What is the treatment for acute gouty arthritis?

From the Guidelines

Acute Gout Treatment Acute gout treatment typically involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin 50mg orally every 8 hours or naproxen 500mg orally twice daily for 3-5 days 1. Alternatively, colchicine 1.2mg orally at the onset of attack, followed by 0.6mg orally every hour until relief is obtained or gastrointestinal side effects occur, may be used 1. Corticosteroids, such as prednisone 20-30mg orally daily for 3-5 days, can also be employed for acute gout management, particularly in patients with contraindications to NSAIDs or colchicine 1.

• Key Treatment Options:
  • NSAIDs (e.g. indomethacin, naproxen)
  • Colchicine
  • Corticosteroids (e.g. prednisone)
• Important Considerations:
  • Patient contraindications (e.g. renal disease, heart failure)
  • Previous response to pharmacologic therapies
  • Associated comorbidities
  • Time since onset of acute gout attack
• Evidence-Based Recommendations:
  • The American College of Physicians (ACP) recommends using corticosteroids, NSAIDs, or colchicine to treat patients with acute gout 1.
  • The European League Against Rheumatism (EULAR) recommends using oral colchicine and/or NSAIDs as first-line agents for systemic treatment of acute gout 1.

From the FDA Drug Label

In patients with acute gout, a favorable response to naproxen was shown by significant clearing of inflammatory changes (e.g., decrease in swelling, heat) within 24 to 48 hours, as well as by relief of pain and tenderness. Indomethacin capsules have been found effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis PredniSONE Tablets are indicated for the treatment of acute gouty arthritis as adjunctive therapy for short-term administration.

The treatment for acute gouty arthritis includes naproxen 2, indomethacin 3, and prednisone 4 for short-term administration to relieve pain, reduce inflammation, and manage symptoms.

From the Research

Treatment Options for Acute Gouty Arthritis

The treatment of acute gouty arthritis involves several options, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) 5, 6, 7, 8
• Colchicine 5, 6, 8
• Corticosteroids 5, 6, 8

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are commonly used to treat acute gout, with several options available, including:

• Non-selective NSAIDs 7
• Selective cyclo-oxygenase-2 (COX-2) inhibitors (COXIBs) 7 NSAIDs may result in little to no difference in pain, function, and inflammation compared to placebo, but may increase withdrawals due to adverse events and total adverse events 7.

Colchicine

Colchicine is an effective treatment for acute gout, but may have gastrointestinal side effects at high dosages 5, 6. It should not be prescribed to patients with severe renal insufficiency or combined hepatic-renal insufficiency 5.

Corticosteroids

Corticosteroids are an effective alternative to NSAIDs and colchicine, and can be given orally or parenterally in patients with dysphagia 6. They may be used in cases of renal insufficiency, and are probably equally beneficial to NSAIDs in terms of pain relief, improvement in function, and treatment success 7.

Urate Lowering Therapy

Urate lowering therapy, such as allopurinol or febuxostat, may be initiated after symptoms of the acute attack have subsided to prevent further attacks 6, 8. The choice of drug depends on the individual risk profile and renal function 6, 8.