From the Guidelines
The recommended treatment for acute gout includes NSAIDs, colchicine, or corticosteroids as first-line options. According to the American College of Physicians guideline 1, these medications are effective in reducing pain and inflammation in patients with acute gout.
- NSAIDs like indomethacin (50mg three times daily), naproxen (500mg twice daily), or ibuprofen (800mg three times daily) should be used for 7-10 days or until symptoms resolve.
- Colchicine is most effective when started early (1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily until symptoms resolve) 1.
- For patients who cannot take NSAIDs or colchicine, oral prednisone (30-40mg daily for 3-5 days, then tapered over 7-10 days) or intra-articular corticosteroid injections are effective alternatives. Some key points to consider when treating acute gout include:
- Rest, ice application, and elevation of the affected joint provide symptomatic relief.
- Patients should avoid alcohol and purine-rich foods during an attack.
- Adequate hydration is important to help excrete uric acid.
- Treatment should begin as soon as possible after symptom onset, as early intervention leads to faster resolution of pain and inflammation. The goal of treatment is to reduce the inflammatory response to urate crystals in the joint, which causes the severe pain, swelling, and redness characteristic of acute gout attacks, as stated in the guideline from the American College of Physicians 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 acute gout is:
- Colchicine: 1.2 mg (two tablets) at the first sign of the flare, followed by 0.6 mg (one tablet) one hour later.
- Maximum dose: 1.8 mg over a one hour period. 2
From the Research
Treatment Options for Acute Gout
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat acute gout, with the most important determinant of therapeutic success being how soon NSAID therapy is initiated 3, 4, 5.
- Colchicine is still an effective acute agent, but care must be taken to monitor toxicity, and low-dose colchicine may have a cost and toxicity advantage over NSAIDs in the prophylaxis of gout 3, 6, 7.
- Systemic corticosteroids have similar efficacy to therapeutic doses of NSAIDs, with studies supporting oral and intramuscular use 4, 5.
- Intra-articular glucocorticosteroid therapy is useful and very safe, and may be used when NSAIDs and colchicine are contraindicated 6, 7.
- Interleukin-1 (IL-1) inhibitors, such as canakinumab, may be effective for the treatment of acute attacks in subjects refractory to and in those with contraindications to NSAIDs and/or colchicine 4.
Non-Pharmacological Treatments
- Topical ice and rest of the inflamed joint are useful nonpharmacological treatments for acute gout 3, 4.
- Education of the patient and identification and correction of cardiovascular risk factors are also important aspects of treatment 7.
Comparison of Treatment Options
- Moderate-quality evidence suggests that selective COX-2 inhibitors and non-selective NSAIDs are probably equally beneficial, although COX-2 inhibitors are likely to be associated with significantly fewer total and gastrointestinal adverse events 5.
- Moderate-quality evidence indicates that systemic glucocorticoids and NSAIDs are also equally beneficial in terms of pain relief, with no withdrawals due to adverse events and similar total adverse events between groups 5.