From the Guidelines
First-Line Treatment for Acute Gout
For the first-line treatment of acute gout, corticosteroids are recommended as the initial therapy in patients without contraindications due to their safety profile and cost-effectiveness 1. Specifically, options include:
- Prednisolone at a dose of 35 mg for 5 days, which has been shown to be effective in treating acute gout 1.
- Alternatively, NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) such as indomethacin 50 mg orally every 8 hours, naproxen 500 mg orally twice daily, or diclofenac 50 mg orally every 8 hours can be used 1.
- Colchicine 1.2 mg orally at the first sign of a gout attack, followed by 0.6 mg orally every hour until relief is obtained or gastrointestinal side effects occur, is also an option 1.
Key Considerations
- The choice of treatment should be based on the presence of contraindications, the patient's previous experience with treatments, and the number and type of joints involved 1.
- Corticosteroids are generally safer and have fewer adverse effects compared to NSAIDs, but may have contraindications such as systemic fungal infections or known contraindications 1.
- Colchicine is contraindicated in patients with renal or hepatic impairment who are using potent cytochrome P450 3A4 inhibitors or P-glycoprotein inhibitors 1.
Treatment Options
- NSAIDs: indomethacin, naproxen, diclofenac
- Corticosteroids: prednisolone
- Colchicine: 1.2 mg orally at the first sign of a gout attack, followed by 0.6 mg orally every hour until relief is obtained or gastrointestinal side effects occur
It is essential to consider the individual patient's needs and medical history when selecting a treatment option for acute gout, and to discuss the benefits, harms, and costs of each treatment with the patient 1.
From the FDA Drug Label
The recommended dose of Colchicine Tablets, USP for treatment of a gout flare is 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later. The first-line treatment for Acute Gout is not explicitly stated in the provided drug labels as the first line of treatment. Colchicine is indicated for the treatment of acute gout flares, but it is not clear if it is the first-line treatment. The FDA drug label does not answer the question.
From the Research
First-Line Treatment for Acute Gout
The first-line treatment for acute gout includes:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 2, 3, 4, 5, 6
- Colchicine 2, 3, 6
- Corticosteroids 2, 3, 4, 5, 6
Considerations for Treatment
When selecting a treatment, considerations should include:
- Patient comorbidities, such as renal insufficiency or gastrointestinal bleeding 2, 3, 4, 5, 6
- Potential adverse effects of NSAIDs, colchicine, and corticosteroids 2, 3, 4, 5, 6
- Efficacy and safety profiles of different treatment options 3, 4
Comparison of Treatment Options
Studies have compared the efficacy and safety of different treatment options, including:
- NSAIDs vs. corticosteroids: no significant difference in efficacy, but corticosteroids may have a more favorable safety profile 4
- Colchicine vs. NSAIDs: colchicine may be effective, but has a higher risk of adverse effects 2, 3
- ACTH: may be effective, but has limitations due to multiple doses and high cost 3, 5