From the Guidelines
Gout management should prioritize corticosteroids as first-line therapy for acute gout, given their effectiveness and lower adverse effect profile compared to NSAIDs, as evidenced by the American College of Physicians guideline 1.
Acute Gout Management
For patients without contraindications, corticosteroids such as prednisolone at a dose of 35 mg for 5 days are recommended due to their safety, efficacy, and low cost 1. Alternatively, NSAIDs like naproxen or ibuprofen can be considered, although they may have more adverse effects, including gastrointestinal issues 1. Colchicine, specifically at a low dose of 1.2 mg followed by 0.6 mg one hour later, is also effective for acute gout management, especially when started within 24 hours of flare onset, with fewer gastrointestinal adverse effects compared to higher doses 1.
Long-term Management and Prevention
For long-term urate-lowering therapy, the decision to initiate should be made cautiously, considering the patient's specific condition and potential benefits and harms. Lifestyle modifications, including weight loss, limiting alcohol intake (especially beer), reducing consumption of purine-rich foods like red meat and seafood, and ensuring adequate hydration, are crucial adjuncts to medication therapy. Prophylaxis with colchicine or a low-dose NSAID should be considered when starting urate-lowering therapy to prevent acute flares. Regular monitoring of serum uric acid levels is essential for optimal management.
Key Considerations
- Contraindications and adverse effects of each medication should be carefully considered, including the potential for corticosteroids to cause dysphoria, mood disorders, and immune suppression, and NSAIDs to cause gastrointestinal issues 1.
- Cost and accessibility of treatments, with corticosteroids generally being a low-cost option, should influence decision-making 1.
- Patient education on lifestyle modifications and the importance of adherence to prescribed medication regimens is vital for effective gout management.
From the FDA Drug Label
KRYSTEXXA is a prescription medicine used in adults to help reduce the signs and symptoms of gout that are not controlled by other treatments. People with gout have too much uric acid in their bodies. Uric acid crystals collect in joints, kidneys, and other organs. This may cause pain, redness and swelling (inflammation) KRYSTEXXA works to lower blood levels of uric acid.
Gout is written out as: Gouty Arthritis or simply Gout.
- Definition: A type of arthritis characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in one or more joints, usually occurring at the base of the big toe.
- Cause: Excess uric acid in the blood, which can form sharp, needle-like urate crystals in a joint or surrounding tissue, causing pain, inflammation, and swelling.
- Treatment: Includes medications such as KRYSTEXXA 2, which works to lower blood levels of uric acid, as well as other treatments like indomethacin 3 to relieve pain and reduce inflammation.
From the Research
Gout Management
Gout management can be divided into several stages, including:
- Treating the acute attack
- Lowering excess stores of uric acid to prevent flares of gouty arthritis and to prevent tissue deposition of urate
- Providing prophylaxis to prevent acute flares 4 The goal of treatment is to reduce acute inflammation, manage hyperuricaemia, and prevent tissue damage.
Acute Gout Treatment
Treatment options for acute gout include:
- Nonpharmacological treatments such as topical ice and rest of the inflamed joint
- NSAIDs, which are the preferred treatment in acute gout 4, 5
- Oral and intravenous colchicine
- Intra-articular and systemic corticosteroids
- Intramuscular corticotropin 4
- IL-1 inhibitors, which are newly established as an option for flare refractory to standard therapies 6
Chronic Gout Treatment
Optimal treatment of chronic gout requires long-standing reduction in serum uric acid 4. Treatment options include:
- Urate-lowering drugs such as allopurinol, febuxostat, and probenecid
- Uricosuric drugs, which are used to increase uric acid excretion
- Xanthine oxidase inhibitors, which are used to reduce uric acid production 4, 6
- Pegloticase, which is effective for patients with recalcitrant gout 7
Emerging Therapies
There are several emerging therapies for gout, including: