From the Guidelines
The treatment of gout focuses on relieving pain and reducing inflammation during acute attacks while preventing future flares, with corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine recommended for acute gout, and urate-lowering therapy for long-term management in patients with frequent attacks or complications. For acute gout attacks, the following options are available:
- NSAIDs like naproxen (500mg twice daily) or indomethacin (50mg three times daily) are first-line treatments, typically continued for 7-10 days 1.
- Colchicine (1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily) is effective when started early but can cause gastrointestinal side effects, with low-dose colchicine (total dose 1.8 mg in 24 h) being more effective than placebo and as effective as high-dose colchicine (total dose 4.8 mg), but with a better safety profile 1.
- Corticosteroids like prednisone (30-40mg daily, tapered over 7-10 days) are options for patients who cannot take NSAIDs or colchicine. Some key points to consider:
- Urate-lowering therapy such as allopurinol (starting at 100mg daily, gradually increasing to 300-600mg daily) or febuxostat (40-80mg daily) is recommended for patients with frequent attacks or complications like tophi, with the goal of reducing serum urate levels to below 6mg/dL 1.
- Lifestyle modifications are also important, including limiting alcohol (especially beer), reducing intake of purine-rich foods (red meat, seafood, organ meats), maintaining healthy weight, and staying hydrated.
- Treatment should be individualized based on comorbidities, with kidney function particularly important when dosing medications like allopurinol and colchicine 1. It is essential to note that the management of gout includes both pharmacologic and nonpharmacologic approaches, with a focus on urate-lowering strategies and anti-inflammatory drugs, as well as dietary and lifestyle changes 1.
From the FDA Drug Label
Probenecid tablets are indicated for the treatment of the hyperuricemia associated with gout and gouty arthritis. Indomethacin capsules have been found effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis For prophylaxis of gout flares in patients with mild (estimated creatinine clearance Cl cr 50 to 80 mL/min) to moderate (Cl cr 30 to 50 mL/min) renal function impairment, adjustment of the recommended dose is not required, but patients should be monitored closely for adverse effects of colchicine.
The treatment for gouty arthritis (Gout) includes:
- Probenecid to treat hyperuricemia associated with gout and gouty arthritis 2
- Indomethacin to relieve pain, reduce fever, swelling, redness, and tenderness of acute gouty arthritis 3
- Colchicine for prophylaxis and treatment of gout flares, with dose adjustments based on renal function impairment 4
From the Research
Treatment of Gouty Arthritis
The treatment of gouty arthritis can be divided into two main categories:
- Treatment of acute gout flares
- Urate-lowering therapy to prevent future flares
Treatment of Acute Gout Flares
The following options are available for the treatment of acute gout flares:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 5, 6, 7, 8, 9
- Colchicine 5, 6, 7, 8, 9
- Corticosteroids (oral or intramuscular) 5, 6, 7, 8
- IL-1 inhibitors for flare refractory to standard therapies 5, 8
Urate-Lowering Therapy
Urate-lowering therapy aims to prevent gout flares by reducing serum uric acid levels. The following options are available:
- Allopurinol 5, 6, 7, 8, 9
- Febuxostat 5, 7, 8
- Uricosuric agents (e.g., probenecid, sulfinpyrazone, benzbromarone) 5, 7, 8
- Recombinant uricases (e.g., pegloticase, rasburicase) 8
Considerations for Treatment
Treatment should be personalized based on patient comorbidities, such as chronic kidney disease and ischemic heart disease, as well as patient preference 5. Additionally, patients receiving urate-lowering medications should be treated concurrently with nonsteroidal anti-inflammatory drugs, colchicine, or low-dose corticosteroids to prevent flares 7.
Lifestyle Modifications
Lifestyle modifications, such as limiting consumption of purine-rich foods and avoiding alcoholic drinks, can also help reduce the likelihood of recurrent flares 7.