From the Guidelines
For managing an acute gout attack affecting the right foot, I strongly recommend starting with corticosteroids, such as prednisolone at a dose of 35 mg for 5 days, as they are generally safer and a low-cost treatment option with high-quality evidence supporting their effectiveness in reducing pain and inflammation 1.
Key Considerations
- The American College of Physicians guideline on management of acute and recurrent gout recommends corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine as effective treatments to reduce pain in patients with acute gout 1.
- Corticosteroids are considered first-line therapy in patients without contraindications due to their safety profile and efficacy comparable to NSAIDs but with fewer adverse effects 1.
- NSAIDs, such as naproxen or indomethacin, can be used as alternatives, but their use should be cautious in patients with renal disease, heart failure, or cirrhosis due to potential adverse effects like dyspepsia and gastrointestinal complications 1.
- Colchicine is another option, especially for patients who cannot tolerate NSAIDs or corticosteroids, but its use may be limited by its higher cost compared to NSAIDs or corticosteroids 1.
Management Approach
- Rest the affected foot and apply ice for 20 minutes several times daily to reduce pain and swelling.
- Elevate the foot when possible to further reduce swelling.
- Drink plenty of fluids (2-3 liters daily) to help flush uric acid from the body.
- Avoid alcohol and purine-rich foods like red meat, seafood, and organ meats during the acute attack to prevent exacerbating the condition.
- Once the acute attack resolves, discuss with your doctor about long-term urate-lowering therapy if you have recurrent gout attacks, as recommended by guidelines such as those from the American College of Rheumatology 1.
From the FDA Drug Label
Indomethacin capsules have been found effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis
- Management of acute gout attack: Indomethacin is effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis.
- Pain and swelling to right foot: Indomethacin can be used to relieve the pain and swelling associated with acute gouty arthritis, including in the foot. 2
From the Research
Management of Acute Gout Attack
The management of acute gout attack involves several treatment options, including:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4, 5, 6, 7
- Colchicine 3, 4, 6, 7
- Systemic or intra-articular corticosteroids 3, 4, 6, 7
- Interleukin-1 (IL-1) inhibitors, such as canakinumab 4, 7
Treatment Options
The choice of treatment depends on various factors, including:
- Severity of symptoms
- Presence of comorbidities
- Patient's medical history
- Concomitant medications Some studies suggest that:
- NSAIDs are preferable to colchicine due to their more favorable side effect profile 3
- Systemic corticosteroids are commonly used to treat acute gouty arthritis, especially in patients with comorbidities that preclude the use of NSAIDs or colchicine 3
- Intra-articular injections are appropriate in the setting of mono- or oligoarticular involvement 3
- Low-dose colchicine is safer than high-dose colchicine and has a comparable tolerability profile to placebo 4, 7
Efficacy and Safety of Treatments
Studies have shown that:
- NSAIDs, systemic corticosteroids, and low-dose colchicine are effective in treating acute gout 3, 4, 5, 6, 7
- Canakinumab is effective in treating acute gout, especially in patients who are refractory to or have contraindications to NSAIDs and/or colchicine 4, 7
- Systemic corticosteroids appear to be safer than NSAIDs, and lower-dose colchicine is safer than higher-dose colchicine 7