Five cases of gouty arthritis encountered in the clinic of Branch Hospital of Okayama University at Misasa Spa are described. Case 1: Y.I., a man aged 58, was first seen on April 24, 1961. His first symptoms had occurred 10 years previously, when he was awakened by severe pain in the left instep. The attack resolved within a few days, but since that time he had 2 or 3 attacks of acute arthritis each year, at first restricted to the dorsum of his left foot, near the base of the big toe, but later involving the ankles and the knees. These attacks usually lasted about a week, but recently such attacks had become more frequent and tended to last longer. In early January, 1961, he noticed pain and swelling of the fingers and consulted this clinic for the purpose of obtaining balneotherapy. A tophaceous mass the size of walnut was presnt on the left olecranon. Nine determinations of the blood uric-acid level were made, ranging from 8.1 to 10.1 mg. per 100 ml. The serum cholesterol level was 279 mg. per 100 ml. Treatment combining the use of phenylbutazone and balneothenapy was effective. Case 2: J.K., a man aged 80, was first seen on July 25, 1961. For 4 years he had been subject to attacks of acute arthritis affecting the fingers and toes. On July 16, he had sudden severe pain in the instep of the left foot. His son had probable gout. The metatarso-phalangeal joint of the left big toe was swollen and painful. The blood uric-acid level was 10.1 mg. per 100 ml. Treatment combined the use of phenylbutazone, dietary regulation, and the drinking of radioactive spring water. In Oct. 1961, he wrote saying that he had remained free from symptoms of gout and had no further treatment. Case 3: I.M., a man aged 52, was first seen on January 24, 1962. His symptoms began in 1935 (at the age of 25), when he had sudden severe pain in his right big toe, which rapidly became swollen and red. The pain lasted about a month. After this, he had at least one similar attack of joint pain in each of the next 10 years. In 1945, he noticed a pain in the dorsum of his right foot. The attacks have tended to last longer and to involve multiple joints, most recently the knees and hands being also affected. He was treated for rheumatoid arthritis and hypercholesterolemia. About the middle of January, 1962, the swelling which had first appeared on his right foot in 1935 became very painful and was accompanied
by fever (38.°5～39.℃.). There was no family history of gout. The metatarso-phalangeal joint of the right big toe was swollen and painful, and the right knee was swollen. Determinations of the blood uric-acid level ranged from 5.5 to 12.0 mg. per 100 ml. The serum cholesterol level was 196 mg. per 100 ml. Therapy with phenylbutazone was started on January 24, 1962, in a total daily dose of 200 mg. and by the middle of Feburary, symptoms had disappeared. He discontinued use of the medication, whereupon a recurrent attack appeared. For the first few days he was given phenylbutazone, 400 mg. daily. This dosage was later reduced to 300 mg. daily, and benemid was added. Case 4: Y.U., a man aged 57, was first seen on Feburary 12, 1962. For 8 years he had been subject to attacks of acute arthritis affecting both insteps. Swelling and limited movement were present in the big toes. He had aural tophi. The blood uric-acid level was 8.2 mg. per 100 ml. Case 5: B.A., a man aged 67, was first seen on April 10, 1962. His first relevant symptoms had occurred 3 years previously, when he developed sudden pain and swelling in his right big toe. The pain lasted about 5 days. Since then he had had similar attacks at the rate of five a year. In March, 1962, he had an attack of joint pain in the right ankle lasting 5 days. The blood uric-acid levels ranged from 5.0 to 9.3 mg. per 100 ml. Administration of phenylbutazone, 200 mg. daily, and balneotherapy relieved the symptoms of gouty arthritis. The Use of balneotherapy in the treatment of chronic gouty arthritis will be discussed in a second paper by the present authors in the next volume of this series.