From the Guidelines
The recommended treatment for gout includes both immediate management of acute attacks and long-term prevention strategies, with a focus on maintaining serum uric acid levels below 6mg/dL to prevent crystal formation and recurrent attacks. For acute gout attacks, nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen (500mg twice daily) or indomethacin (50mg three times daily) are first-line treatments, typically continued for 7-10 days until symptoms resolve 1. Colchicine is another effective option, given as 1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily until the attack subsides. For patients who cannot take NSAIDs or colchicine, oral corticosteroids like prednisone (30-40mg daily, tapered over 7-10 days) may be used. Rest and ice application to the affected joint can provide additional relief.
Key Recommendations
- For long-term management, lifestyle modifications are essential, including:
- Weight loss if overweight
- Limiting alcohol (especially beer)
- Avoiding purine-rich foods like organ meats and shellfish
- Staying well-hydrated
- Urate-lowering therapy with medications such as allopurinol (starting at 100mg daily and gradually increasing to 300-600mg daily) or febuxostat (40-80mg daily) is recommended for patients with frequent attacks, tophi, joint damage, or kidney stones 1.
Important Considerations
- Treatment should aim to maintain serum uric acid levels below 6mg/dL to prevent crystal formation and recurrent attacks.
- 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.
- Patients with gout should receive full information and be fully involved in decision-making concerning the use of urate-lowering therapy 1.
From the FDA Drug Label
The recommended dosage of Colchicine Tablets, USP for prophylaxis of gout flares for adults and adolescents older than 16 years of age is 0.6 mg once or twice daily. The maximum recommended dose for prophylaxis of gout flares is 1.2 mg/day. 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 recommended treatment for gout is:
- Prophylaxis of Gout Flares: 0.6 mg of Colchicine Tablets, USP once or twice daily, with a maximum dose of 1.2 mg/day.
- Treatment of Gout Flares: 1.2 mg (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
Treatment Options for Gout
The recommended treatment for gout includes both pharmacological and non-pharmacological approaches.
- For acute gout flares, standard pharmacotherapies include:
- Urate-lowering therapies aim to prevent gout flares, with an emphasis on a treat-to-target strategy, including:
- Emerging therapies, such as pegloticase, are also being developed for the treatment of gout 6, 5
Considerations for Treatment
When prescribing medications for gout, it is essential to consider factors such as:
- Pharmacokinetics and pharmacodynamics of each drug
- Population specifics, including comorbidities such as chronic kidney disease and cardiovascular disease
- Benefits and contraindications of each medication 6, 5, 7
- Lifestyle modifications, such as diet and exercise, can also play a role in preventing gout flares 5
Safety Concerns
The safety of treatment options for gout is a concern, particularly in patients with comorbidities.
- Clinicians should be aware of potential safety concerns, such as the risk of allopurinol hypersensitivity syndrome and cardiovascular safety with febuxostat 5, 7
- Studies are needed to better understand the safety issues associated with gout treatment, particularly in patients with chronic kidney disease and/or cardiovascular disease 7