From the Guidelines
Gout treatment should prioritize urate-lowering therapy (ULT) with allopurinol as the first-line option, along with lifestyle modifications and anti-inflammatory prophylaxis for acute attacks, as recommended by the 2020 American College of Rheumatology guideline 1.
Treatment Options for Gout
The management of gout involves both immediate relief for acute attacks and long-term management to prevent recurrences. For acute gout attacks, the following options are recommended:
- Colchicine (1.2mg followed by 0.6mg one hour later, then 0.6mg once or twice daily) if started within 24 hours of symptom onset
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen (500mg twice daily) or indomethacin (50mg three times daily) for 3-5 days
- Glucocorticoids (oral, intraarticular, or intramuscular) for those who cannot take NSAIDs or colchicine ### Long-term Management For long-term management, the following are recommended:
- Urate-lowering therapy (ULT) with allopurinol (starting at 100mg daily, gradually increasing to 300-600mg daily) or febuxostat (40-80mg daily) for patients with frequent attacks, tophi, joint damage, or kidney stones
- Lifestyle modifications, including:
- Limiting alcohol (especially beer)
- Reducing intake of purine-rich foods like red meat and seafood
- Maintaining a healthy weight
- Staying hydrated
- A treat-to-target management strategy with ULT dose titration guided by serial serum urate (SU) measurements, with an SU target of <6 mg/dl 1 ### Important Considerations When initiating ULT, concomitant anti-inflammatory prophylaxis therapy for a duration of at least 3-6 months is strongly recommended 1. Additionally, patients with moderate-to-severe chronic kidney disease (CKD; stage ≥3) should start with a low dose of allopurinol (≤100 mg/day) or febuxostat (≤40 mg/day) 1.
From the FDA Drug Label
The efficacy of KRYSTEXXA was studied in adult patients with chronic gout refractory to conventional therapy Indomethacin capsules have been found effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis Probenecid tablets are indicated for the treatment of the hyperuricemia associated with gout and gouty arthritis
The treatment options for Gout (Gouty Arthritis) include:
- Pegloticase (IV): for adult patients with chronic gout refractory to conventional therapy 2
- Indomethacin (PO): for relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis 3
- Probenecid (PO): for the treatment of the hyperuricemia associated with gout and gouty arthritis 4 Key points:
- These medications have different mechanisms of action and are used in different stages of gout treatment
- Pegloticase is used for chronic gout refractory to conventional therapy
- Indomethacin is used for acute gouty arthritis
- Probenecid is used for the treatment of hyperuricemia associated with gout and gouty arthritis