From the Guidelines
The treatment of acute gout involves prompt management with anti-inflammatory medications, with corticosteroids, NSAIDs, or colchicine being the first-line options, as recommended by the American College of Physicians 1. The choice of medication depends on the patient's comorbidities and the presence of contraindications.
- NSAIDs, such as naproxen 500mg twice daily or indomethacin 50mg three times daily, are effective options but should be avoided in patients with renal impairment or peptic ulcer disease.
- Colchicine, at a dose of 1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily, is also effective but should be used with caution in patients with severe kidney or liver disease.
- Corticosteroids, such as prednisone 30-40mg daily, are effective and can be used in patients without contraindications, but should be used cautiously in diabetics. Additionally, lifestyle modifications, such as weight loss, avoidance of alcohol and sugar-sweetened drinks, and regular exercise, can help reduce the risk of gout attacks, as recommended by the European League Against Rheumatism (EULAR) 1. It is essential to individualize treatment based on patient-specific factors, such as comorbidities, medication tolerance, and personal preferences, to optimize outcomes and minimize adverse effects.
From the FDA Drug Label
The dosage of allopurinol tablets to accomplish full control of gout and to lower serum uric acid to normal or near-normal levels varies with the severity of the disease. Indomethacin capsules have been found effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis
Treatment of Acute Gout:
- Allopurinol is not typically used for the treatment of acute gout attacks, but rather for the prevention of future attacks and the reduction of serum uric acid levels.
- Indomethacin is effective in relieving the pain and reducing the inflammation of acute gouty arthritis. The recommended dosage of indomethacin for acute gout is not specified in the provided drug label, but it is typically administered in a dose of 50 mg three times a day until the symptoms resolve 2. It is essential to note that the treatment of acute gout should be individualized, and the choice of medication depends on the patient's specific needs and medical history.
From the Research
Treatment Options for Acute Gout
- The primary treatment options for acute gout include nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids 3, 4, 5, 6, 7
- IL-1 inhibitors, such as canakinumab, are also effective for treating acute gout flares, particularly in patients who are refractory to standard therapies 3, 4, 7
- NSAIDs, including COX-2 inhibitors, are commonly used to treat acute gout and have been shown to be effective in reducing pain and inflammation 4, 6
- Corticosteroids, including oral and intramuscular formulations, are also effective in treating acute gout and can be used in patients who are unable to tolerate NSAIDs 4, 5, 6
Urate-Lowering Therapies
- Urate-lowering therapies, such as allopurinol and febuxostat, are used to prevent gout flares and reduce serum uric acid levels 3, 5, 7
- These therapies are typically initiated after the resolution of an acute gout flare and are continued long-term to prevent future flares 3, 5
- Novel uricosurics, such as verinurad and arhalofenate, are being developed as potential treatments for gout 7
Emerging Therapies
- Emerging therapies, such as pegloticase, are available for patients with recalcitrant gout 7
- These therapies may offer new treatment options for patients who are refractory to standard therapies, but may also have potential risks and side effects 7