On several occasions when my patient’s podagra has been unresponsive to colchicine and indomethacin, I have had remarkable results with ultrasound to the big toe. What do your experts think?
—Stanley Miller, MD, Goodyear, Ariz.

I am not aware that others have utilized this therapy, but its success is surprising since mechanical disruption of gouty tophi typically causes gouty flares. Most rheumatologists turn to steroids—oral, IM, or intra-articular—for nonsteroidal anti-inflammatory drug or colchicine failure. Many patients forget to add ice, rest, and elevation to their regimen, which prolongs their course.
—Jack Waxman, MD (107-1)

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