Treatment of Associated Morbid Conditions
When dealing with the clinical account, it was pointed out that acute gout is frequently complicated by symptoms pointing to involvement of the fibrous tissues in muscles and nerve sheaths; moreover, that both during acute attacks and alike in the inter-paroxysmal periods gouty subjects are prone to two special varieties of fibrositis, viz., lumbago and sciatica. I may add, too, that in these individuals it is not uncommon for them to suffer with these local varieties of fibrositis from time to time prior to the advent of regular or articular gout.
Fibrositis.—As Bassett Jones and I in our work on fibrositis have dealt exhaustively with the treatment of its various forms, our remarks here must necessarily be devoted largely to the general principles of therapy, and for further details we would refer the reader to our treatise on the subject.
Whatever the type of fibrositis we are confronted with, the therapeutic indications are precisely similar to those advocated for articular gout. In other words, the indispensable preliminary measures are to control the production, absorption, and elimination of toxins. To this end, we must secure adequate evacuation of the bowels, free action of the skin, and diuresis. These ends will the more surely be attained if at the onset a temporary fast be enjoined, or a suitable dietary with copious drinking of bland, unirritating fluid. The general malaise and pyrexia indicate clearly that these cases of acute fibrositis must be treated in accordance with the general rules applicable to the febrile state.
Acute Lumbago.—Brisk purgatives are here our most efficient allies, for there is usually marked functional derangement, with high-coloured urine and dark, offensive fæces. In such cases it is well to give 3-4 grains of calomel at night, followed in the morning by a saline purge, and the same often has to be repeated once or twice during the acute stage. Also the following prescription, preferably rendered effervescent by adding a few grains of citric acid to each dose, may swiftly abate the intensity of the suffering:—
| ℞ | Pot. bicarb. | gr. 15 |
| Pot. nitrat. | gr. 10 | |
| Vin. colchici | ♏︎ 10-15 | |
| Aquæ ad unciam, quartis horis sumenda. | ||
Or, as in acute gout, we may give an initial large dose of 30-40 minims of colchicum wine, with subsequent attenuation of the same. It is in cases with scanty, high-coloured urine and costive bowels that colchicum succeeds best. On the other hand, in some cases of acute lumbago the urine is copious and light-coloured, and the bowels regular, and the fæces normal in appearance. Here the value of the initial purge is not so apparent, and a mixture containing salicylates and alkalies will be more likely to give relief, aided, if necessary, by nightly doses of Dover’s powder, followed by a morning draught of some aperient.
Where the case shows some disposition to linger on in a sub-acute form, and the urine still remains charged with lithates, a mixture of citrate or nitrate of potash, spirits of nitrous ether, and infusion of buchu should be given thrice daily. Sometimes, too, in broken-down subjects with sluggish circulation, we have found the addition of a few minims of tincture of digitalis most helpful in clearing up the condition.
Next to lumbago, pleurodynia is the most common muscular type of fibrositis to be met with in the trunk. I have seen its subsidence prove the signal for an outbreak of acute articular gout in the great toe. This significant sequence indicates the necessity of being alive to the possibility of a gouty basis in such cases and the advisability of combining colchicum with our remedies.
Sciatica.—This almost invariably is the outcome of a preceding attack of lumbago, of which, indeed, it is but an extension. If seen sufficiently early, and certainly when there are febrile symptoms, a mercurial purge, followed by an alkaline and diuretic mixture in combination with colchicum or salicylate of soda, should be resorted to vigorously, so as to abort, if possible, the attack.