What advice and treatment should be provided to an adult patient with a suspected gout flare in the knee?

Management of Suspected Gout Flare in the Knee

For a suspected gout flare in your knee, start treatment immediately with one of three equally effective first-line medications: colchicine (1.2 mg followed by 0.6 mg one hour later), a full-dose NSAID like indomethacin or naproxen, or prednisone 30-35 mg daily for 3-5 days—the single most important factor for success is starting treatment within the first 12 hours of symptoms, not which medication you choose. 1, 2

Immediate Treatment Options

You have three equally effective choices for treating your acute gout flare, and the decision depends on your other medical conditions: 3, 1

Option 1: Colchicine

• Dosing: Take 1.2 mg (two tablets) immediately at the first sign of the flare, followed by 0.6 mg (one tablet) one hour later 4
• Maximum dose: 1.8 mg total over one hour 4
• Most effective when: Started within 12 hours of symptom onset 1, 2
• Do NOT use if you have: Severe kidney disease (GFR <30 mL/min) or are taking certain antibiotics like clarithromycin, cyclosporine, or other strong drug interactions 1, 4

Option 2: NSAIDs (Full Anti-inflammatory Doses)

• Examples: Indomethacin 50 mg three times daily, or naproxen 500 mg twice daily 1
• Do NOT use if you have: Peptic ulcer disease, kidney failure, uncontrolled high blood pressure, heart failure, or cardiovascular disease 1, 2

Option 3: Prednisone (Oral Corticosteroid)

• Dosing: 30-35 mg once daily for 5 days (no taper needed for short course) 5, 2
• Best choice if you have: Kidney disease, heart problems, or cannot take NSAIDs or colchicine 1, 5
• Safest option for: Patients with multiple medical problems 5

Additional Measures You Can Take

• Apply ice to the affected knee for additional pain relief 3, 1
• Rest the joint and avoid weight-bearing activities 6
• Stay well-hydrated 7

Dietary and Lifestyle Changes to Start Now

To reduce future flare risk, begin these modifications immediately: 7, 8

• Avoid or limit: Organ meats (liver, kidney), shellfish, red meat, beer and other alcoholic beverages, and drinks sweetened with high-fructose corn syrup 1, 7
• Increase consumption of: Low-fat or non-fat dairy products and vegetables 7
• If overweight: Begin a weight loss program 1

Critical Warning Signs

Seek immediate medical attention if: 4

• You develop fever (could indicate joint infection, not gout)
• You experience muscle pain, weakness, or tingling/numbness in fingers or toes while on colchicine
• Symptoms worsen despite treatment after 24-48 hours

What Happens After This Flare

If This Is Your First Gout Attack:

You generally do NOT need to start long-term uric acid-lowering medication (like allopurinol) unless you have: 3

• Kidney disease stage 3 or worse
• Uric acid level >9 mg/dL
• Kidney stones
• Visible tophi (lumps under the skin)

If You Have Frequent Flares (≥2 per year):

You SHOULD start long-term uric acid-lowering therapy with allopurinol, starting at a low dose (≤100 mg/day) and gradually increasing 3, 1

When starting uric acid-lowering medication, you must also take prophylaxis (low-dose colchicine 0.5-0.6 mg once or twice daily, or low-dose prednisone <10 mg/day) for 3-6 months to prevent triggering more flares 1, 5

Common Pitfalls to Avoid

• Don't delay treatment: Every hour you wait reduces effectiveness—treat at the very first sign of symptoms 1, 2
• Don't use high-dose colchicine: The old regimen of taking colchicine every hour is dangerous and no more effective than the low-dose regimen 3, 4
• Don't stop medications you're already taking: If you're already on allopurinol or febuxostat, continue taking it during the flare—stopping it will make the flare worse 1, 2
• Don't take colchicine with certain antibiotics: Fatal toxicity can occur when combined with clarithromycin, erythromycin, or cyclosporine 1, 4

When to Follow Up

Schedule an appointment with your healthcare provider within 1-2 weeks after the flare resolves to: 3

• Confirm the diagnosis (may need joint fluid analysis if uncertain)
• Check uric acid levels
• Determine if long-term prevention therapy is needed
• Review medication interactions and optimize your treatment plan