From the Guidelines
Acute gouty arthritis should be treated promptly with anti-inflammatory medications, such as NSAIDs, colchicine, or oral corticosteroids, to reduce pain and swelling, as recommended by the 2012 American College of Rheumatology guidelines 1. The treatment of acute gouty arthritis aims to reduce inflammation, pain, and swelling, and improve quality of life.
Treatment Options
- NSAIDs, such as indomethacin (50mg three times daily), naproxen (500mg twice daily), or ibuprofen (800mg three times daily) for 7-10 days, are effective first-line treatment options 1.
- Colchicine is another effective option, given as 1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily until symptoms resolve 1.
- For patients who cannot take NSAIDs or colchicine, oral corticosteroids like prednisone (30-40mg daily, tapered over 7-10 days) or intra-articular corticosteroid injections may be used 1.
Combination Therapy
- Initial combination therapy is an appropriate option for an acute, severe gout attack, particularly with involvement of multiple large joints or polyarticular arthritis, and may include the simultaneous use of colchicine and NSAIDs, oral corticosteroids and colchicine, or intra-articular steroids with all other modalities 1.
- For patients not responding adequately to initial pharmacologic monotherapy, adding a second appropriate agent is an acceptable option 1.
Additional Measures
- During an acute attack, patients should rest the affected joint, apply ice for 20 minutes several times daily, and maintain adequate hydration.
- Urate-lowering therapy should not be initiated during an acute attack but can be continued if already established. These treatments work by reducing inflammation caused by urate crystal deposition in joints, which triggers the inflammatory cascade responsible for the intense pain, redness, and swelling characteristic of gout attacks. The affected joint should begin to improve within 24-48 hours of starting appropriate treatment.
From the FDA Drug Label
In patients with acute gout, a favorable response to naproxen was shown by significant clearing of inflammatory changes (e.g., decrease in swelling, heat) within 24 to 48 hours, as well as by relief of pain and tenderness. Indomethacin capsules have been found effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis PredniSONE Tablets are indicated for the treatment of acute gouty arthritis as adjunctive therapy for short-term administration.
Treatment of Acute Gouty Arthritis:
- Naproxen can be used to treat acute gouty arthritis, with significant clearing of inflammatory changes and relief of pain and tenderness within 24 to 48 hours 2.
- Indomethacin is also effective in relieving the pain and reducing the fever, swelling, redness, and tenderness of acute gouty arthritis 3.
- Prednisone can be used as adjunctive therapy for short-term administration to treat acute gouty arthritis 4.
From the Research
Treatment Options for Acute Gouty Arthritis
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective agents for the treatment of acute gout attacks 5, 6
- Colchicine is also effective, with low-dose colchicine demonstrating a comparable tolerability profile as placebo and a significantly lower side effect profile to high-dose colchicine 5, 6
- Corticosteroids have similar efficacy to therapeutic doses of NSAIDs, with studies supporting oral and intramuscular use 6
- Adrenocorticotropic hormone (ACTH) is suggested to be efficacious in acute gout 6
- Interleukin-1 (IL-1) inhibitors, such as canakinumab, are effective for the treatment of acute attacks in subjects refractory to and in those with contraindications to NSAIDs and/or colchicine 6, 7
Combination Therapy
- Combination of two agents, such as NSAIDs and colchicine, or corticosteroids and colchicine, may be used to treat acute gouty arthritis 5, 8
- Chronic anti-inflammatory therapy should be added to chronic urate-lowering therapy (ULT) to reduce the risk of acute gouty arthritis flares 9
Prophylaxis
- Prophylaxis with colchicine, NSAIDs, or corticosteroids is universally recommended when initiating any urate-lowering therapy in order to prevent acute gouty arthritis for a period of at least 6 months 5, 9
- IL-1β inhibitors, such as rilonacept and canakinumab, may be used as alternative prophylaxis agents in patients with contraindications to NSAIDs and/or colchicine 9, 7