From the Guidelines
Management of a gout flare involves treating the acute symptoms and preventing future flares. The most effective treatment options for acute gout flares are colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), or glucocorticoids (oral, intraarticular, or intramuscular) 1.
Treatment Options
- Colchicine: should be started within 12 hours of flare onset, with a loading dose of 1 mg followed by 0.5 mg on day 1 1
- NSAIDs: should be used with proton pump inhibitors if appropriate, and avoided in patients with severe renal impairment 1
- Glucocorticoids: can be used orally or intraarticularly, with a dose of 30-35 mg/day of equivalent prednisolone for 3-5 days 1
Prevention of Future Flares
- Urate-lowering therapy (ULT): should be considered for all patients with recurrent gout flares, and started at a low dose with titration upwards until the serum uric acid (SUA) target is reached 1
- Prophylaxis against flares: should be fully explained and discussed with the patient, and recommended during the first 6 months of ULT, with colchicine 0.5-1 mg/day or NSAIDs at low dosage if not contraindicated 1
Lifestyle Modifications
- Weight loss: if appropriate, and avoidance of alcohol (especially beer and spirits) and sugar-sweetened drinks, heavy meals and excessive intake of meat and seafood 1
- Regular exercise: and low-fat dairy products should be encouraged, while consumption of coffee and cherries may be beneficial in reducing the frequency of acute gout 1
From the Research
Management of Gout Flare
The management of a gout flare involves several treatment options, including:
- Colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), or glucocorticoids (oral, intraarticular, or intramuscular) as first-line agents for gout flare management 2, 3, 4
- Interleukin-1 inhibitors as an option for flare refractory to standard therapies 2
- Anti-inflammatory agents, such as NSAIDs, for the acute management of gout flares 5
- Urate-lowering therapy (ULT) to prevent gout flares, with an emphasis on treat-to-target strategy; the escalation of therapies until the target serum uric acid is reached 2, 3, 5, 4
Urate-Lowering Therapy
Urate-lowering therapy aims to prevent gout flares, with the following options:
- Allopurinol as the preferred first-line ULT, including for those with moderate-to-severe chronic kidney disease (CKD; stage >3) 3
- Febuxostat as an alternative ULT option, with a gradual dose-escalation strategy to serum uric acid target 2, 5
- Uricosuric agents, such as probenecid, benzbromarone, and lesinurad, as adjuncts to ULT 2, 5, 6
Treatment Considerations
Treatment considerations for gout flare management include:
- Patient comorbidities, such as chronic kidney disease and ischemic heart disease, which may affect treatment choices 2, 3, 4
- Patient preference, which should be taken into account when selecting treatment options 2
- The need for concomitant anti-inflammatory prophylaxis therapy for a duration of at least 3-6 months when initiating ULT 3