From the Guidelines
Alternative treatments for gout should prioritize a combination of medication and lifestyle approaches, with a focus on reducing inflammation and lowering uric acid levels to prevent crystal formation in joints, as recommended by the most recent and highest quality study 1. For acute gout attacks, non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen (500mg twice daily) or indomethacin (50mg three times daily) can provide relief within 24-48 hours. Colchicine (0.6mg taken twice daily) is effective when started early but may cause digestive side effects. Corticosteroids like prednisone (20-40mg daily, tapered over 7-10 days) are options for those who cannot take NSAIDs. Some key points to consider in the management of gout include:
- The use of urate-lowering therapy (ULT) to achieve a serum urate target of <6 mg/dL, with allopurinol as the first-line ULT and febuxostat as an alternative 1
- The importance of lifestyle modifications, including maintaining a healthy weight, limiting alcohol consumption, avoiding high-purine foods, and staying hydrated 1
- The potential benefits of prophylactic therapy with low-dose colchicine or low-dose NSAIDs to reduce the risk of acute gout attacks in patients initiating ULT 1
- The need for ongoing monitoring and adjustment of treatment to achieve optimal outcomes and minimize adverse effects 1
Overall, the management of gout requires a comprehensive approach that incorporates both medication and lifestyle modifications, with a focus on reducing inflammation and lowering uric acid levels to prevent crystal formation in joints. By prioritizing the most recent and highest quality evidence, clinicians can provide optimal care for patients with gout and improve outcomes in terms of morbidity, mortality, and quality of life 1.
From the FDA Drug Label
Gout refractory to conventional therapy occurs in patients who have failed to normalize serum uric acid and whose signs and symptoms are inadequately controlled with xanthine oxidase inhibitors at the maximum medically appropriate dose or for whom these drugs are contraindicated. The alternative treatments for gout include:
- Xanthine oxidase inhibitors for patients who have not failed to normalize serum uric acid
- Pegloticase (IV), such as KRYSTEXXA, for adult patients refractory to conventional therapy 2
- Colchicine (PO) for the treatment of gout flares in patients with mild to moderate renal function impairment 3 3 Note that these alternatives may have specific dosing recommendations and precautions based on patient renal and hepatic function.
From the Research
Alternative Treatments for Gout
Alternative treatments for gout include a range of pharmacological and non-pharmacological options. The choice of treatment depends on the stage of gout, patient comorbidities, and other factors.
- Non-pharmacological treatments: Topical ice and rest of the inflamed joint are useful in acute gout attacks 4.
- Pharmacological treatments:
- NSAIDs: The preferred treatment for acute gout, with the most important determinant of therapeutic success being how soon NSAID therapy is initiated 4.
- Colchicine: Considered safe and potentially reduces the risk of myocardial infarction in patients with cardiovascular disease or heart failure 5.
- Corticosteroids: May be used in acute gout attacks, especially in patients who cannot tolerate colchicine or NSAIDs 4, 5.
- Urate-lowering therapy (ULT): Allopurinol and febuxostat are first-line medications for the prevention of recurrent gout, while colchicine and/or probenecid are reserved for patients who cannot tolerate first-line agents or in whom first-line agents are ineffective 6, 7.
- Uricosuric drugs: Probenecid, benzbromarone, and losartan increase uric acid excretion and may be used as second-line treatment 4, 8.
Lifestyle Modifications
Lifestyle modifications can also play a crucial role in managing gout, including:
- Dietary changes: Limiting consumption of purine-rich foods, avoiding alcoholic drinks, and encouraging consumption of vegetables and low-fat or nonfat dairy products 6.
- Avoiding certain medications: Discontinuing diuretics if possible, and using fenofibrate and losartan with caution in patients with dyslipidemia and high blood pressure, respectively 6, 8.