From the Guidelines
For treating a gout flare, the most effective approach is to start with an anti-inflammatory medication as soon as possible after symptoms begin, with colchicine, NSAIDs, or oral corticosteroids being first-line options. According to the 2020 American College of Rheumatology guideline for the management of gout 1, colchicine, nonsteroidal anti-inflammatory drugs, or glucocorticoids (oral, intraarticular, or intramuscular) are strongly recommended for managing gout flares. The choice of drug 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, as recommended by the 2016 updated EULAR evidence-based recommendations for the management of gout 1.
Some key considerations for treatment include:
- Colchicine should be started within 12 hours of flare onset, with a loading dose of 1 mg followed by 0.5 mg one hour later, then 0.5 mg once or twice daily until the flare resolves 1.
- NSAIDs, such as naproxen or indomethacin, can be used as first-line options for most patients, but should be avoided in patients with severe renal impairment 1.
- Oral corticosteroids, such as prednisone, can be used as an alternative for those who cannot take NSAIDs or colchicine, at a dose of 30-35 mg/day for 3-5 days 1.
- During a flare, rest, ice, and hydration can help reduce pain and swelling.
It's essential to continue the chosen medication until the flare completely resolves, typically 7-10 days, and to discuss long-term urate-lowering therapy with a doctor to prevent future attacks, as recurrent gout flares can lead to joint damage over time.
From the FDA Drug Label
The recommended dose of Colchicine Tablets, USP for treatment of a gout flare is 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later. Higher doses have not been found to be more effective. The maximum recommended dose for treatment of gout flares is 1.8 mg over a one hour period.
The treatment for acute gout (gouty arthritis) flare is 1.2 mg of colchicine at the first sign of the flare, followed by 0.6 mg one hour later. The maximum recommended dose is 1.8 mg over a one hour period 2.
- Key points:
- Initial dose: 1.2 mg
- Second dose: 0.6 mg one hour later
- Maximum dose: 1.8 mg over one hour
- Important consideration: Higher doses have not been found to be more effective.
From the Research
Treatment Options for Acute Gout
The treatment for acute gout (gouty arthritis) flare includes several options, such as:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4, 5, 6
- Colchicine 3, 4, 5, 6
- Corticosteroids (oral or intramuscular) 3, 4, 5, 6
- Interleukin-1 inhibitors (e.g. canakinumab, rilonacept) 4, 6, 7
Considerations for Treatment
When selecting a treatment, several factors should be considered, including:
- The patient's medical history and comorbidities 3, 4, 5, 6
- The potential side effects of each treatment option 3, 4, 5, 6, 7
- The cost and cost-effectiveness of each treatment option 7
- The patient's preference and adherence to treatment 4, 6
Emerging Therapies
New emerging therapies, such as novel uricosurics (e.g. verinurad, arhalofenate) and pegloticase, are being developed and may offer alternative treatment options for patients with acute gout 4, 6.