From the Guidelines
Gout is a type of arthritis characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in one or more joints, often occurring at the base of the big toe.
Diagnosis of Gout
To diagnose gout, it is recommended to use synovial fluid analysis when clinical judgment indicates that diagnostic testing is necessary in patients with possible acute gout 1.
Treatment of Gout
To manage gout, it is recommended to start with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 800mg every 8 hours or indomethacin 50mg every 8 hours for 3-5 days to reduce pain and inflammation 1.
- For patients who cannot tolerate NSAIDs, colchicine 1.2mg at the first sign of a gout attack, followed by 0.6mg every hour until relief is obtained or gastrointestinal side effects occur, can be used 1.
- In addition to these medications, it is essential to stay hydrated by drinking plenty of water, avoid alcohol and foods high in purines, and consider taking uric acid-lowering therapy such as allopurinol 100-300mg daily or febuxostat 40-80mg daily for long-term management and prevention of future gout attacks 1.
Long-term Management
It is crucial to consult a healthcare provider for proper diagnosis and treatment, as they can provide personalized guidance and adjust the treatment plan as needed. The treatment target is serum urate below 0.36 mmol/L (6 mg/dL), and the eventual absence of gout attacks and resolution of tophi 1.
- Allopurinol is recommended as first-line urate-lowering therapy and its dosage should be adjusted according to renal function 1.
- If the serum uric acid target cannot be achieved with allopurinol, then febuxostat, a uricosuric or combining a xanthine oxidase inhibitor with a uricosuric should be considered 1.
- For patients with refractory gout, pegloticase is recommended 1.
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
- Diagnosis of Gout: The provided drug labels do not directly address the diagnosis of gout.
- Treatment of Gout:
- Colchicine: The recommended dose for the treatment of gout flares is 0.6 mg (1 tablet) × 1 dose, followed by 0.3 mg (1/2 tablet) 1 hour later. Dose to be repeated no earlier than 3 days.
- Indomethacin: Indomethacin capsules have been found effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis.
- Key Considerations:
From the Research
Diagnosis of Gout
- The diagnosis of gout can be confirmed if monosodium urate crystals are present in synovial fluid 4
- A presumptive diagnosis of gout can be made clinically based on the presence of hyperuricemia, rapid development of pain, tenderness, and swelling in a single toe (male) or elbow or finger joint (female), and family history 5
- Diagnosis of gout can be made using several validated clinical prediction rules 6
- Arthrocentesis should be performed when suspicion for an underlying septic joint is present; synovial fluid or tophus analysis should be performed if the diagnosis is uncertain 6
Treatment of Acute Gout
- First-line therapy for acute gout is nonsteroidal anti-inflammatory drugs or corticosteroids, depending on comorbidities; colchicine is second-line therapy 4
- Colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids relieve pain in adults with acute gout episodes 6
- The drugs of first choice for acute gouty arthritis are nonsteroidal antiinflammatory drugs (NSAID), corticosteroids, and colchicine 7
Treatment of Chronic Gout
- Urate-lowering therapy for gout is initiated after multiple attacks or after the development of tophi or urate nephrolithiasis 4
- Allopurinol is the most common therapy for chronic gout 4
- Indications for long-term urate-lowering therapy include chronic kidney disease, two or more flare-ups per year, urolithiasis, the presence of tophus, chronic gouty arthritis, and joint damage 6
- Allopurinol and febuxostat are used to prevent flare-ups, although febuxostat is associated with an increase in all-cause and cardiovascular mortality and is therefore not routinely recommended 6
- Treatment with xanthine oxidase inhibitors (XOI) or uricosuric drugs is indicated for patients with a recurrent or severe course; the target uric acid value is <6 mg/dL 7
- Lesinurad (approved in February 2016) in combination with XOI is a new treatment option that can be considered for patients with refractory gout 7
Lifestyle Modifications
- A healthy lifestyle is always recommended and patient education is critical to support self-management and long-term adherence 5
- Modifiable risk factors (e.g., high-purine diet, alcohol use, obesity, diuretic therapy) should be addressed after the first gout attack 4
- Comprehensive patient education and counseling is an important component of the treatment of patients with gout 7