From the Guidelines
The best treatment for a gout attack is to start with an anti-inflammatory medication as soon as symptoms begin, with corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine being effective options. For most people, NSAIDs like naproxen (500mg twice daily) or indomethacin (50mg three times daily) are effective first-line treatments 1. Colchicine is another excellent option, typically taken as 1.2mg immediately, followed by 0.6mg one hour later, then 0.6mg once or twice daily until the attack resolves, as recommended by the American College of Physicians 1. For those who cannot take NSAIDs or colchicine, corticosteroids like prednisone (30-40mg daily, tapered over 7-10 days) can provide relief 1. During an attack, rest the affected joint, apply ice for 20-30 minutes several times daily, and drink plenty of water (at least 8-10 glasses daily). Avoid alcohol and purine-rich foods like red meat, seafood, and organ meats which can worsen symptoms.
Some key points to consider when treating a gout attack include:
- The choice of drug should be based on the presence of contraindications, the patient’s previous experience with treatments, time of initiation after flare onset, and the number and type of joint(s) involved 1
- Colchicine and NSAIDs should be avoided in patients with severe renal impairment, and colchicine should not be given to patients receiving strong P-glycoprotein and/or CYP3A4 inhibitors 1
- Prophylaxis against flares should be fully explained and discussed with the patient, and recommended prophylactic treatment is colchicine, 0.5–1 mg/day, a dose that should be reduced in patients with renal impairment 1
It's also important to note that lifestyle modifications can help reduce the risk of gout attacks, including:
- Weight loss if appropriate
- Avoidance of alcohol (especially beer and spirits) and sugar-sweetened drinks
- Avoidance of heavy meals and excessive intake of meat and seafood
- Encouragement of low-fat dairy products
- Regular exercise
These medications and lifestyle modifications work by reducing inflammation caused by urate crystal deposits in the joints, and most acute gout attacks will improve within 3-10 days with proper treatment. If attacks occur frequently, preventive medication like allopurinol may be needed to lower uric acid levels long-term, but this should not be started during an acute attack 1.
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 The best treatment for a gout attack is indomethacin 2, as it has been found to be effective in relieving the symptoms of acute gouty arthritis.
- Key benefits of indomethacin for gout attack treatment include:
- Relief of pain
- Reduction of fever
- Reduction of swelling, redness, and tenderness It is essential to follow the recommended dosage and administration instructions to ensure safe and effective treatment.
From the Research
Treatment Options for Gout Attack
- The 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 3, 4, 5, 6, 7
- Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and colchicine are considered first-line agents for treating acute gouty arthritis 4, 5, 6, 7
- IL-1β antagonists are highly effective for arresting flares but are considered salvage therapies due to their cost-effectiveness 6
- Glucocorticoids, NSAIDs, low-dose colchicine, and canakinumab are all effective treatments for acute gout, but there is insufficient evidence to rank them 7
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 3
- Initial treatments include allopurinol and febuxostat, with uricosuric agents, such as probenecid, sulfinpyrazone, and benzbromarone, as adjuncts 3, 4, 5, 6
- Allopurinol is an agent of first choice for urate-lowering therapy, but screening for HLA*B58:01 mutation is recommended in certain populations to decrease the occurrence of allopurinol hypersensitivity syndrome 6
- Febuxostat is another efficacious urate-lowering therapy, but it has received a U.S. FDA black box warning for cardiovascular safety 6