What are the treatment options for acute inflammation?

Treatment Options for Acute Inflammation

For acute inflammation, NSAIDs at full anti-inflammatory doses are the first-line pharmacologic treatment, with corticosteroids reserved for severe cases or when NSAIDs are contraindicated. 1, 2

Initial Assessment and Treatment Timing

Treatment should be initiated within 24 hours of symptom onset for optimal effectiveness. 1, 3, 2 The severity of inflammation, number of affected sites, and patient-specific contraindications determine the treatment approach. 1, 2

First-Line Pharmacologic Options

NSAIDs (Preferred Initial Therapy)

NSAIDs should be used at full FDA-approved anti-inflammatory/analgesic doses to reduce swelling and control pain. 1, 2, 4 For acute inflammatory conditions like gout, naproxen has demonstrated significant clearing of inflammatory changes (decreased swelling, heat) within 24-48 hours, with pain relief beginning within 1 hour and lasting up to 12 hours. 4

• Naproxen is FDA-approved for acute inflammatory conditions and has been shown to cause statistically significantly less gastric bleeding than aspirin in comparative studies. 4
• Effects may not be seen for several days in severe cases, and gastrointestinal side effects are common. 5
• Avoid NSAIDs in patients with heart failure, peptic ulcer disease, significant renal disease, or when combined with systemic corticosteroids due to increased gastrointestinal toxicity risk. 2

Corticosteroids (For Severe Inflammation or NSAID Contraindications)

Corticosteroids are indicated when NSAIDs are contraindicated or for severe inflammatory presentations. 1, 2, 6

Oral prednisone at 0.5 mg/kg per day for 5-10 days is an appropriate regimen for acute inflammation. 1, 2 Prednisone is FDA-indicated for acute gouty arthritis, acute and subacute bursitis, acute nonspecific tenosynovitis, and other acute inflammatory conditions. 6

• Intra-articular corticosteroid injections are effective for 1-2 affected joints, with dosing based on joint size. 1
• A brief course of topical corticosteroids may be indicated for severe conjunctival or eyelid inflammation. 1
• Major precautions: Corticosteroids can boost secondary infections through immunosuppression or mask infections through anti-inflammatory activity. 7 The benefit/risk ratio must be carefully weighed. 7

Colchicine (Specific Inflammatory Conditions)

For acute gout specifically, low-dose colchicine (1.2 mg followed by 0.6 mg one hour later) is as effective as higher doses with fewer gastrointestinal side effects when started within 36 hours of symptom onset. 1, 3, 2

Non-Pharmacologic Adjunctive Measures

Physical Methods (Immediate Application)

• Ice application immediately after injury for mild cases. 3, 5
• Adequate rest for the injured site. 5
• Ultrasound and electrical stimulation may be needed for more severe cases. 5

When to Advance to Rehabilitation

Once inflammation is controlled and repair is underway, therapeutic exercises should restore range of motion, strength, and endurance. 5 The injured site should be protected (e.g., taped) during exercise until rehabilitation is complete. 5

Treatment Algorithm by Severity

Mild inflammation (1-3 small joints or localized area):

• Ice application and rest 5
• NSAIDs at full anti-inflammatory doses 1, 2
• Analgesics alone if pain is the only symptom 5

Moderate to severe inflammation (polyarticular or systemic symptoms):

• NSAIDs at full doses OR oral corticosteroids 1, 2
• Consider combination therapy for severe presentations 1
• Ultrasound/electrical stimulation as adjuncts 5

Contraindications to NSAIDs present:

• Oral prednisone 0.5 mg/kg/day for 5-10 days 1, 2
• Intra-articular corticosteroids for accessible joints 1

Critical Pitfalls to Avoid

• Delaying treatment beyond 24 hours significantly reduces effectiveness. 1, 3, 2
• Using analgesics alone when inflammation is present rather than anti-inflammatory agents. 5
• Combining NSAIDs with systemic corticosteroids increases gastrointestinal toxicity risk. 2
• Failing to protect the injured site during rehabilitation can prolong recovery. 5
• Prescribing corticosteroids without considering infection risk, as they can mask or worsen infections through immunosuppression. 7