What medication is used to treat an acute gout (gouty arthritis) attack?

From the Guidelines

For a gout attack, corticosteroids should be considered as first-line therapy in patients without contraindications, with prednisolone at a dose of 35 mg for 5 days being a recommended option. This is based on the American College of Physicians' clinical practice guideline from 2017, which suggests that corticosteroids are generally safer and a low-cost treatment option compared to other medications 1.

Some key points to consider when treating a gout attack include:

• Corticosteroids, such as prednisolone, have been shown to be as effective as NSAIDs for managing gout, with fewer adverse effects 1
• NSAIDs, including indomethacin, naproxen, and ibuprofen, can be used as alternative options, but may have adverse effects such as dyspepsia and potential gastrointestinal perforations, ulcers, and bleeding 1
• Colchicine is another effective option, with a recommended low-dose regimen of 1.2 mg followed by 0.6 mg 1 hour later, which is as effective as higher doses but with fewer gastrointestinal adverse effects 1
• It is essential to consider the patient's medical history and potential contraindications before initiating treatment, such as renal disease, heart failure, or cirrhosis for NSAIDs, and renal or hepatic impairment for colchicine 1

When treating a gout attack, it is crucial to prioritize the patient's safety and quality of life, and to choose the most effective treatment option with the fewest adverse effects. Corticosteroids, such as prednisolone, are a recommended first-line treatment option due to their efficacy and safety profile. However, it is essential to consult with a healthcare provider to determine the best course of treatment for each individual patient.

From the FDA Drug Label

Acute gouty arthritis. Suggested Dosage: 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. For the treatment of a gout attack, the suggested dosage of indomethacin is 50 mg taken three times a day until the pain is tolerable. The dose should then be rapidly reduced to complete cessation of the drug.

• Key points:
  • Dose: 50 mg t.i.d.
  • Duration: Until pain is tolerable
  • Relief: Definite relief of pain within 2 to 4 hours
  • Resolution: Tenderness and heat subside in 24 to 36 hours, and swelling disappears in 3 to 5 days 2

From the Research

Medication Options for Gout Attack

• Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat acute gout, as they have been shown to be effective in reducing pain and inflammation 3, 4.
• Colchicine is another medication option for acute gout, with low-dose colchicine demonstrating a comparable tolerability profile to placebo and a significantly lower side effect profile compared to high-dose colchicine 3, 5.
• Corticosteroids, including oral and intramuscular forms, have similar efficacy to NSAIDs in treating acute gout 3, 5.
• Interleukin-1 (IL-1) inhibitors, such as canakinumab, have been shown to be effective in treating acute gout, particularly in patients who are refractory to or have contraindications to NSAIDs and/or colchicine 3, 5.
• Adrenocorticotropic hormone (ACTH) has also been suggested to be efficacious in acute gout 3.

Comparison of Medication Options

• NSAIDs and COX-2 inhibitors have been shown to be effective agents for the treatment of acute gout attacks, with similar efficacy to systemic corticosteroids 3.
• Non-selective NSAIDs and selective COX-2 inhibitors (COXIBs) have been compared, with moderate-certainty evidence suggesting that they are probably equally beneficial in terms of improvement in pain, function, inflammation, and treatment success, although non-selective NSAIDs may increase withdrawals due to adverse events and total adverse events 4.
• Systemic glucocorticoids and NSAIDs have been compared, with moderate-certainty evidence suggesting that they are probably equally beneficial in terms of pain relief, improvement in function, and treatment success, although NSAIDs may result in more total adverse events 4.

Treatment Guidelines

• Updated guidelines from various medical organizations, such as the American College of Physicians, the European League Against Rheumatism, and the American College of Rheumatology, provide clear guidance on the optimal use of medication options for acute and chronic gout 6.
• These guidelines emphasize the importance of individualized treatment, taking into account patient comorbidities, preferences, and response to treatment 7, 6.