From the Guidelines
The recommended treatment for a gout flare-up includes anti-inflammatory medications such as NSAIDs, colchicine, or corticosteroids, which should be started as soon as possible after symptoms appear, ideally within 24 hours, and continued until the flare resolves completely, typically 5-7 days. The choice of treatment 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. Some key treatment options include:
- Colchicine (1 mg loading dose, followed by 0.5 mg on day 1 and/or an NSAID)
- NSAIDs (plus proton pump inhibitors if appropriate)
- Oral corticosteroid (30–35 mg/day of equivalent prednisolone for 3–5 days)
- Articular aspiration and injection of corticosteroids It is also important to rest the affected joint, apply ice for 20-30 minutes several times daily to reduce inflammation, and stay well-hydrated by drinking 8-10 glasses of water daily 1. Additionally, patients should avoid alcohol and purine-rich foods (red meat, seafood, organ meats) during a flare, as these can exacerbate symptoms 1. For those with frequent flares, preventive therapy with medications like allopurinol or febuxostat may be recommended to lower uric acid levels long-term, but these should not be started during an acute attack as they can initially worsen symptoms 1. It is essential to discuss the benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks 1. Overall, the goal of treatment is to reduce inflammation, alleviate symptoms, and prevent future flares, while also considering the patient's individual needs and preferences.
From the FDA Drug Label
The recommended dose of Colchicine Tablets, USP for treatment of a gout flare is 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later. The maximum recommended dose for treatment of gout flares is 1.8 mg over a one hour period.
The recommended treatment for a gout flare-up is 1.2 mg of Colchicine Tablets, USP (two tablets) at the first sign of the flare, followed by 0.6 mg (one tablet) one hour later, with a maximum dose of 1.8 mg over a one-hour period 2.
From the Research
Gout Flare-Up Management
The recommended treatment for a gout flare-up includes several pharmacotherapies, such as:
- Colchicine
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Oral or intramuscular corticosteroids
- IL-1 inhibitors for flare refractory to standard therapies 3 These treatments aim to reduce pain and inflammation associated with gout flares.
Treatment Options
Some key points to consider for gout flare-up management:
- NSAIDs are commonly used to treat acute gout and may improve pain at 24 hours, but may have little to no effect on function, inflammation, or adverse events 4
- Canakinumab may be the most effective intervention for pain reduction and joint tenderness at day 2 5
- Intravenous or intramuscular corticosteroids may be inferior to canakinumab but may be better than other commonly used interventions 5
- Acetic acid derivative NSAIDs may be superior to ibuprofen NSAIDs in improving joint swelling and patient global assessment 5
Urate-Lowering Therapies
Urate-lowering therapies aim to prevent gout flares and include:
- Allopurinol
- Febuxostat
- Uricosuric agents, such as probenecid, sulfinpyrazone, and benzbromarone 3
- Dotinurad, a selective urate reabsorption inhibitor, which may be superior to febuxostat in achieving serum urate levels ≤6.0 mg/dL at week 24 6
Personalization of Treatment
Treatment should be personalized based on comorbidities, such as chronic kidney disease and ischemic heart disease, as well as patient preference 3