From the Guidelines
Management of gout exacerbation should prioritize rapid pain relief and inflammation reduction, with the most recent guidelines recommending the use of colchicine, NSAIDs, or corticosteroids as first-line treatments for acute gout attacks, as stated in the 2020 American College of Rheumatology guideline for the management of gout 1.
Key Considerations
- For acute gout attacks, start with an NSAID like naproxen (500mg twice daily) or indomethacin (50mg three times daily) for 3-5 days, as recommended by the 2017 American College of Physicians guideline for the management of acute and recurrent gout 1.
- Alternatively, colchicine is effective when started early at 1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily until symptoms resolve, as suggested by the 2016 updated EULAR evidence-based recommendations for the management of gout 1.
- For patients with contraindications to these medications, oral prednisone (30-40mg daily for 3-5 days with a taper) or intra-articular corticosteroid injection can be used, as recommended by the 2020 American College of Rheumatology guideline for the management of gout 1.
Long-term Management
- Once the acute attack resolves, address underlying hyperuricemia with allopurinol (starting at 100mg daily and gradually increasing) or febuxostat (40-80mg daily) for long-term management, as recommended by the 2016 updated EULAR evidence-based recommendations for the management of gout 1.
- Lifestyle modifications including weight loss, limiting alcohol (especially beer), and reducing intake of purine-rich foods (red meat, seafood, organ meats) are essential complementary strategies to prevent future attacks, as suggested by the 2017 American College of Physicians guideline for the management of acute and recurrent gout 1.
Additional Recommendations
- Rest the affected joint, apply ice for 20 minutes several times daily, and elevate the limb to reduce swelling, as recommended by the 2012 American College of Rheumatology guidelines for management of gout 1.
- Maintain hydration by drinking 2-3 liters of water daily, as suggested by the 2016 updated EULAR evidence-based recommendations for the management of gout 1.
From the FDA Drug Label
In patients with acute gout, a favorable response to naproxen was shown by significant clearing of inflammatory changes (e.g., decrease in swelling, heat) within 24 to 48 hours, as well as by relief of pain and tenderness. Indomethacin capsules have been found effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis PredniSONE Tablets are indicated for the treatment of acute gouty arthritis as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation)
Gout Exacerbation Management:
- Naproxen can be used to manage gout exacerbation, with significant clearing of inflammatory changes and relief of pain and tenderness within 24 to 48 hours 2.
- Indomethacin is effective in relieving pain, reducing fever, swelling, redness, and tenderness of acute gouty arthritis 3.
- Prednisone can be used as adjunctive therapy for short-term administration to tide the patient over an acute episode or exacerbation of gouty arthritis 4.
From the Research
Gout Exacerbation Management
Gout exacerbation management involves several treatment options, including:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 5, 6, 7
- Corticosteroids 5, 6, 8
- Colchicine 5, 6, 8, 7
- Xanthine oxidase inhibitors (XOI) such as allopurinol and febuxostat 5, 6, 8
- Uricosuric drugs such as probenecid 5, 9
- IL-1β antagonists 6
- Novel therapies such as lesinurad, verinurad, and arhalofenate 5, 6
- Lifestyle modifications 6
Treatment Guidelines
Treatment guidelines for gout exacerbation management recommend:
- Starting anti-inflammatory treatment as soon as possible, preferably within 24 hours 9
- Using low-dose colchicine 9
- Treating to a target serum urate level of less than 6 mg/dL, and less than 5 mg/dL for patients with more severe disease 5, 9
- Concurrent anti-inflammatory prophylaxis 9
- Comprehensive patient education and counseling 5
- Regular laboratory follow-up 5
Comparison of Treatment Options
Studies have compared the effectiveness and safety of different treatment options for gout exacerbation management, including:
- Naproxen and low-dose colchicine 7
- Allopurinol and febuxostat 6, 8
- Probenecid and other uricosuric drugs 5, 9 These studies have found that different treatment options have varying degrees of effectiveness and safety, and that the choice of treatment should be individualized based on patient-specific characteristics 8, 7