From the Guidelines
Inpatient gout flare treatment should prioritize corticosteroids as first-line therapy due to their effectiveness and safety profile, as evidenced by high-quality evidence from the American College of Physicians guideline 1. When managing acute gout in an inpatient setting, the primary goal is to reduce pain and inflammation. The treatment options include:
- Corticosteroids, such as prednisolone at a dose of 35 mg for 5 days, which have been shown to be as effective as NSAIDs with fewer adverse effects 1
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin or naproxen, which can be used as an alternative to corticosteroids
- Colchicine, which can be used in patients who cannot tolerate corticosteroids or NSAIDs The choice of medication depends on patient comorbidities, such as renal impairment or GI bleeding risk, and the potential for adverse effects. Key considerations in inpatient gout flare treatment include:
- Initiating treatment within 24 hours of flare onset for maximum effectiveness
- Continuing treatment until the flare resolves, typically 7-10 days
- Providing supportive measures, such as adequate hydration, joint rest, and ice application
- Avoiding urate-lowering therapy during an acute flare, unless the patient was already taking it.
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. Inpatient gout flare treatment is with colchicine 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later 2, 2.
- The maximum recommended dose for treatment of gout flares is 1.8 mg over a one hour period.
- Colchicine Tablets, USP may be administered for treatment of a gout flare during prophylaxis at doses not to exceed 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later.
- Wait 12 hours and then resume the prophylactic dose.
From the Research
Inpatient Gout Flare Treatment
The treatment for inpatient gout flare typically involves the use of various medications to manage symptoms and reduce inflammation.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat acute gout attacks, as they have been shown to be effective in reducing pain and inflammation 3.
- Corticosteroids are also used to treat acute gout, with systemic corticosteroids having similar efficacy to therapeutic doses of NSAIDs 3.
- Colchicine is another option for treating acute gout, with low-dose colchicine demonstrating a comparable tolerability profile to placebo and a significantly lower side effect profile to high-dose colchicine 3.
- Adrenocorticotropic hormone (ACTH) and interleukin-1 (IL-1) inhibitors, such as canakinumab, may also be used to treat acute gout, particularly in patients who are refractory to or have contraindications to NSAIDs and/or colchicine 3.
Treatment Guidelines
Current treatment guidelines for gout recommend the use of NSAIDs, corticosteroids, and colchicine as first-line treatments for acute gouty arthritis 4.
- Xanthine oxidase inhibitors (XOI) or uricosuric drugs may be used for long-term treatment to lower serum uric acid levels, with a target value of <6 mg/dL 4.
- Lesinurad, in combination with XOI, is a new treatment option for patients with refractory gout 4.
- Updated guidelines from the American College of Physicians, the European League Against Rheumatism, and the American College of Rheumatology provide clear guidance on the optimal use of these therapeutic options to improve the medical management of gout 5.