From the Guidelines
Naproxen is a viable treatment option for acute gout flares, but corticosteroids should be considered as first-line therapy due to their safety and efficacy, as evidenced by high-quality evidence from the American College of Physicians 1.
Treatment Considerations
When considering naproxen for gout treatment, it's essential to weigh the benefits against potential risks, particularly in patients with renal disease, heart failure, or cirrhosis, as NSAIDs like naproxen can exacerbate these conditions 1.
- Naproxen dosage: Typically prescribed at 500 mg twice daily for 7-14 days until the flare resolves.
- Administration: Take with food to minimize gastrointestinal side effects.
- Additional measures: Rest the affected joint, apply ice for 20 minutes several times daily, and stay well-hydrated.
Alternative Treatments
For patients with contraindications to NSAIDs or those who do not respond to naproxen, alternative treatments include:
- Colchicine: Effective for acute gout, but more expensive than NSAIDs or corticosteroids, with potential gastrointestinal adverse effects 1.
- Corticosteroids: Shown to be as effective as NSAIDs for managing gout, with fewer adverse effects, making them a preferred first-line option for patients without contraindications 1.
Long-term Management
While naproxen is effective for acute flares, it does not lower uric acid levels and is not suitable for long-term prevention. For recurrent gout attacks, consider urate-lowering therapy, such as allopurinol, alongside lifestyle modifications:
- Weight management
- Limiting alcohol intake
- Reducing consumption of purine-rich foods High-strength evidence supports the use of urate-lowering therapy to reduce the long-term risk of acute gout attacks 1.
From the FDA Drug Label
Naproxen tablets are also indicated: For relief of the signs and symptoms of acute gout 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.
Naproxen can be used for the treatment of acute gout. It has been shown to provide relief from signs and symptoms of acute gout, including pain and inflammatory changes, within 24 to 48 hours 2. The FDA-approved indication for naproxen includes the relief of signs and symptoms of acute gout 2.
From the Research
Gout Treatment with Naproxen
- Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) that can be used to treat gout flares 3
- A study comparing naproxen and prednisolone for the treatment of monoarticular gout found that both treatments were equally effective in reducing pain over 4 days 3
- The study found that after 90 hours, the reduction in pain score was 44.7 mm for prednisolone and 46.0 mm for naproxen, suggesting equivalence between the two treatments 3
- Adverse effects were similar between the two groups and were minor and resolved by 3-week follow-up 3
Comparison with Other Treatments
- Other studies have discussed the use of NSAIDs, colchicine, and glucocorticoids as first-line agents for gout flares, with IL-1β antagonists being highly effective but costly 4
- Urate-lowering therapies such as allopurinol and febuxostat are also commonly used to treat gout, with febuxostat having a higher persistence rate than allopurinol in some studies 5
- Emerging therapies such as pegloticase and novel uricosurics are also being developed to treat gout 4, 6
Key Findings
- Naproxen is an effective treatment for gout flares, with equivalent efficacy to prednisolone in some studies 3
- The choice of treatment for gout should be individualized based on patient characteristics and medical history 4, 6
- Further research is needed to fully understand the efficacy and safety of different treatments for gout, including naproxen 4, 6