Robinson )17.7 (WD, Mikkelsen )17.7 (WM, Galindez)]TJ
1.675 -1.225 Td
[(H. Long term uricosuric therapy in gout. )54.8 (Arthritis Rheum)]TJ
0 Tc 0 Tw T*
(1962;5:384-96.)Tj
-0.00011 Tc 0.02499 Tw -1.675 -1.225 Td
[(6.)-875.1 (Klinenber)17.7 (g JR, Goldfinger SE, Seegmiller JE. )17.7 (The ef)17.7 (fectiveness of)]TJ
1.675 -1.225 Td
(the xanthine oxidase inhibitor allopurinol in the treatment of gout.)Tj
T*
(Ann Intern Med 1965;62:639-47.)Tj
-1.675 -1.225 Td
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1.675 -1.225 Td
(lowering drugs? [editorial]. J Rheumatol 1995;22:1621-3.)Tj
-1.675 -1.225 Td
[(8.)-875.1 (Schlesinger N, Schumacher HR. Gout: can management be)]TJ
1.675 -1.225 Td
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-1.675 -1.225 Td
[(9.)-875.1 (Y)99.8 (amanaka H, )17.7 (T)69.9 (ogashi R, Hakoda M, et al. Optimal range of serum)]TJ
1.675 -1.225 Td
(urate concentrations to minimize risk of gouty attacks during )Tj
T*
[(anti-hyperuricemic treatment. )54.8 (Adv Exp Med Biol 1998;431:13-8.)]TJ
-2.175 -1.225 Td
[(10.)-875.1 (Hollingworth P)110.7 (, Reardon JA, Scott JT)73.9 (. )54.8 (Acute gout during)]TJ
2.175 -1.225 Td
[(hypouricemic therapy: prophylaxis with colchicine. )54.8 (Ann Rheum)]TJ
0 Tc T*
(Dis 1980;39:529-30.)Tj
-0.00011 Tc -2.1381 -1.225 Td
[(1)36.8 (1)-0.1 (.)-875.1 (Emmerson BT)73.9 (. )17.7 (Therapeutics of hyperuricemia and gout. Med )]TJ
0 Tc -0.02991 Tw 2.1381 -1.225 Td
[(J Aust )-54.9 (1984;141:31-6.)]TJ
-0.00011 Tc 0.02499 Tw -2.175 -1.225 Td
[(12.)-875.1 (Y)110.8 (u)-0.1 ( )17.7 (TF)79.7 (, Gutman )54.8 (AB. Ef)17.7 (ficacy of colchicine prophylaxis. Prevention)]TJ
2.175 -1.225 Td
(of recurrent gouty arthritis over a mean period of 5 years in 208)Tj
T*
[(gouty subjects. )54.8 (Ann Intern Med 1961;55:179-91.)]TJ
-2.175 -1.225 Td
[(13.)-875.1 (Y)110.8 (u)-0.1 ( )17.7 (T)74 (.)-0.1 ( )17.7 (The ef)17.7 (ficacy of colchicine prophylaxis in articular gout. )54.8 (A)]TJ
2.175 -1.225 Td
[(reappraisal after 20 years. Semin )54.8 (Arthritis Rheum 1982;12:256-64.)]TJ
-2.175 -1.2 Td
[(14.)-875.1 (Harris MD, Siegel LB, )54.8 (Alloway JA. Gout and hyperuricemia. )54.8 (Am)]TJ
0 Tc 2.175 -1.2 Td
(Fam Phys 1999;59:925-34.)Tj
-0.00011 Tc -2.175 -1.2 Td
[(15.)-875.1 (Kot )17.7 (TV)128.8 (, Day RO, Brooks PM. Preventing acute gout when starting)]TJ
2.175 -1.2 Td
[(allopurinol therapy)64.8 (. Colchicine or NSAIDs? Med J )54.8 (Aust)]TJ
0 Tc 0 Tw 0 -1.2 TD
(1993;159:182-4.)Tj
-0.00011 Tc 0.02499 Tw -2.175 -1.2 Td
[(16.)-875.1 (Doornum S, R)39.7 (yan PF)79.7 (. Clinical manifestations of gout and their)]TJ
2.175 -1.2 Td
[(management. Med J )54.8 (Aust 2000;172:493-7.)]TJ
