From the Guidelines
For a gout flare, I recommend a combination approach using anti-inflammatory medications, starting with colchicine 1.2mg immediately, followed by 0.6mg one hour later, then continuing with 0.6mg once or twice daily until the flare resolves, as supported by high-quality evidence from the American College of Physicians guideline 1.
Key Recommendations
- Colchicine: Start with 1.2mg immediately, followed by 0.6mg one hour later, then continue with 0.6mg once or twice daily until the flare resolves 1.
- NSAIDs: Use an NSAID like naproxen 500mg twice daily or indomethacin 50mg three times daily for 3-5 days as an alternative to colchicine 1.
- Corticosteroids: For those who cannot take these medications, prednisone 30-40mg daily for 3-5 days with a gradual taper over 10-14 days is effective 1.
Additional Measures
- Apply ice to the affected joint for 20 minutes several times daily.
- Elevate the joint and rest.
- Drink plenty of water.
- Avoid alcohol and purine-rich foods (red meat, seafood, organ meats) during the flare.
Long-term Management
- Discuss long-term urate-lowering therapy with your healthcare provider to prevent future attacks, considering the patient's individual preferences, benefits, and harms of treatment 1.
From the FDA Drug Label
The efficacy of a low-dosage regimen of oral colchicine (total dose 1. 8 mg over one hour) for treatment of gout flares was assessed in a multicenter, randomized, double-blind, placebo-controlled, parallel group, one week, dose-comparison study. Patients meeting American College of Rheumatology criteria for gout were randomly assigned to three groups: high-dose colchicine (1.2 mg, then 0.6 mg hourly × six hours [4.8 mg total]); low-dose colchicine (1.2 mg, then 0. 6 mg in one hour [1. 8 mg total] followed by five placebo doses hourly); or placebo (two capsules, then one capsule hourly × six hours). Rates of response were similar for the recommended low-dose treatment group (38%) and the nonrecommended high-dose group (33%) but were higher as compared to the placebo group (16%)
The recommended pain management regimen for acute gout (gouty arthritis) flare is low-dose colchicine with a total dose of 1.8 mg over one hour.
- The dose is 1.2 mg, then 0.6 mg in one hour.
- This regimen has been shown to be effective in reducing pain in patients with acute gout flare, with a response rate of 38% 2.
- Indomethacin is also an option for the treatment of acute gouty arthritis, as it has been found to be effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis 3.
From the Research
Recommended Pain Management Regimen for Acute Gout
The recommended pain management regimen for acute gout (gouty arthritis) flare includes:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 4, 5, 6, 7
- Colchicine 4, 5, 6, 7
- Corticosteroids (oral or intramuscular) 4, 5, 6, 7
- Interleukin-1 (IL-1) inhibitors, such as canakinumab and rilonacept, for flare refractory to standard therapies 4, 5, 8
Prophylaxis for Acute Gout Flares
Prophylaxis for acute gout flares is recommended when initiating urate-lowering therapy, with options including:
- Low-dose colchicine (0.5 mg once or twice a day) 5
- Low-dose NSAIDs, such as naproxen 250 mg orally twice a day 5
- Low-dose corticosteroids, such as prednisone or prednisolone, if contraindicated or not tolerated 5
- IL-1 inhibitors, such as canakinumab and rilonacept, for patients with intolerance or contraindication to colchicine, NSAIDs, or corticosteroids 5, 8
Urate-Lowering Therapy
Urate-lowering therapy aims to prevent gout flares, with options including: