From the Guidelines
For acute gout treatment, corticosteroids, NSAIDs, or colchicine are recommended as first-line therapy, with the choice of drug based on the presence of contraindications, patient's previous experience with treatments, and time of initiation after flare onset. The most recent and highest quality study, published in 2017 in the Annals of Internal Medicine 1, provides strong evidence for this recommendation.
Treatment Options
- NSAIDs like naproxen (500mg twice daily) or indomethacin (50mg three times daily) for 5-7 days
- Colchicine at a loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1
- Oral corticosteroid (30–35 mg/day of equivalent prednisolone for 3–5 days)
- Articular aspiration and injection of corticosteroids
Considerations
- Continue urate-lowering therapy if already established; don't initiate it during an acute flare
- Rest the affected joint, apply ice for 20-minute intervals several times daily to reduce inflammation, and maintain adequate hydration
- Avoid alcohol and purine-rich foods during flares
- These treatments work by reducing inflammation—NSAIDs inhibit prostaglandin synthesis, colchicine prevents neutrophil activation and migration, and corticosteroids suppress multiple inflammatory pathways
Patient Education
- Fully informed patients should be educated to self-medicate at the first warning symptoms
- 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
Indomethacin capsules have been found effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis
- Treatment for acute gouty arthritis is indomethacin, which is effective in relieving pain and reducing inflammation.
- The dosage and administration of indomethacin for acute gouty arthritis is not specified in the provided text, but it is mentioned that indomethacin capsules are virtually 100% bioavailable and have a mean half-life of about 4.5 hours 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 choosing a treatment option, several factors should be considered, including:
- Comorbidities, such as renal insufficiency, gastrointestinal bleeding, and haemorrhage diathesis 3, 4, 5, 6
- Potential adverse effects of each treatment option 3, 4, 5, 6, 7
- The need for prophylaxis to prevent acute flares 4, 6
- The importance of long-term management of gout, including urate-lowering therapy 4, 5, 6
Urate-Lowering Therapy
Urate-lowering therapy is an important aspect of gout management, with options including: