What is the treatment for gouty arthritis?

From the Guidelines

Gout arthritis treatment should prioritize a combination of immediate pain relief and long-term management, with a focus on urate-lowering therapy and lifestyle changes to prevent future attacks and improve quality of life. For acute gout attacks, the most effective treatment options include NSAIDs like naproxen (500mg twice daily) or indomethacin (50mg three times daily) for 3-5 days, colchicine (1.2mg followed by 0.6mg one hour later, then 0.6mg once or twice daily), and corticosteroids like prednisone (30-40mg daily, tapered over 7-10 days) for those who cannot take NSAIDs 1.

Some key points to consider in the management of gout include:

• The use of colchicine, NSAIDs, or corticosteroids for acute gout attacks, with the choice of treatment depending on the individual patient's needs and medical history 1
• The importance of lifestyle changes, such as maintaining a healthy weight, limiting alcohol consumption, avoiding high-purine foods, and staying hydrated, to prevent future gout attacks 1
• The use of urate-lowering therapy, such as allopurinol or febuxostat, to prevent future gout attacks and improve quality of life, with a target serum uric acid level of less than 6mg/dL 1
• The need for regular monitoring of uric acid levels and adjustment of medication dosages as needed to achieve optimal control of gout symptoms 1

In terms of specific medication regimens, allopurinol is recommended as the first-line urate-lowering therapy, with a starting dose of 100mg daily and gradual increase to 300-600mg as needed and tolerated 1. Febuxostat is also an option for patients who cannot tolerate allopurinol, with a starting dose of 40mg daily and gradual increase to 80mg as needed and tolerated 1. Colchicine (0.6mg daily) can be used to prevent flares during the initial months of urate-lowering therapy 1.

It is essential to consult a healthcare provider before starting any medication regimen, as dosages may need adjustment based on kidney function and other individual factors 1. By prioritizing a combination of immediate pain relief and long-term management, patients with gout can effectively manage their symptoms and improve their quality of life.

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 Probenecid tablets are indicated for the treatment of the hyperuricemia associated with gout and gouty arthritis. Colchicine is used for prophylaxis and treatment of gout flares

Treatment Options for Gout Arthritis:

• Indomethacin: can be used to relieve pain, reduce fever, swelling, redness, and tenderness of acute gouty arthritis 2
• Probenecid: can be used to treat hyperuricemia associated with gout and gouty arthritis 3
• Colchicine: can be used for prophylaxis and treatment of gout flares 4

From the Research

Treatment Options for Gout Arthritis

• Gout is a common form of acute inflammatory arthritis caused by the deposition of monosodium urate crystals within the synovium of joints, leading to severe pain and reduced quality of life for patients 5.
• Standard pharmacotherapies for gout flares include colchicine, NSAIDs, and oral or intramuscular corticosteroids, with IL-1 inhibitors as an option for flare refractory to standard therapies 5, 6.

Urate-Lowering Therapies

• Urate-lowering therapies aim to prevent gout flares, with an emphasis on a treat-to-target strategy, escalating therapies until the target serum uric acid is reached 5, 7.
• Initial treatments include allopurinol and febuxostat, with uricosuric agents such as probenecid, sulfinpyrazone, and benzbromarone as adjuncts 5, 6, 7.

Emerging Therapies and Personalization of Treatment

• There are emerging therapies in development, including novel uricosurics such as verinurad and arhalofenate, and pegloticase for patients with recalcitrant gout 6, 7.
• Treatment is increasingly personalized, adjusting pharmacotherapy depending on comorbidities such as chronic kidney disease and ischemic heart disease, as well as patient preference 5, 8.

Safety Concerns and Comparative Efficacy of Treatments

• Clinicians should be aware of safety concerns of medications used to treat acute and chronic gout, particularly in patients with comorbidities and those taking multiple drugs 8.
• Low-dose colchicine (0.6 mg/day) has been shown to be as effective as regular-dose colchicine (1.2 mg/day) in preventing gout flares, with fewer adverse events 9.