From the Guidelines
For managing a gout flare, a combination of Kenalog (triamcinolone) and Toradol (ketorolac) can be effective, as supported by the 2020 American College of Rheumatology guideline for the management of gout 1.
Management Approach
The management approach for a gout flare using Kenalog (triamcinolone) and Toradol (ketorolac) involves:
- A single intramuscular injection of Kenalog 40mg along with Toradol 60mg IM for rapid relief
- Alternatively, Kenalog can be injected directly into the affected joint at a dose of 10-40mg depending on joint size
- Toradol can be given as 30-60mg IM or 10mg orally every 4-6 hours for up to 5 days
Rationale
This combination works well because triamcinolone reduces inflammation through corticosteroid action, while ketorolac provides immediate pain relief through its NSAID properties.
Monitoring and Precautions
Patients should be monitored for potential side effects including:
- Elevated blood glucose (particularly in diabetics)
- Gastrointestinal irritation
- Renal effects
Accompanying Measures
This approach should be accompanied by:
- Rest
- Ice application
- Joint elevation
- Increased fluid intake
Long-term Management
For long-term management, patients should be started on allopurinol or febuxostat after the acute flare resolves to prevent future attacks by lowering uric acid levels, as recommended by the American College of Physicians 1.
Lifestyle Modifications
Patients with recurrent gout should also be counseled on lifestyle modifications including:
- Weight loss
- Limiting alcohol intake
- Avoiding purine-rich foods, as suggested by the 2016 updated EULAR evidence-based recommendations for the management of gout 1.
From the Research
Management Approach for Gout Flare
The management approach for a gout flare using Kenalog (triamcinolone) and Toradol (ketorolac) involves the following:
- Kenalog (triamcinolone) is a corticosteroid that can be used to treat acute gout flares, especially in patients who cannot tolerate non-steroidal anti-inflammatory drugs (NSAIDs) or colchicine 2, 3.
- Toradol (ketorolac) is an NSAID that can be used to treat acute gout flares, but its use should be limited to a short duration and in low doses due to the risk of adverse events 2, 3.
- The use of corticosteroids, such as Kenalog, may be considered in patients with acute gout flares who have contraindications to NSAIDs or colchicine, or in those who have failed to respond to these treatments 4.
- Prophylaxis for acute gout flares after initiation of urate-lowering therapy can be achieved with low-dose colchicine or low-dose NSAIDs, such as naproxen, for up to 6 months 5.
Treatment Options
Treatment options for acute gout flares include:
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as Toradol (ketorolac) 2, 3
- Colchicine 2, 4
- Corticosteroids, such as Kenalog (triamcinolone) 2, 3, 4
- Interleukin-1 inhibitors, such as canakinumab and rilonacept 6
Considerations
Considerations for the management of gout flares include:
- Patient comorbidities, such as cardiovascular disease or renal impairment, which may affect treatment choices 3
- Potential drug interactions and side effects, such as gastrointestinal toxicity with NSAIDs or corticosteroids 2, 3
- The need for prophylaxis to prevent acute gout flares after initiation of urate-lowering therapy 5