From the Guidelines
The treatment of acute gout involves prompt management with anti-inflammatory medications, and first-line options include NSAIDs, colchicine, or corticosteroids. According to the American College of Physicians guideline 1, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine are recommended to treat patients with acute gout. The choice of medication should be based on the presence of contraindications, the patient's previous experience with treatments, and the number and type of joint(s) involved.
Some key points to consider when treating acute gout include:
- Treatment should begin within 24 hours of symptom onset for maximum effectiveness
- Rest, ice application to the affected joint, and elevation can provide additional relief
- Adequate hydration is important to help eliminate uric acid
- Patients should avoid alcohol and purine-rich foods during an acute attack
- For those with contraindications to standard therapies, such as renal impairment or gastrointestinal issues, medication selection must be tailored accordingly
- Corticosteroids are often preferred for patients with renal dysfunction
The American College of Rheumatology guidelines also recommend that an acute gouty arthritis attack should be treated with pharmacologic therapy, initiated within 24 hours of onset 1. Additionally, oral colchicine is appropriate first-line gout attack prophylaxis therapy, including with appropriate dose adjustment in chronic kidney disease and for drug interactions 1.
It's worth noting that low-dose colchicine is recommended when using colchicine to treat acute gout 1, and that corticosteroids should be considered as first-line therapy in patients without contraindications 1.
Overall, the goal of treatment is to reduce inflammation and alleviate symptoms, and the choice of medication should be individualized based on the patient's specific needs and medical history.
From the FDA Drug Label
Acute gouty arthritis. Suggested Dosage: Indomethacin capsules 50 mg t.i.d. until pain is tolerable. The dose should then be rapidly reduced to complete cessation of the drug. Definite relief of pain has been reported within 2 to 4 hours. Tenderness and heat usually subside in 24 to 36 hours, and swelling gradually disappears in 3 to 5 days.
The treatment option for acute gouty arthritis is indomethacin. The suggested dosage is 50 mg three times a day until the pain is tolerable, then the dose should be rapidly reduced to complete cessation of the drug 2.
From the Research
Treatment Options for Acute Gouty Arthritis
The treatment of acute gouty arthritis involves several options, including:
- Non-steroidal anti-inflammatory drugs (NSAIDs) 3
- Colchicine 4, 5
- Oral or intramuscular corticosteroids 4, 5
- Interleukin-1 (IL-1) inhibitors, such as anakinra, rilonacept, and canakinumab 4, 6, 5
Urate-Lowering Therapies
Urate-lowering therapies aim to prevent gout flares and include:
- Allopurinol 4, 5, 7
- Febuxostat 4, 5, 7
- Uricosuric agents, such as probenecid and benzbromarone 4, 5, 7
- Recombinant uricases, such as pegloticase and rasburicase 5
Considerations for Treatment
The choice of treatment for acute gouty arthritis depends on various factors, including:
- Patient's age and comorbidities 5
- Presence of renal impairment 5
- Patient preference 4
- Potential side effects and interactions with other medications 4, 5, 3
Emerging Therapies
There are emerging therapies in development for the treatment of gout, including new urate-lowering agents and IL-1 inhibitors 4, 6, 7