From the Guidelines
To treat acute gout pain, clinicians should choose corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine as first-line treatment, as recommended by the American College of Physicians 1. The treatment of acute gout pain involves a combination of medication and non-drug approaches.
- Medication options include:
- NSAIDs like naproxen (500mg twice daily) or indomethacin (50mg three times daily) for 3-5 days
- Colchicine (1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily until pain resolves) as an alternative to NSAIDs
- Oral prednisone (30-40mg daily for 3-5 days, then tapered over 7-10 days) for severe cases or when other medications are contraindicated
- Non-drug approaches include:
- Resting the affected joint
- Applying ice for 20 minutes several times daily
- Elevating the area to reduce swelling
- Staying well-hydrated
- Avoiding alcohol and purine-rich foods like red meat and seafood during an attack These medications work by reducing inflammation—NSAIDs block inflammatory prostaglandins, colchicine prevents neutrophil activity in joints, and corticosteroids suppress multiple inflammatory pathways 1. It is essential to contact a healthcare provider if pain worsens or doesn't improve within 48 hours of treatment, as dosage adjustments or alternative treatments may be needed.
From the FDA Drug Label
Indomethacin capsules have been found effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis
- Treatment of acute gout pain: Indomethacin is effective in relieving the pain of acute gouty arthritis 2.
- Key points:
- Indomethacin is a non-steroidal anti-inflammatory drug (NSAID) that exhibits antipyretic and analgesic properties.
- It is a potent inhibitor of prostaglandin synthesis, which may contribute to its therapeutic effect in acute gouty arthritis.
- Note: Allopurinol is not typically used for the treatment of acute gout pain, but rather for the prevention of gout attacks and the reduction of serum uric acid levels 3.
From the Research
Treatment Options for Acute Gout Pain
- The primary goal of treating acute gout is to reduce pain and inflammation, with various pharmacotherapies available, including colchicine, NSAIDs, and oral or intramuscular corticosteroids 4, 5, 6.
- Colchicine is a commonly used treatment for acute gout, with low-dose colchicine demonstrating a comparable tolerability profile to placebo and a significantly lower side effect profile compared to high-dose colchicine 7.
- NSAIDs and COX-2 inhibitors are also effective agents for the treatment of acute gout attacks, with systemic corticosteroids showing similar efficacy to therapeutic doses of NSAIDs 6.
- IL-1 inhibitors, such as canakinumab, have been shown to be effective for the treatment of acute gout attacks in subjects refractory to and in those with contraindications to NSAIDs and/or colchicine 6.
Pharmacologic Treatments
- Colchicine: low-dose colchicine may improve treatment outcome compared to placebo with little or no increased risk of adverse events 7.
- NSAIDs: effective agents for the treatment of acute gout attacks, with similar efficacy to systemic corticosteroids 6.
- Corticosteroids: oral and intramuscular use have been shown to be effective in treating acute gout 6.
- IL-1 inhibitors: canakinumab has been shown to be effective for the treatment of acute gout attacks in subjects refractory to and in those with contraindications to NSAIDs and/or colchicine 6.
Non-Pharmacologic Treatments
- Ice: topical ice has been suggested as a potential treatment for acute gout, although more research is needed to confirm its effectiveness 6.
- Herbal supplements: some herbal supplements, such as Chuanhu anti-gout mixture, have been studied as potential treatments for acute gout, although more research is needed to confirm their effectiveness 7.
Treatment Guidelines
- The American College of Rheumatology and other major international societies have published guidelines for the treatment of acute gout, including recommendations for pharmacologic and non-pharmacologic treatments 4, 5.
- Treatment should be individualized based on patient factors, such as comorbidities and patient preference 4, 5.