From the Guidelines
For acute treatment of monosodium urate crystal deposition in the knee (gout), I strongly recommend choosing corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine as the first-line treatment options. According to the American College of Physicians guideline 1, these medications are effective in reducing pain and inflammation in patients with acute gout.
Treatment Options
- NSAIDs such as naproxen 500mg twice daily or indomethacin 50mg three times daily for 3-5 days can be used as a first-line treatment.
- Colchicine can be used at 1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily for 7-10 days, with a strong recommendation to use low-dose colchicine 1.
- For patients with contraindications to these medications, corticosteroids are effective options, either as an intra-articular injection (methylprednisolone 40-80mg) or oral prednisone (30-40mg daily, tapered over 7-10 days).
Additional Measures
- Joint rest, ice application for 20 minutes several times daily, and elevation of the affected limb will help reduce pain and swelling.
- Adequate hydration is important to help eliminate urate crystals.
- These treatments work by reducing inflammation caused by the immune response to urate crystals in the joint space.
Long-term Management
Once the acute attack resolves, patients should discuss long-term urate-lowering therapy with their healthcare provider to prevent recurrent attacks and joint damage, considering the benefits, harms, costs, and individual preferences 1.
From the Research
Acute Treatment for Monourate Crystals in Knee
- The treatment of acute gout, which is caused by the deposition of monosodium urate crystals in and around joints, typically involves the use of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and colchicine 2, 3, 4, 5.
- NSAIDs are commonly used to treat acute gout and have been shown to be effective in reducing pain and inflammation, although they may have little to no effect on function or adverse events 2.
- Colchicine is also effective in treating acute gout, with low-dose colchicine being associated with fewer adverse events than high-dose colchicine 4.
- Corticosteroids, including systemic and intraarticular glucocorticoids, have been shown to be effective in treating acute gout, with moderate-quality evidence suggesting that they are as effective as NSAIDs but safer 5.
- Interleukin-1 (IL-1) inhibitors, such as canakinumab, have also been shown to be effective in treating acute gout, with moderate-quality evidence suggesting that they are more effective than a single dose of intramuscular glucocorticoids and equally safe 5.
Comparison of Treatments
- A comparison of NSAIDs and COX-2 inhibitors found 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 2.
- A comparison of NSAIDs and glucocorticoids found 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 2.
- A comparison of colchicine and NSAIDs found that low-dose colchicine may be an effective treatment for acute gout, with similar benefits to NSAIDs but fewer adverse events 4.
Current Management Approaches
- Current management approaches for gout include treating acute flares, addressing gout through the long-term regulation of serum urate, and prophylaxis against gouty flares during urate lowering 6.
- The treatment of acute gout should be individualized, taking into account the patient's medical history, comorbidities, and concomitant medications 3, 5.