Duration of NSAID Therapy for Pseudogout
NSAIDs for pseudogout should be continued at full anti-inflammatory doses for 5-10 days, or until complete resolution of the acute attack, then stopped. 1
Evidence-Based Duration Recommendations
While the provided evidence focuses primarily on gout rather than pseudogout specifically, the treatment principles and duration are clinically identical for both crystal arthropathies. The most relevant guideline evidence indicates:
Standard Treatment Duration
- Continue NSAIDs at maximum FDA-approved doses until the acute attack has completely resolved 1
- Typical duration is 5-10 days at full dose, then stop 1
- For severe or polyarticular attacks, treatment may extend to the full 10-day course 1
Clinical Approach
The treatment strategy mirrors that used for acute gout flares:
- Start NSAIDs immediately at full anti-inflammatory doses (e.g., indomethacin 50 mg three times daily, naproxen 500 mg twice daily, or ibuprofen 800 mg three times daily) 2
- Maintain full dosing throughout the acute inflammatory phase - do not taper the dose during active inflammation 1
- Discontinue abruptly once symptoms resolve rather than tapering, as there is no evidence supporting a taper for acute crystal arthropathy 1
Important Caveats
Monitor for NSAID-related adverse effects, particularly gastrointestinal complications (dyspepsia, ulcers, bleeding) and renal impairment, which are the primary concerns with short-term high-dose use 2
Avoid prolonged courses beyond 10-14 days as long-term use of higher doses can cause chronic renal insufficiency and increase cardiovascular risk 2
Consider alternative agents if NSAIDs are contraindicated: Corticosteroids (prednisone 30-35 mg daily for 5 days) are equally effective and safer in patients with renal impairment, cardiovascular disease, or gastrointestinal contraindications 1