From the Guidelines
The recommended treatment approach for acute gout involves prompt use of anti-inflammatory medications to reduce pain and inflammation, with first-line options including corticosteroids, NSAIDs, or colchicine. According to the American College of Physicians guideline 1, corticosteroids, NSAIDs, and colchicine are effective treatments to reduce pain in patients with acute gout. The choice of drug(s) 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 points to consider when treating acute gout include:
- Corticosteroids should be considered as first-line therapy in patients without contraindications because they are generally safer and a low-cost treatment option 1.
- Colchicine can be used at a dose of 1 mg initially, followed by 0.5 mg one hour later, then 0.5 mg once or twice daily until symptoms resolve, but should be avoided in patients with severe renal impairment or those receiving strong P-glycoprotein and/or CYP3A4 inhibitors 1.
- NSAIDs, such as indomethacin, naproxen, or celecoxib, can be used to treat acute gout, but should be avoided in patients with renal disease, heart failure, or cirrhosis 1.
- Treatment should begin within 24 hours of symptom onset for maximum effectiveness, and patients should rest the affected joint, apply ice to reduce pain, and maintain adequate hydration.
It's also important to note that urate-lowering therapy should not be initiated during an acute attack, but can be started or continued if already established 1. Additionally, lifestyle modifications, such as weight loss, avoidance of alcohol and sugar-sweetened drinks, and regular exercise, can help reduce the risk of gout attacks and improve overall health 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.
The recommended treatment approach for acute gout includes the use of naproxen, which has been shown to be effective in reducing inflammatory changes and relieving pain and tenderness within 24 to 48 hours 2.
- Key points:
- Naproxen has been studied in patients with acute gout and has been shown to be effective.
- The drug can reduce inflammatory changes and relieve pain and tenderness.
- Onset of pain relief can begin within 1 hour in patients taking naproxen.
- Important consideration: Naproxen may be used safely in combination with gold salts and/or corticosteroids, but its use in combination with salicylates is not recommended.
From the Research
Treatment Approaches for Acute Gout
The recommended treatment approach for acute gout involves several options, including:
- Non-steroidal anti-inflammatory drugs (NSAIDs) 3, 4, 5, 6
- Corticosteroids 4, 7, 5
- Colchicine 4, 7, 5
- Interleukin-1 (IL-1) inhibitors 4, 5
- Adrenocorticotropic hormone (ACTH) 4, 7
Efficacy of Treatment Options
The efficacy of these treatment options varies:
- NSAIDs are effective in reducing pain and inflammation, but may have higher rates of adverse events compared to other options 3, 6
- Corticosteroids are as effective as NSAIDs, but may be safer 5
- Colchicine is effective, especially at low doses, and has a safer side effect profile compared to high doses 4, 5
- IL-1 inhibitors, such as canakinumab, are effective in treating acute gout, especially in patients who are refractory to or have contraindications to NSAIDs and/or colchicine 4, 5
Safety and Adverse Events
The safety and adverse event profiles of these treatment options also vary:
- NSAIDs are associated with higher rates of adverse events, such as gastrointestinal events, compared to other options 3, 6
- Corticosteroids may be safer than NSAIDs, with lower rates of adverse events 5
- Colchicine, especially at low doses, has a safer side effect profile compared to high doses 4, 5
- IL-1 inhibitors, such as canakinumab, may have a safer side effect profile compared to NSAIDs and colchicine 4, 5