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Am Fam Physician. 1999;60(9):2504-2507

to the editor: I would like to offer a few comments on the article by Pittman and Bross1 on the diagnosis and management of gout.

It is nice to see that the authors recommend intravenous colchicine for the relief of podagra. The use of this agent represents one of those “dramatic” moments in clinical medicine. The patient hobbles into the examining room in acute pain and walks out just minutes later with almost total relief.

This dramatic relief of pain after administration of colchicine is also an important diagnostic clue in gout—and the thought of injecting an acutely inflamed joint to aspirate diagnostic synovial fluid to look for urate crystals . . . well, just the thought gives one real pause.

Intravenous colchicine is not only helpful therapeutically, it is also helpful diagnostically.

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