From the Guidelines
The recommended treatment for acute gout involves 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. The choice of medication depends on patient comorbidities, with NSAIDs being avoided in those with kidney disease or peptic ulcers, while corticosteroids require caution in diabetics. Some key points to consider when treating acute gout include:
- Starting treatment as early as possible, with fully informed patients self-medicating at the first warning symptoms 1
- Using colchicine, NSAIDs, or oral corticosteroids as first-line options, with the choice of drug based on the presence of contraindications and patient preferences 1
- Avoiding colchicine in patients with severe renal impairment and avoiding NSAIDs in patients with renal disease, heart failure, or cirrhosis 1
- Considering alternative treatments, such as IL-1 blockers, in patients with frequent flares and contraindications to colchicine, NSAIDs, and corticosteroids 1
- Providing prophylaxis against flares, particularly during the first 6 months of urate-lowering therapy, with colchicine or low-dose NSAIDs being recommended options 1
- Maintaining adequate hydration and avoiding alcohol during acute attacks, with existing urate-lowering therapy continued to prevent fluctuations in serum urate levels 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 Tablets, USP 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 one hour 2.
- Key points:
- Initial dose: 1.2 mg
- Second dose: 0.6 mg one hour later
- Maximum dose: 1.8 mg over one hour
- Important consideration: Patients with renal or hepatic impairment may require dose adjustments, and those undergoing dialysis should receive a reduced dose of 0.6 mg (one tablet) for treatment of gout flares, not to be repeated more than once every two weeks 2, 2, 2.
From the Research
Acute Gout Treatment Options
- Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat acute gout 3, 4, 5, 6, 7
- Colchicine is another treatment option for acute gout 3, 4, 5, 6
- Corticosteroids can be used to treat acute gout, either orally or intra-articularly 3, 4, 7
- Selective COX-2 inhibitors can be used as an alternative treatment option in patients with peptic ulcer disease 3
Treatment Considerations
- Asymptomatic hyperuricaemia does not require specific treatment, but patients should be screened for atherosclerosis risk factors and advised on lifestyle modifications to reduce serum urate levels 3, 5
- In patients with renal impairment, allopurinol is the treatment of choice for urate lowering therapy, but doses of allopurinol and colchicine must be adjusted 3
- Urate lowering therapy should only be used if recurrent episodes of gout occur despite aggressive attempts to reverse or control the underlying causes 3, 4, 6
- Gout prophylaxis (NSAIDs or colchicine) should be prescribed during the introduction of urate lowering therapy 3
Comparison of Treatment Options
- A systematic review of randomized controlled trials found that corticosteroids and NSAIDs have similar efficacy in managing pain in acute gout, but corticosteroids may have a more favorable safety profile for selected adverse events 7
- The choice of treatment should be individualized based on patient factors, such as comorbidities and concomitant medications 3, 4, 6