From the Guidelines
For treating a gout attack, start with an anti-inflammatory medication as soon as symptoms begin, with corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine being recommended options, as stated by the American College of Physicians 1. The choice of medication depends on the patient's medical history, current medications, and the severity of the attack.
- NSAIDs like naproxen (500mg twice daily) or indomethacin (50mg three times daily) can be used for 3-5 days to reduce pain and inflammation.
- Colchicine is effective when started early (1.2mg immediately, followed by 0.6mg one hour later, then 0.6mg once or twice daily until the attack resolves) and is recommended to be used at a low dose 1.
- For severe attacks or when other medications aren't suitable, oral prednisone (30-40mg daily for 3-5 days, then taper) may be prescribed. In addition to medication, rest the affected joint, apply ice for 20-30 minutes several times daily, and elevate it to reduce pain and swelling.
- Stay well-hydrated but avoid alcohol and purine-rich foods (red meat, seafood, organ meats) during an attack. These treatments work by reducing inflammation caused by urate crystal deposits in the joint. Once the acute attack resolves, discuss long-term urate-lowering therapy with your doctor to prevent future attacks, especially if you have recurrent gout, as recommended by the American College of Physicians 1.
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. Naproxen can be used for the treatment of gout attacks, with a favorable response expected within 24 to 48 hours, including:
- Decrease in swelling
- Decrease in heat
- Relief of pain
- Relief of tenderness 2
From the Research
Treatment Options for Gout Attacks
- NSAIDs and COX-2 inhibitors are effective agents for the treatment of acute gout attacks 3
- Systemic corticosteroids have similar efficacy to therapeutic doses of NSAIDs, with studies supporting oral and intramuscular use 3
- Oral colchicine is effective, with low-dose colchicine demonstrating a comparable tolerability profile as placebo and a significantly lower side effect profile to high-dose colchicine 3
- The IL-1β inhibitory antibody, canakinumab, is effective for the treatment of acute attacks in subjects refractory to and in those with contraindications to NSAIDs and/or colchicine 3, 4
Prophylaxis for Gout Flares
- Low-dose colchicine (0.5 mg once or twice a day) or low-dose NSAIDs such as naproxen 250 mg orally twice a day are recommended for prophylaxis of gout flares after initiation of urate-lowering therapy 4
- Low-dose corticosteroids (prednisone or prednisolone) may be used if colchicine and NSAIDs are contraindicated, not tolerated, or ineffective 4
- IL-1 inhibitors, such as canakinumab and rilonacept, may be an option for patients with gout who have intolerance or contraindication to colchicine, NSAIDs, or corticosteroids 4
Management of Gout
- Obtaining an accurate patient history, including comorbidities, concomitant medications, and familial history, is important for optimal results 5
- Therapeutic options for treating acute gout flares include colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids 5
- Prophylaxis with a flare prevention medication, such as colchicine, should be administered after flare remission, followed by initiation of urate-lowering therapy with allopurinol or febuxostat 5