From the Guidelines
The best treatment for gout involves a combination of lifestyle modifications, urate-lowering therapy, and management of acute attacks, with allopurinol being the preferred first-line urate-lowering therapy, as recommended by the 2020 American College of Rheumatology guideline 1.
Key Recommendations
- For acute gout attacks, NSAIDs, colchicine, or corticosteroids are recommended as first-line treatments, with the choice of medication depending on patient-specific factors and comorbidities 1.
- Urate-lowering therapy is recommended for patients with frequent gout attacks, tophaceous gout, or radiographic damage due to gout, with a target serum uric acid level of less than 6mg/dL 1.
- Lifestyle modifications, including limiting alcohol consumption, reducing purine-rich foods, maintaining a healthy weight, and staying hydrated, are also important for managing gout 1.
Urate-Lowering Therapy
- Allopurinol is the preferred first-line urate-lowering therapy, with a starting dose of 100mg daily and gradual titration to achieve a target serum uric acid level of less than 6mg/dL 1.
- Febuxostat is an alternative for patients who cannot tolerate allopurinol, with a starting dose of 40mg daily and gradual titration as needed 1.
Management of Acute Attacks
- NSAIDs, such as naproxen or indomethacin, are effective for managing acute gout attacks, typically used for 3-5 days until symptoms resolve 1.
- Colchicine is also effective for managing acute gout attacks, with a recommended dose of 1.2mg initially, followed by 0.6mg one hour later, and then 0.6mg once or twice daily as needed 1.
- Corticosteroids, such as prednisone, are alternatives for patients who cannot take NSAIDs or colchicine, with a recommended dose of 30-40mg daily, tapered over 7-10 days 1.
From the FDA Drug Label
The evidence for the efficacy of colchicine in patients with chronic gout is derived from the published literature. Two randomized clinical trials assessed the efficacy of colchicine 0.6 mg twice a day for the prophylaxis of gout flares in patients with gout initiating treatment with urate-lowering therapy. In both trials, treatment with colchicine decreased the frequency of gout flares. The recommended dosage of Colchicine Tablets, USP for prophylaxis of gout flares for adults and adolescents older than 16 years of age is 0.6 mg once or twice daily. The maximum recommended dose for prophylaxis of gout flares is 1.2 mg/day. 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 best treatment for gout is colchicine at a dose of 0.6 mg once or twice daily for prophylaxis of gout flares, and 1.2 mg followed by 0.6 mg one hour later for treatment of a gout flare 2 2.
- Key points:
- Colchicine is effective in decreasing the frequency of gout flares.
- The recommended dose for prophylaxis is 0.6 mg once or twice daily.
- The recommended dose for treatment of a gout flare is 1.2 mg followed by 0.6 mg one hour later.
From the Research
Treatment Options for Gout
The treatment of gout can be divided into two main categories: acute flare treatment and urate-lowering therapy.
- Acute flare treatment aims to reduce the pain and inflammation associated with a gout attack.
- Urate-lowering therapy aims to prevent future gout attacks by reducing the level of uric acid in the blood.
Acute Flare Treatment
The following medications are commonly used to treat acute gout flares:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4
- Corticosteroids 3, 4
- Colchicine 5, 6, 3, 4
- IL-1 inhibitors, such as canakinumab, for patients who are refractory to standard therapies 5, 3
Urate-Lowering Therapy
The goal of urate-lowering therapy is to reduce the level of uric acid in the blood to prevent future gout attacks.
- Allopurinol and febuxostat are commonly used as initial treatments 5, 6, 4
- Uricosuric agents, such as probenecid, sulfinpyrazone, and benzbromarone, can be used as adjuncts 5, 6
- Lesinurad, in combination with xanthine oxidase inhibitors (XOI), is a new treatment option for patients with refractory gout 4
Personalized Treatment
Treatment of gout should be personalized based on individual patient factors, such as comorbidities and patient preference 5, 4.