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[(17.)-875.1 (T)69.9 (erkeltaub R. Pathogenesis and treatment of crystal-induced )]TJ
2.175 -1.2 Td
[(inflammation. In: Koopman )17.7 (WJ, editor)54.8 (. )54.8 (Arthritis and allied )]TJ
T*
[(conditions. 14th ed. Philadelphia: Lippincott )17.7 (W)39.8 (illiams and )17.7 (W)39.8 (ilkins;)]TJ
0 Tc 0 Tw T*
(2001:2339-40.)Tj
-0.00011 Tc 0.02499 Tw -2.175 -1.2 Td
[(18.)-875.1 (W)79.9 (ortmann RL, Kelley )17.7 (WN. Gout and hyperuricemia. In: Ruddy S,)]TJ
2.175 -1.2 Td
[(Harris ED, Sledge CB, editors. Kelley\325)54.8 (s textbook of rheumatology)64.8 (.)]TJ
T*
[(6th ed. Phildadelphia: )17.7 (W)91.9 (.)-0.1 (B. Saunders; 2001:1367-8.)]TJ
-2.175 -1.2 Td
[(19.)-875.1 (Cohen MG, Emmerson BT)73.9 (. Gout. In: Klippel JH, Dieppe P)91.7 (A, )]TJ
2.175 -1.2 Td
[(editors. Rheumatology)64.8 (. London: Mosby\320Y)99.8 (ear Book Europe)]TJ
T*
(Limited; 1994:7.12.1-16.)Tj
-2.175 -1.2 Td
[(20.)-875.1 (Stuart RA, Gow PJ, Bellamy N, Campbell J, Grigor R. )54.8 (A)-220.1 (survey of)]TJ
2.175 -1.2 Td
(current prescribing practices of anti-inflammatory and )Tj
T*
[(urate-lowering drugs in gouty arthritis. NZ Med J 1991;104:1)36.8 (15-17.)]TJ
-2.175 -1.175 Td
[(21.)-875.1 (Bellamy N, Gilbert JR, Brooks PM, Emmerson BT)73.9 (, Campbell J. )54.8 (A)]TJ
2.175 -1.175 Td
(survey of current prescribing practices of anti-inflammatory and)Tj
0 -1.175 TD
(urate lowering drugs in gouty arthritis in the Province of Ontario. )Tj
T*
(J Rheumatol 1988;15:1841-7.)Tj
-2.175 -1.2 Td
[(22.)-875.1 (Bellamy N, Brooks PM, Emmerson BT)73.9 (, Gilbert JR, Campbell J,)]TJ
2.175 -1.2 Td
[(McCredie M. )54.8 (A)-220.1 (survey of current prescribing practices of )]TJ
0 -1.2 TD
(anti-inflammatory and urate-lowering drugs in gouty arthritis in)Tj
T*
[(New South )17.7 (W)79.9 (ales and Queensland. Med J )54.8 (Aust 1989;151:531-2,)]TJ
0 Tc 0 Tw T*
(535-7.)Tj
-0.00011 Tc 0.02499 Tw -2.175 -1.2 Td
[(23.)-875.1 (W)79.9 (allace SL, Singer JZ, Duncan GJ, )17.7 (W)39.9 (igley FM, Kuncl R)54.8 (W)91.8 (. Renal)]TJ
2.175 -1.2 Td
(function predicts colchicine toxicity: Guidelines for the )Tj
T*
(prophylactic use of colchicine in gout. J Rheumatol 1991;18:264-9.)Tj
-2.175 -1.2 Td
[(24.)-875.1 (Kuncl R)54.9 (W)91.8 (, Duncan G, )17.7 (W)79.9 (atson D, )54.8 (Alderson K, Rogawski MA,)]TJ
2.175 -1.2 Td
[(Peper M. Colchicine myopathy and neuropathy)64.8 (. N Engl J Med)]TJ
0 Tc 0 Tw T*
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-0.00011 Tc 0.02499 Tw -2.175 -1.25 Td
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2.175 -1.25 Td
(nontophaceous interval gout. J Rheumatol 1995;22:1618-20.)Tj
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