From the Guidelines
Inpatient gout flare treatment should prioritize corticosteroids as the 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, it is crucial to consider the patient's comorbidities and potential contraindications for various treatments.
- Corticosteroids, such as prednisolone at a dose of 35 mg for 5 days, are recommended as the initial treatment option for patients without contraindications, given their strong anti-inflammatory effects and lower risk of adverse events compared to NSAIDs 1.
- NSAIDs, including indomethacin, can be considered as alternative options, but their use should be cautious in patients with renal impairment or gastrointestinal bleeding risk.
- Colchicine is also an effective treatment for acute gout, but its use should be approached with caution in patients with hepatic or renal dysfunction. Key considerations in the management of inpatient gout flares include:
- Prompt initiation of treatment within 24 hours of symptom onset to maximize effectiveness
- Selection of medication based on patient comorbidities and potential contraindications
- Adjunctive measures such as adequate hydration, joint rest, and ice application to support symptom relief
- Avoidance of initiating prophylactic treatment with allopurinol or febuxostat during an acute flare, unless already established.
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 with colchicine is 1.2 mg (two tablets) at the first sign of the flare followed by 0.6 mg (one tablet) one hour later.
- The maximum recommended dose for treatment of gout flares is 1.8 mg over a one hour period.
- If the patient is already on prophylactic colchicine, the treatment dose for a gout flare is the same, but the prophylactic dose should be resumed 12 hours after the treatment dose 2.
From the Research
Inpatient Gout Flare Treatment
The treatment for inpatient gout flare includes several pharmacotherapies, such as:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) 3, 4, 5, 6, 7
- Colchicine 3, 4, 5, 6, 7
- Oral or intramuscular corticosteroids 3, 4, 5, 6, 7
- Interleukin-1 (IL-1) inhibitors, such as canakinumab, for patients with flares refractory to standard therapies 3, 4, 6, 7
Treatment Considerations
When treating inpatient gout flares, considerations should be made for:
- Patient comorbidities, such as chronic kidney disease and ischemic heart disease 3, 6
- Patient preference 3
- The need for comprehensive patient education and counseling 5
- Regular laboratory follow-up 5
Emerging Therapies
Emerging therapies for gout treatment include: