From the Guidelines
The best treatment option for an acute gout episode is a short course of anti-inflammatory medication, with corticosteroids being the preferred first-line option due to their effectiveness and safety profile, as supported by high-quality evidence from the American College of Physicians 1.
Key Considerations
- Corticosteroids, such as prednisolone at a dose of 35 mg for 5 days, are effective in reducing pain and inflammation in patients with acute gout, with fewer adverse effects compared to NSAIDs 1.
- NSAIDs, including naproxen and indomethacin, are also effective options, but may have more adverse effects, such as gastrointestinal issues, and are contraindicated in patients with renal disease, heart failure, or cirrhosis 1.
- Colchicine is another effective option, but may have more gastrointestinal adverse effects and is contraindicated in patients with renal or hepatic impairment 1.
Treatment Approach
- Treatment should be started as soon as possible after symptom onset to reduce pain and inflammation.
- The affected joint should be rested, elevated, and ice can be applied for 20 minutes several times daily.
- Adequate hydration is important, but urate-lowering therapy should not be initiated during an acute attack as it may worsen symptoms.
Patient Education
- Patients should be educated on the importance of early treatment and the potential benefits and risks of different treatment options.
- Lifestyle modifications, such as weight loss, avoidance of alcohol and sugar-sweetened drinks, and regular exercise, may also be beneficial in reducing the risk of future gout attacks, as recommended by the European League Against Rheumatism (EULAR) 1.
From the FDA Drug Label
The recommended dose of Colchicine Tablets, USP for treatment of a gout flare is 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later. Indomethacin capsules have been found effective in relieving the pain, reducing the fever, swelling, redness, and tenderness of acute gouty arthritis.
The best treatment option for an acute gout episode is Colchicine or Indomethacin.
- Colchicine: 1.2 mg at the first sign of the flare, followed by 0.6 mg one hour later.
- Indomethacin: dosage is not specified in the provided text for acute gout episode, but it has been found effective in relieving the pain and reducing the symptoms of acute gouty arthritis. 2 2 3
From the Research
Treatment Options for Acute Gout
- The standard pharmacotherapies for gout flares include colchicine, NSAIDs, and oral or intramuscular corticosteroids, with IL-1 inhibitors as an option for flare refractory to standard therapies 4.
- NSAIDs, COX-2 inhibitors, corticosteroids, colchicine, ACTH, and canakinumab have evidence to suggest efficacy in the treatment of acute gout 5.
- The drugs of first choice for acute gouty arthritis are nonsteroidal anti-inflammatory drugs (NSAID), corticosteroids, and colchicine 6.
- GC, NSAID, low-dose colchicine, and canakinumab all effectively treat acute gout, with insufficient evidence to rank them 7.
Colchicine for Acute Gout
- Low-dose colchicine may improve treatment outcome compared to placebo with little or no increased risk of adverse events 8.
- High-dose colchicine compared to placebo may improve symptoms, but with increased risk of harms 8.
- Low-dose colchicine may be an effective treatment for acute gout when compared to placebo, and its benefits may be similar to NSAIDs 8.
Comparison of Treatment Options
- Systemic GC appeared safer than NSAID and lower-dose colchicine was safer than higher-dose colchicine 7.
- Low-quality evidence suggests that high-dose (but not low-dose) colchicine may increase the number of adverse events compared to placebo, while low-quality evidence indicates that the number of adverse events may be similar with low-dose colchicine and NSAIDs 8.