From the Guidelines
The treatment for acute gout should focus on reducing inflammation and pain quickly, with first-line therapy including corticosteroids, NSAIDs, or colchicine, as recommended by the American College of Physicians 1. The choice of treatment depends on the presence of contraindications, the patient's previous experience with treatments, and the number and type of joints involved.
- Corticosteroids, such as prednisolone at a dose of 35 mg for 5 days, are a safe and low-cost treatment option and should be considered as first-line therapy in patients without contraindications 1.
- NSAIDs, such as naproxen or indomethacin, are also effective in reducing pain and inflammation, but may have adverse effects such as dyspepsia and gastrointestinal perforations 1.
- Colchicine is another effective option, given as 1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily until symptoms resolve, and is recommended to be used at a low dose to minimize adverse effects 1. Additionally, lifestyle modifications such as weight loss, avoidance of alcohol and sugar-sweetened drinks, and regular exercise can help reduce the risk of gout attacks and improve overall health 1. It's also important to continue any existing urate-lowering therapy during the acute attack, as stopping can worsen symptoms, and to maintain adequate hydration and avoid alcohol during an acute attack. Treatment should begin as soon as possible after symptom onset, as early intervention leads to faster resolution. These medications work by reducing the inflammatory response to urate crystals in the joint, which causes the severe pain, swelling, and redness characteristic of acute gout attacks.
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 The treatment for acute gout is indomethacin 2.
- Indomethacin is a non-steroidal anti-inflammatory drug (NSAID) that exhibits antipyretic and analgesic properties.
- It is effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis.
- Prednisone 3 is also indicated for acute gouty arthritis as adjunctive therapy for short-term administration.
From the Research
Treatment Options for Acute Gout
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective agents for the treatment of acute gout attacks 4
- Systemic corticosteroids have similar efficacy to therapeutic doses of NSAIDs, with studies supporting oral and intramuscular use 4
- Colchicine is effective, with low-dose colchicine demonstrating a comparable tolerability profile as placebo and a significantly lower side effect profile to high-dose colchicine 4
- Interleukin-1 (IL-1) inhibitors, such as canakinumab, are effective for the treatment of acute attacks in subjects refractory to and in those with contraindications to NSAIDs and/or colchicine 4
- Adrenocorticotropic hormone (ACTH) is suggested to be efficacious in acute gout 4
Urate-Lowering Therapies
- Allopurinol is an agent of first choice for urate lowering therapy 5
- Febuxostat is another efficacious urate lowering therapy, but has received a U.S. FDA black box warning for cardiovascular safety 5
- Novel uricosurics, such as verinurad and arhalofenate, are agents with future promise 5
- Pegloticase is effective for patients with recalcitrant gout, but its immunogenicity significantly threatens the achievement of sustained urate lowering responses 5
Combination Therapies
- Acute gouty arthritis should be treated with nonsteroidal antiinflammatory drugs (NSAIDs), colchicine, or corticosteroids, or a combination of two agents 6
- Prophylaxis of acute gout with NSAIDs, colchicine, or corticosteroids is universally recommended when initiating any urate-lowering therapy in order to prevent acute gouty arthritis for a period of at least 6 months 6