From the Guidelines
Allopurinol is the most effective medicine for long-term gout management, with a typical starting dose of 100mg daily, gradually increasing to 300-600mg daily as needed to reach target uric acid levels below 6 mg/dL. For acute gout attacks, the American College of Physicians recommends choosing corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout, with high-quality evidence showing that these treatments are effective in reducing pain 1.
Some key points to consider when managing gout include:
- Proper hydration, with 8-10 glasses of water daily, to help reduce uric acid levels in the blood
- Limiting alcohol and purine-rich foods, such as red meat and seafood, to reduce uric acid production
- Maintaining a healthy weight to reduce the risk of gout attacks
- Continuing uric acid-lowering therapy, such as allopurinol, during acute attacks to prevent further crystal formation in joints
The European League Against Rheumatism (EULAR) also recommends allopurinol as the first-line urate-lowering therapy, with a target serum uric acid level of <6 mg/dL (360 mmol/L) and <5 mg/dL (300 mmol/L) in patients with severe gout 1. For those who cannot tolerate allopurinol, febuxostat (Uloric) is an alternative option, starting at 40mg daily.
It's worth noting that the management of gout should be individualized, taking into account the patient's medical history, comorbidities, and lifestyle. The goal of treatment is to reduce uric acid levels, prevent crystal formation, and alleviate symptoms, ultimately improving the patient's quality of life.
From the FDA Drug Label
In patients with acute gout, a favorable response to naproxen was shown by significant clearing of inflammatory changes (e.g., decrease in swelling, heat) within 24 to 48 hours, as well as by relief of pain and tenderness. Indomethacin capsules 50 mg t.i. d. until pain is tolerable. The dose should then be rapidly reduced to complete cessation of the drug. Definite relief of pain has been reported within 2 to 4 hours. Tenderness and heat usually subside in 24 to 36 hours, and swelling gradually disappears in 3 to 5 days.
Naproxen and Indomethacin are both effective for treating acute gout.
- Naproxen provides relief of pain and tenderness, and significant clearing of inflammatory changes within 24 to 48 hours.
- Indomethacin provides definite relief of pain within 2 to 4 hours, and tenderness and heat usually subside in 24 to 36 hours. The choice between Naproxen and Indomethacin should be based on individual patient needs and medical history, as both drugs have their own set of potential side effects and interactions 2, 3, 3.
From the Research
Treatment Options for Gout
The treatment of gout involves the use of various medications to manage symptoms and prevent future attacks. Some of the most commonly used medications for gout include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 4, 5, 6
- Colchicine 4, 5, 7
- Corticosteroids 4, 5, 7
- Urate-lowering therapy (ULT) 7
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are widely used to treat acute gout attacks. They work by reducing inflammation and relieving pain. Some examples of NSAIDs used to treat gout include:
- Indomethacin
- Ibuprofen
- Naproxen
- Celecoxib (a COX-2 inhibitor) 5, 6 Studies have shown that NSAIDs are effective in reducing pain and inflammation in acute gout attacks 5, 6. However, they may have adverse effects, such as gastrointestinal bleeding and renal impairment 4, 6.
Colchicine
Colchicine is another medication commonly used to treat gout. It works by reducing inflammation and relieving pain. However, it can have adverse effects, such as gastrointestinal toxicity 4, 5. Low-dose colchicine has been shown to be effective and have a better tolerability profile compared to high-dose colchicine 5.
Corticosteroids
Corticosteroids, such as prednisone and triamcinolone, can be used to treat acute gout attacks. They work by reducing inflammation and relieving pain. However, they may have adverse effects, such as weight gain and mood changes 4, 5.
Urate-Lowering Therapy (ULT)
ULT is used to prevent future gout attacks by reducing uric acid levels in the blood. Some examples of ULT medications include: