From the Guidelines
Hydroxychloroquine (HCQ) is not typically recommended for treating gout. The standard first-line medications for acute gout attacks are non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen or indomethacin, colchicine, or corticosteroids. For long-term management, medications such as allopurinol, febuxostat, or probenecid are used to lower uric acid levels. While hydroxychloroquine is an antimalarial drug that has anti-inflammatory properties and is used for autoimmune conditions like rheumatoid arthritis and lupus, it doesn't effectively address the underlying cause of gout, which is elevated uric acid levels leading to crystal formation in joints. Some research suggests HCQ might have a modest uric acid-lowering effect, but this is insufficient for gout management. Additionally, hydroxychloroquine has potential side effects including retinal toxicity with long-term use, which makes it an inappropriate choice when more effective and established treatments for gout are available 1.
Key Points to Consider:
- The American College of Physicians recommends using corticosteroids, NSAIDs, or colchicine to treat patients with acute gout 1.
- Urate-lowering therapy is not necessary in cases where the patient would have no or infrequent recurrences of gout attacks 1.
- The goal of long-term management is to lower uric acid levels to prevent future gout attacks, and medications such as allopurinol, febuxostat, or probenecid are used for this purpose 1.
- Hydroxychloroquine is not a recommended treatment for gout due to its lack of effectiveness in addressing the underlying cause of the disease and its potential side effects 1.
Treatment Options:
- NSAIDs (e.g. naproxen, indomethacin)
- Colchicine
- Corticosteroids
- Urate-lowering therapy (e.g. allopurinol, febuxostat, probenecid)
Important Considerations:
- Potential side effects of hydroxychloroquine, including retinal toxicity with long-term use 1.
- Importance of shared decision-making with patients to review possible harms and benefits of urate-lowering therapy 1.
From the Research
Treatment of Gout
The treatment of gout typically involves a combination of medications to manage acute attacks and prevent future flares. Some of the commonly used medications include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation
- Colchicine to reduce inflammation and prevent future flares
- Corticosteroids to reduce inflammation and pain
- Urate-lowering therapy (ULT) to reduce uric acid levels and prevent future flares
Use of Hydroxychloroquine for Gout
There is no mention of hydroxychloroquine (HCQ) in the provided studies as a treatment for gout 2, 3, 4, 5, 6. The studies discuss various other medications, such as allopurinol, febuxostat, probenecid, and colchicine, as treatments for gout, but HCQ is not mentioned.
Alternative Treatments for Gout
Some of the alternative treatments for gout include:
- Dietary changes, such as limiting purine-rich foods and avoiding alcoholic drinks
- Increasing consumption of vegetables and low-fat or nonfat dairy products
- Using loop and thiazide diuretics with caution, as they can increase uric acid levels
- Using angiotensin receptor blockers, such as losartan, which can increase urinary excretion of uric acid 3