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chronic process and could therefore occur during either a haz- ard or control period.

In summary, we found that recent use of thiazide and pos- sibly loop diuretics was associated with a significantly increased risk for recurrent gouty arthritis. Despite the well known association of gout and diuretics, a relatively large pro- portion of our patient population with preexisting gout was prescribed this class of antihypertensive therapy. Given the wide availability of alternative effective agents for the treat- ment of hypertension and congestive heart failure, clinicians have ample ability to individualize management for this pop- ulation, and could reduce risk of recurrent gout attacks by avoiding the use of thiazide and possibly loop diuretics in per- sons with preexisting gout.


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