What are the treatment options for gout?

From the Guidelines

Treatment options for gout include both medication and lifestyle changes, with the goal of reducing inflammation and preventing crystal formation in joints. For acute gout attacks, nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen (500mg twice daily) or indomethacin (50mg three times daily) are typically used for 7-10 days, as recommended by the American College of Physicians 1. Colchicine (1.2mg at onset, followed by 0.6mg one hour later, then 0.6mg once or twice daily) is effective when started early, with a strong recommendation for low-dose colchicine use 1. Corticosteroids like prednisone (30-40mg daily, tapered over 7-10 days) are options for patients who cannot take NSAIDs or colchicine, with a strong recommendation for their use in patients without contraindications 1. For long-term management, urate-lowering therapy such as allopurinol (starting at 100mg daily, gradually increasing to 300-600mg daily) or febuxostat (40-80mg daily) is prescribed to maintain uric acid levels below 6 mg/dL, as recommended by the American College of Rheumatology 1 and the European League Against Rheumatism (EULAR) 1. Lifestyle modifications are also important, including:

• Weight loss if overweight
• Limiting alcohol (especially beer)
• Avoiding high-purine foods like organ meats and shellfish
• Staying hydrated
• Managing comorbidities like hypertension and diabetes These treatments work by either reducing inflammation during acute attacks or lowering uric acid levels to prevent crystal formation in joints, which causes the painful inflammation characteristic of gout. It is essential to note that the choice of treatment should be based on the presence of contraindications, the patient's previous experience with treatments, and the number and type of joint(s) involved, with a strong recommendation for patient education and involvement in decision-making concerning the use of urate-lowering therapy 1.

From the FDA Drug Label

For prophylaxis of gout flares in patients with mild (estimated creatinine clearance Cl cr 50 to 80 mL/min) to moderate (Cl cr 30 to 50 mL/min) renal function impairment, adjustment of the recommended dose is not required, but patients should be monitored closely for adverse effects of colchicine. However, in patients with severe impairment, the starting dose should be 0.3 mg/day and any increase in dose should be done with close monitoring. For the prophylaxis of gout flares in patients undergoing dialysis, the starting doses should be 0.3 mg given twice a week with close monitoring. Treatment of Gout Flares For treatment of gout flares in patients with mild (Cl cr 50 to 80 mL/min) to moderate (Cl cr 30 to 50 mL/min) renal function impairment, adjustment of the recommended dose is not required, but patients should be monitored closely for adverse effects of colchicine However, in patients with severe impairment, while the dose does not need to be adjusted for the treatment of gout flares, a treatment course should be repeated no more than once every two weeks.

The treatment options for gout include:

• Prophylaxis of gout flares: The recommended dose may not need to be adjusted for patients with mild to moderate renal function impairment, but close monitoring is required. For patients with severe impairment, the starting dose should be 0.3 mg/day.
• Treatment of gout flares: The recommended dose may not need to be adjusted for patients with mild to moderate renal function impairment, but close monitoring is required. For patients with severe impairment, the treatment course should be repeated no more than once every two weeks. According to 2 and 2.

From the Research

Treatment Options for Gout

• The primary goal of gout treatment is to reduce pain and inflammation during acute flares and to prevent future flares by lowering serum uric acid levels 3, 4, 5, 6, 7.
• Treatment options for acute gout flares include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) 4, 5, 6, 7
  • Colchicine 3, 4, 5, 6, 7
  • Corticosteroids 3, 4, 5, 6, 7
  • IL-1 inhibitors for flare refractory to standard therapies 3, 5
• Urate-lowering therapies aim to prevent gout flares and include:
  • Allopurinol 3, 4, 5, 6, 7
  • Febuxostat 3, 4, 5, 6, 7
  • Uricosuric agents such as probenecid, sulfinpyrazone, and benzbromarone 3, 4, 7
  • Pegloticase for patients with recalcitrant gout 5, 7
• Lifestyle modifications, such as dietary changes and weight loss, can also help prevent gout flares 5, 6
• Comprehensive patient education and counseling, as well as regular laboratory follow-up, are important components of gout treatment 4, 6

Emerging Therapies

• New emerging therapies, such as lesinurad and novel uricosurics, are being developed and may offer additional treatment options for gout patients 3, 4, 5
• Verinurad and arhalofenate are agents with future promise for urate lowering therapy 5
• Abrogating pegloticase's immunogenicity with immunomodulatory co-therapy may lend to sustained efficacy 5

Personalized Treatment

• Treatment should be personalized based on individual patient factors, such as comorbidities and patient preference 3
• Screening for HLA*B58:01 mutation is a cost-effective approach to decrease the occurrence of allopurinol hypersensitivity syndrome in certain populations 5