From the Guidelines
The main treatments for gout focus on pain relief during acute attacks and prevention of future flares, with first-line options including colchicine, NSAIDs, and corticosteroids. For acute gout attacks, 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 1.
Key Treatment Options
- Colchicine (1 mg loading dose, followed by 0.5 mg on day 1) is effective when started early, but should be avoided in patients with severe renal impairment or those receiving strong P-glycoprotein and/or CYP3A4 inhibitors 1.
- NSAIDs (plus a proton pump inhibitor if appropriate) are also first-line options, but should be used with caution in patients with renal impairment or gastrointestinal issues 1.
- Corticosteroids (30–35 mg/day of equivalent prednisolone for 3–5 days) can be used for patients who cannot take NSAIDs or colchicine, and can also be administered via articular aspiration and injection 1.
Long-term Management
For long-term management, medications that lower uric acid levels are prescribed, but the decision to initiate urate-lowering therapy should be based on individual patient factors, including the frequency and severity of gout attacks, and patient preferences 1.
Lifestyle Modifications
Lifestyle modifications, including weight loss if overweight, limiting alcohol (especially beer), avoiding high-purine foods like organ meats and shellfish, and staying well-hydrated, are also important for managing gout and preventing future flares 1.
From the FDA Drug Label
The dosage of allopurinol tablets to accomplish full control of gout and to lower serum uric acid to normal or near-normal levels varies with the severity of the disease. KRYSTEXXA® (pegloticase) is a PEGylated uric acid specific enzyme indicated for the treatment of chronic gout in adult patients refractory to conventional therapy Probenecid tablets are indicated for the treatment of the hyperuricemia associated with gout and gouty arthritis.
The main treatments for gout include:
- Allopurinol (2): a xanthine oxidase inhibitor that reduces serum uric acid levels
- Pegloticase (3): a PEGylated uric acid specific enzyme for the treatment of chronic gout in adult patients refractory to conventional therapy
- Probenecid (4): a uricosuric agent that increases the excretion of uric acid in the urine
These treatments aim to reduce serum uric acid levels and prevent gout attacks.
From the Research
Main Treatments for Gout
The main treatments for gout can be categorized into two main types: treatments for acute gout flares and urate-lowering therapies to prevent future flares.
- Treatments for acute gout flares include:
- Urate-lowering therapies aim to prevent gout flares and include:
Treatment Considerations
Treatment choices are guided by comorbidities, such as chronic kidney disease and ischemic heart disease, as well as patient preference 5, 7.
- Non-pharmacologic treatments and pharmacologic treatments, including monotherapy versus combination therapy, are also considered in the treatment of acute gout 8.
- The use of adrenocorticotropic hormone (ACTH) has been suggested as an effective treatment for acute gout, with evidence showing its efficacy in reducing acute inflammation 6, 9.
Emerging Therapies
There are emerging therapies in development for the treatment of gout, including new uricosuric agents and other treatments that have not yet reached clinical practice 5, 7.