From the Research
NSAIDs are a first-line treatment option for acute gout flares, with indomethacin, naproxen, and ibuprofen being commonly prescribed options. The most effective dosing regimens include indomethacin at 50mg three times daily for 3-5 days, then tapered over 7-10 days as symptoms improve 1. Naproxen is another effective option at 500mg twice daily for 3-5 days, followed by 250mg twice daily until the flare resolves 1. Ibuprofen can be used at 800mg three times daily for 7-10 days 1.
For maximum effectiveness, NSAIDs should be started at the first sign of a gout attack and continued until symptoms fully resolve. These medications work by inhibiting prostaglandin synthesis, reducing inflammation and pain associated with gout. Patients should take NSAIDs with food to minimize gastrointestinal side effects. Some key points to consider when prescribing NSAIDs for gout include:
- NSAIDs should be used cautiously in patients with kidney disease, heart failure, hypertension, or history of gastrointestinal bleeding 2.
- For patients with these conditions, colchicine or corticosteroids may be safer alternatives 2, 1.
- Adequate hydration is important during treatment, and patients should avoid alcohol and purine-rich foods during acute flares.
- Recent guidelines, such as those from the American College of Physicians, the European League Against Rheumatism, and the American College of Rheumatology, provide clear guidance on the optimal integration of therapeutic options into practice to improve the medical management of gout 3.