From the Guidelines
The recommended initial treatment for acute gout is a non-steroidal anti-inflammatory drug (NSAID) such as naproxen (500mg twice daily), indomethacin (50mg three times daily), or ibuprofen (800mg three times daily) for 7-10 days, or colchicine at a loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1 and/or an oral corticosteroid (30–35 mg/day of equivalent prednisolone for 3–5 days) 1.
Key Considerations
- 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.
- Colchicine and NSAIDs should be avoided in patients with severe renal impairment, and colchicine should not be given to patients receiving strong P-glycoprotein and/or CYP3A4 inhibitors such as cyclosporin or clarithromycin 1.
- Oral corticosteroids like prednisone (30-40mg daily for 3-5 days, then tapered over 7-10 days) are appropriate for patients who cannot take NSAIDs or colchicine due to contraindications such as kidney disease, heart failure, or gastrointestinal issues 1.
- Joint aspiration with injection of a corticosteroid is another effective option, especially for single joint involvement 1.
Additional Recommendations
- Treatment should be initiated as soon as possible after symptom onset for maximum effectiveness 1.
- Rest, ice application, and elevation of the affected joint can provide additional symptomatic relief during treatment 1.
- Patients should receive full information and be fully involved in decision-making concerning the use of urate-lowering therapy (ULT) 1.
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 recommended initial treatment for acute gout is 1.2 mg of colchicine (two tablets) at the first sign of the flare, followed by 0.6 mg (one tablet) one hour later 2.
- The maximum recommended dose for treatment of gout flares is 1.8 mg over a one-hour period.
- Higher doses have not been found to be more effective.
- It is essential to note that colchicine is not an analgesic medication and should not be used to treat pain from other causes.
From the Research
Recommended Initial Treatment for Acute Gout
The recommended initial treatment for acute gout includes several options, such as:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4, 5
- Corticosteroids 6, 5
- Colchicine 6, 5
- Interleukin-1 inhibitors, such as canakinumab, for patients with flare refractory to standard therapies 6, 7
Comparison of Treatment Options
Studies have compared the effectiveness of different treatment options for acute gout, including:
- NSAIDs versus placebo: NSAIDs were found to be effective in reducing pain and improving function 3, 4
- NSAIDs versus COX-2 inhibitors: both were found to be equally effective in reducing pain and improving function, but COX-2 inhibitors had fewer adverse events 3, 4
- NSAIDs versus glucocorticoids: both were found to be equally effective in reducing pain and improving function, but glucocorticoids had fewer adverse events 3, 4
- Canakinumab versus triamcinolone acetonide: canakinumab was found to be more effective in reducing pain and improving function, but had more adverse events 7
Considerations for Treatment
When selecting a treatment option for acute gout, considerations should include: