From the Guidelines
The recommended treatment for gout is urate-lowering therapy (ULT) with allopurinol as the preferred first-line treatment, along with anti-inflammatory prophylaxis therapy, such as colchicine or nonsteroidal anti-inflammatory drugs (NSAIDs), to prevent acute gout flares.
Urate-Lowering Therapy (ULT)
- Allopurinol is the preferred first-line ULT, with a low starting dose of ≤100 mg/day, which can be titrated upwards to achieve a serum urate (SU) target of <6 mg/dl 1.
- Febuxostat is an alternative ULT option, especially for patients with moderate-to-severe chronic kidney disease (CKD) or those who cannot tolerate allopurinol 1.
Anti-Inflammatory Prophylaxis Therapy
- Colchicine is recommended as a first-line anti-inflammatory prophylaxis therapy, with a dose of 0.5-1 mg/day, to prevent acute gout flares during the first 6 months of ULT 1.
- NSAIDs are also effective in preventing acute gout flares, but should be used with caution in patients with renal impairment or gastrointestinal risks 1.
Management of Acute Gout Flares
- Colchicine, NSAIDs, and glucocorticoids are all effective in treating acute gout flares, and the choice of treatment should be based on individual patient characteristics and safety profiles 1.
- Low-dose colchicine (total dose 1.8 mg in 24 hours) is as effective as high-dose colchicine, but with a better safety profile 1.
Lifestyle Modifications
- Weight loss, avoidance of alcohol and sugar-sweetened drinks, and regular exercise are recommended to reduce serum urate levels and prevent acute gout flares 1.
From the Research
Treatment Options for Gout
The recommended treatment for gout includes:
- Anti-inflammatory agents, such as corticosteroids, NSAIDs, and colchicine, for the treatment of gout flare 2, 3, 4, 5, 6
- Urate-lowering therapy, such as allopurinol, to reduce serum urate levels and prevent gout flares 2, 3, 4, 5, 6
- Febuxostat, another xanthine oxidase inhibitor, as an alternative to allopurinol 3, 4
- Uricosuric drugs, such as probenecid, to increase uric acid excretion 4
- Lesinurad, in combination with xanthine oxidase inhibitors, for patients with refractory gout 5
Acute Gout Management
For acute gout management:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids are equally efficacious and can be used to relieve pain 3, 4, 5, 6
- The choice of treatment should be guided by comorbidities 4
- Prophylaxis of acute gout with NSAIDs, colchicine, or corticosteroids is recommended when initiating urate-lowering therapy to prevent acute gouty arthritis for a period of at least 6 months 6
Long-term Management
For long-term management:
- Sustained reduction in serum urate levels using urate-lowering therapy is vital to dissolve MSU crystals, suppress gout flares, and resolve tophi 2
- Allopurinol is the first-line urate-lowering therapy and should be started at a low dose, with gradual dose escalation 2, 3, 4
- Indications for long-term urate-lowering therapy include chronic kidney disease, two or more flare-ups per year, urolithiasis, the presence of tophus, chronic gouty arthritis, and joint damage 3