From the Guidelines
For an acute gout attack, besides steroids, the primary medications recommended are NSAIDs and colchicine, as they have been shown to be effective in reducing pain and inflammation, with high-quality evidence supporting their use 1.
Medication Options
- NSAIDs (Non-Steroidal Anti-Inflammatory Drugs):
- Examples: Naproxen (500mg twice daily), Indomethacin (50mg three times daily), or Celecoxib (400mg initially, then 200mg twice daily)
- Duration: Usually for 5-7 days or until the attack resolves
- Colchicine:
- Dosage: 1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily
- Duration: Continue for 7-10 days or until the attack subsides
Important Considerations
- When using these medications, ensure proper hydration and consider gastroprotection if using NSAIDs.
- Adjust dosages for patients with renal impairment.
- Combine with rest, ice application, and elevation of the affected joint for optimal relief.
- Avoid aspirin as it can interfere with uric acid excretion.
Additional Treatment Options
- IL-1 inhibitors (for severe cases or when other treatments are contraindicated):
- Example: Anakinra, 100mg subcutaneously daily for 3 days These medications work by reducing inflammation in the affected joint. NSAIDs inhibit prostaglandin synthesis, colchicine prevents neutrophil activation and migration, and IL-1 inhibitors block a key inflammatory cytokine. It is essential to note that the choice of medication 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.
From the FDA Drug Label
NSAID medicines are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as: different types of arthritis NSAID medicines should only be used: exactly as prescribed at the lowest dose possible for your treatment for the shortest time needed
Medications besides corticosteroids that can be used to treat an acute gouty arthritis attack include:
- NSAIDs, such as naproxen, which can be used to treat pain and inflammation from gouty arthritis.
From the Research
Medications for Acute Gouty Arthritis
Besides corticosteroids, several medications can be used to treat an acute gouty arthritis attack, including:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4, 5, 6
- Colchicine 3, 4, 5, 7
- Adrenocorticotropic hormone (ACTH) 4, 7
- Intra-articular corticosteroids 5, 7
- Interleukin-1 (IL-1) inhibitors, such as canakinumab 4
- COX-2 inhibitors 4, 6
Considerations for Medication Use
When selecting a medication, considerations should include:
- The patient's medical history and comorbidities 3, 5
- The potential for adverse effects, such as gastrointestinal complications with NSAIDs 3, 5, 6
- The need for dose adjustments in patients with renal impairment 3, 5
- The importance of initiating therapy promptly and using an appropriate dose 7
Comparison of Medications
Studies have compared the efficacy of different medications for acute gouty arthritis, including: