From the Guidelines
Acute gout treatment involves prompt use of anti-inflammatory medications to reduce pain and swelling, with first-line options including corticosteroids, NSAIDs, or colchicine, as recommended by the American College of Physicians 1.
Treatment Options
- Corticosteroids, such as prednisolone at a dose of 35 mg for 5 days, are effective and generally safer than NSAIDs, with fewer adverse effects 1.
- NSAIDs, including naproxen and indomethacin, are also effective, but may have adverse effects such as dyspepsia and gastrointestinal perforations, ulcers, and bleeding 1.
- Colchicine, using a loading dose of 1.2mg followed by 0.6mg one hour later, then 0.6mg once or twice daily until symptoms resolve, is also effective, especially when started early 1.
Lifestyle Modifications
- Patients should be advised to rest the affected joint, apply ice for 20 minutes several times daily, and maintain adequate hydration during an acute attack 1.
- Urate-lowering therapy should not be initiated during an acute attack as it may worsen symptoms, but existing therapy should be continued 1.
Key Considerations
- The choice of treatment should be based on the presence of contraindications, the patient’s previous experience with treatments, time of initiation after flare onset, and the number and type of joint(s) involved 1.
- Prophylaxis against flares should be fully explained and discussed with the patient, and recommended prophylactic treatment is colchicine, 0.5–1 mg/day, a dose that should be reduced in patients with renal impairment 1.
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. The treatment for acute gouty arthritis is indomethacin capsules 50 mg three times a day until 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 for acute gouty arthritis includes several options, such as:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4, 5, 6, 7
- Colchicine 3, 4, 5, 6, 7
- Corticosteroids 3, 4, 5, 6, 7
- Adrenocorticotropic hormone (ACTH) 6, 7
- Interleukin-1 (IL-1) inhibitors, such as canakinumab 7
Considerations for Treatment
When selecting a treatment option, several factors should be considered, including:
- Comorbidities, such as renal insufficiency, gastrointestinal bleeding, and haemorrhage diathesis 3, 5
- Potential adverse effects, such as gastrointestinal toxicity and renal impairment 3, 5
- Pharmacokinetic properties, such as rapid absorption and short half-life 3
- Patient preference and lifestyle modifications to reduce serum urate levels 4, 5
Dosage and Administration
The dosage and administration of these treatment options may vary depending on the patient's condition and response to treatment. For example:
- Colchicine should be administered hourly or 2-hourly, but alternative schedules, such as 8-hourly administration, may be equally effective and have fewer adverse effects 3
- NSAIDs should be selected based on their pharmacokinetic properties and potential adverse effects 3
- Corticosteroids may be administered orally, intramuscularly, or intra-articularly 5, 7