From the Guidelines
The treatment of gout and pseudogout should focus on managing acute attacks and preventing future episodes, with a strong emphasis on urate-lowering therapy and lifestyle modifications to improve morbidity, mortality, and quality of life. For acute gout attacks, the most recent and highest quality study recommends using corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine as first-line treatments 1.
- NSAIDs like indomethacin (50mg three times daily) or naproxen (500mg twice daily) are effective for 7-10 days.
- Colchicine (1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily) is effective if started within 24 hours of symptom onset, with a recommendation to use low-dose colchicine 1.
- Corticosteroids, such as prednisone (30-40mg daily for 3-5 days with tapering), are options for patients who cannot take NSAIDs or colchicine. For pseudogout, similar anti-inflammatory treatments apply, though response may be less dramatic.
- Joint aspiration and intra-articular steroid injection can provide rapid relief for both conditions. For long-term gout management, urate-lowering therapy with allopurinol (starting at 100mg daily, gradually increasing to 300-600mg daily) or febuxostat (40-80mg daily) is recommended for patients with frequent attacks, tophi, or kidney stones 1.
- These medications inhibit uric acid production, reducing crystal formation.
- Prophylaxis with low-dose colchicine (0.6mg daily) or NSAIDs during the first 3-6 months of urate-lowering therapy helps prevent flares. Lifestyle modifications including weight loss, limiting alcohol (especially beer), avoiding high-purine foods, and adequate hydration are important adjunctive measures for both conditions.
- It is essential to discuss benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks 1.
From the FDA Drug Label
Allopurinol tablets reduce both the serum and urinary uric acid levels by inhibiting the formation of uric acid The use of allopurinol tablets to block the formation of urates avoids the hazard of increased renal excretion of uric acid posed by uricosuric drugs. Colchicine is indicated for the prophylaxis and treatment of gout flares. Gout is a metabolic disorder which is characterized by hyperuricemia and resultant deposition of monosodium urate in the tissues, particularly the joints and kidneys.
The treatments for gout include:
- Allopurinol: a xanthine oxidase inhibitor that reduces serum and urinary uric acid levels
- Colchicine: for prophylaxis and treatment of gout flares
- Uricosuric drugs: increase urinary excretion of uric acid, but may pose a hazard of increased renal excretion of uric acid
There is no information in the provided drug labels about the treatment of pseudogout (calcium pyrophosphate deposition disease). 2, 3, 2
From the Research
Treatments for Gout
- Acute gout treatment options include non-steroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids, administered either intra-articularly, orally, or parenterally 4, 5, 6
- Urate-lowering therapies aim to prevent gout flares, with an emphasis on treat-to-target strategy; the escalation of therapies until the target serum uric acid is reached 4, 6, 7
- Initial treatments for urate-lowering therapy include allopurinol and febuxostat, with uricosuric agents, probenecid, sulfinpyrazone, and benzbromarone, as adjuncts 4, 6, 7
- IL-1 inhibitors are newly established as an option for flare refractory to standard therapies 4
- Lifestyle modifications, such as limiting consumption of purine-rich foods and avoiding alcoholic drinks, can help reduce serum urate levels 7
Treatments for Pseudogout (Calcium Pyrophosphate Deposition Disease)
- Acute treatment for pseudogout is similar to acute gouty arthritis treatment 8
- There is no standard regimen for long-term chronic therapies of pseudogout 8
- Treatment options for pseudogout are not well-established, but may include anti-inflammatory medications and other therapies similar to those used for gout 8