From the Guidelines
The treatment for acute gouty arthritis is primarily focused on relieving pain and inflammation, with options including corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine.
Treatment Options
- Corticosteroids: can be used orally or via articular injection, with a typical dose of 30-35 mg/day of equivalent prednisolone for 3-5 days 1
- NSAIDs: can be used, but should be avoided in patients with severe renal impairment, and should be used with proton pump inhibitors if appropriate 1
- Colchicine: should be used at a low dose, with a loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1, and should be avoided in patients with severe renal impairment or those receiving strong P-glycoprotein and/or CYP3A4 inhibitors 1
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
- Patients should be fully informed and educated to self-medicate at the first warning symptoms of an acute flare 1
- Prophylaxis against flares should be considered, especially during the first 6 months of urate-lowering therapy (ULT), with recommended prophylactic treatment being colchicine, 0.5-1 mg/day 1
From the Research
Treatment Options for Acute Gouty Arthritis
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are a common treatment option for acute gouty arthritis, as they can help reduce pain and inflammation 2, 3, 4, 5.
- Colchicine is another effective treatment for acute gout, with low-dose colchicine demonstrating a comparable tolerability profile to placebo and a significantly lower side effect profile to high-dose colchicine 2, 3, 4, 5.
- Corticosteroids, including oral and intramuscular use, have similar efficacy to therapeutic doses of NSAIDs and can be used to treat acute gouty arthritis 3, 4, 5.
- Other treatment options for acute gout include adrenocorticotropic hormone (ACTH), interleukin-1 (IL-1) inhibitors, and topical ice 4.
- The choice of treatment for acute gouty arthritis should be guided by comorbidities and the patient's individual needs 3, 6.
Prevention of Recurrent Gout
- Xanthine oxidase inhibitors, such as allopurinol and febuxostat, are effective treatments for reducing concentrations of uric acid and preventing recurrent gout 2, 3, 5, 6.
- Uricosuric drugs, such as probenecid, can increase uric acid excretion and may be used in patients who do not respond to other treatments 2, 3, 6.
- Prophylaxis with NSAIDs, colchicine, or corticosteroids is universally recommended when initiating urate-lowering therapy to prevent acute gouty arthritis for a period of at least 6 months 5.