From the Guidelines
The recommended treatment for an acute gout flare includes nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids, started as soon as possible after symptom onset. According to the most recent and highest quality study, 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.
Some key points to consider when treating acute gout flares include:
- Starting treatment as early as possible, ideally within 12 hours of flare onset
- Using colchicine at a loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1, or an NSAID (plus a proton pump inhibitor if appropriate), or oral corticosteroids (30–35 mg/day of equivalent prednisolone for 3–5 days)
- Avoiding colchicine and NSAIDs in patients with severe renal impairment
- Considering combination therapy, such as colchicine and an NSAID or colchicine and corticosteroids, for patients with particularly severe acute gout
It's also important to note that patients should avoid alcohol and purine-rich foods during flares, and that rest, ice application to the affected joint, and elevation can provide additional symptom relief. Treatment choice depends on patient comorbidities, medication contraindications, and previous response to therapy, as stated in 1 and 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 maximum recommended dose for treatment of gout flares is 1.8 mg over a one hour period.
The recommended treatment for an acute gout flare is 1.2 mg of colchicine at the first sign of the flare, followed by 0.6 mg one hour later.
- The dose should not exceed 1.8 mg over a one hour period.
- If the patient is undergoing dialysis, the recommended dose is 0.6 mg (one tablet), and the treatment course should not be repeated more than once every two weeks 2.
- For patients with severe renal impairment, the treatment course should be repeated no more than once every two weeks 2.
- For patients with severe hepatic impairment, the treatment course should be repeated no more than once every two weeks 2.
From the Research
Treatment Options for Acute Gout Flare
The recommended treatment for an acute gout flare includes several options, such as:
- Non-steroidal anti-inflammatory drugs (NSAIDs) 3
- Colchicine 4, 5, 6
- Oral or intramuscular corticosteroids 4, 5, 6
- IL-1 inhibitors, which are newly established as an option for flare refractory to standard therapies 4
Efficacy and Safety of Treatments
Studies have shown that:
- NSAIDs are effective in treating acute gout, with low-certainty evidence suggesting improvement in pain at 24 hours 3
- Colchicine is effective, with low-dose colchicine demonstrating a comparable tolerability profile to placebo and a significantly lower side effect profile to high-dose colchicine 5, 6
- Systemic corticosteroids have similar efficacy to therapeutic doses of NSAIDs, with studies supporting oral and intramuscular use 5, 6
- IL-1 inhibitors, such as canakinumab, are effective for the treatment of acute attacks in subjects refractory to and in those with contraindications to NSAIDs and/or colchicine 5, 6
Comparison of Treatments
Comparisons between treatments have shown that:
- Non-selective NSAIDs probably result in little to no difference in pain, swelling, treatment success, or quality of life compared to selective COX-2 inhibitors (COXIBs) 3
- NSAIDs probably result in little to no difference in pain, inflammation, function, or treatment success compared to glucocorticoids, but may increase withdrawals due to adverse events and total adverse events 3
- Systemic glucocorticoids appear safer than NSAIDs, and lower-dose colchicine is safer than higher-dose colchicine 6