From the Guidelines
For a 63-year-old male with acute gout flare and underlying osteoarthritis of the right knee, you can prescribe meloxicam 15 mg once daily along with a short course of oral prednisone at 30-35 mg daily for 3-5 days, as recommended by the American College of Physicians 1. These medications can be used concurrently with the colchicine he's already taking. Meloxicam helps manage both the gout inflammation and osteoarthritis pain, while the short-course steroid provides faster relief for the acute gout flare. Some key points to consider when prescribing these medications include:
- Monitoring for gastrointestinal side effects, particularly since he's taking multiple anti-inflammatory medications
- Ensuring the patient stays well-hydrated and temporarily avoids high-purine foods
- Considering dose adjustments if he has any history of peptic ulcer disease, renal impairment, or heart failure
- The choice of drug(s) should be based on the presence of contraindications, the patient’s previous experience with treatments, time of initiation after flare onset and the number and type of joint(s) involved, as recommended by the EULAR evidence-based recommendations for the management of gout 1 After the acute flare resolves, consider long-term urate-lowering therapy such as allopurinol to prevent future attacks, especially since he has both gout and osteoarthritis affecting the same joint, which can accelerate joint damage if not properly managed. It is also important to advise the patient on lifestyle modifications, including weight loss if appropriate, avoidance of alcohol and sugar-sweetened drinks, and encouragement of low-fat dairy products and regular exercise, as recommended by the EULAR guidelines 1.
From the Research
Gout Management
- The patient's condition is consistent with gout, characterized by swelling, pain, or tenderness in a peripheral joint or bursa, as described in the study 2.
- The patient's history of consuming foods high in risk for gout, such as meat and seafood, is a contributing factor to the development of gout, as mentioned in the study 2.
- The patient is currently taking colchicine, which is a common treatment for acute gout episodes, as stated in the study 2.
Use of Meloxicam and Steroids
- Meloxicam, a nonsteroidal anti-inflammatory drug (NSAID), can be used to relieve pain in adults with acute gout episodes, as mentioned in the study 2.
- The study 3 evaluated the use of meloxicam in combination with allopurinol-lowering therapy in patients with gout and found that it prevented the exacerbation of the articular syndrome and improved the quality of life of patients with gout.
- Steroids, such as corticosteroids, can also be used to relieve pain in adults with acute gout episodes, as stated in the study 2.
- The dose of steroids and meloxicam would depend on the patient's specific condition and medical history, but the study 3 used a total daily dose of meloxicam of 7.5 mg.
Considerations
- The patient's osteoarthritis (OA) of the right knee, as shown in the X-rays, should be considered when managing the patient's gout, as OA can contribute to the patient's overall pain and discomfort.
- The patient's use of colchicine and potential use of meloxicam and steroids should be monitored for any adverse events, such as gastrointestinal issues or increased risk of gout, as mentioned in the study 4.