From the Guidelines
Gout treatment should prioritize acute management with NSAIDs, colchicine, or corticosteroids, and long-term prevention with urate-lowering therapy, such as allopurinol or febuxostat, to reduce morbidity, mortality, and improve quality of life. For acute gout attacks, the following treatments are recommended:
- NSAIDs like indomethacin (50mg three times daily) or naproxen (500mg twice daily) as first-line treatments, typically continued for 7-10 days 1
- Colchicine (1.2mg initially, followed by 0.6mg one hour later, then 0.6mg once or twice daily) is effective when started early 1
- Corticosteroids, either oral prednisone (30-40mg daily, tapered over 7-10 days) or intra-articular injections, are options for patients who cannot take NSAIDs or colchicine 1 For long-term management, urate-lowering therapy with:
- Allopurinol (starting at 100mg daily, gradually increasing to 300-600mg daily) 1
- Febuxostat (40-80mg daily) 1
- Probenecid (250-500mg twice daily) can be used as an alternative 1 Regarding imaging, the following modalities can aid in diagnosis:
- Plain radiographs may show joint damage in chronic gout but are often normal in early disease 1
- Ultrasound can detect urate crystal deposits and the "double contour" sign 1
- Dual-energy CT is highly specific for detecting urate deposits, while MRI helps evaluate complications or alternative diagnoses 1 These imaging modalities aid in diagnosis when joint aspiration for crystal analysis isn't feasible, though synovial fluid analysis remains the gold standard for confirming gout 1. Key points to consider in gout management include:
- Patient education on diet, lifestyle, treatment objectives, and management of comorbidities 1
- Xanthine oxidase inhibitor (XOI) therapy with either allopurinol or febuxostat as the first line pharmacologic urate-lowering therapy (ULT) approach in gout 1
- Serum urate should be lowered sufficiently to durably improve signs and symptoms of gout, with the target <6 mg/dL at a minimum, and often <5 mg/dL 1
- The starting dose of allopurinol should be no greater than 100 mg per day, and less than that in moderate to severe chronic kidney disease (CKD), followed by gradual upwards titration of the maintenance dose, which can exceed 300 mg daily even in patients with CKD 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Gout Treatment
- Gout is a common form of acute inflammatory arthritis caused by the deposition of monosodium urate crystals within synovium of joints, leading to severe pain and reduced quality of life for patients 2.
- 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 2, 3.
- Urate-lowering therapies aim to prevent gout flares, with an emphasis on treat-to-target strategy, and initial treatments include allopurinol and febuxostat 2, 4, 3.
Imaging in Gout
- There is no direct mention of imaging in the provided studies, however, it is known that imaging techniques such as X-rays, ultrasound, and dual-energy computed tomography (DECT) can be used to diagnose gout and monitor the progression of the disease.
Treatment Options
- Nonpharmacologic and pharmacologic treatments, monotherapy versus combination therapy, and suggested recommendations are discussed in the treatment of acute gout 5.
- Treatment with xanthine oxidase inhibitors (XOI) or uricosuric drugs is indicated for patients with a recurrent or severe course, with a target uric acid value of <6 mg/dL 4.
- Lesinurad in combination with XOI is a new treatment option for patients with refractory gout 4.
- Pegloticase is effective for patients with recalcitrant gout, but its immunogenicity significantly threatens the achievement of sustained urate lowering responses 3.