The treatment focus for patients experiencing gout flares should be on eliminating the pain as quickly as possible. Because of this, gout flares are generally treated with anti-inflammatory therapies to help appease intense pain and reduce swelling – although, these do not address the underlying problem of uric acid elevation.
For acute gout flares, the sooner anti-inflammatory therapy begins, the better. It is more difficult to control a flare once it has progressed. Anti-inflammatory therapies provide relief of pain and inflammation, but symptoms are likely to return until the underlying hyperuricemia is addressed. Uric acid-lowering therapies are the cornerstone of preventing gouty arthritis progression over time.
Treatments to Relieve Pain and Reduce Swelling in Acute Flares
- Colchicine – Taken orally, colchicine may be the most effective when taken within the first 12 hours of an acute flare; however, other medications may be needed for treating pain. A common dosing schedule is to take two 1.2 mg tablets together at once, then a third tablet one hour later, followed by one tablet 2-3 times per day over the next week. Occasionally, patients may have side effects such as nausea, vomiting, abdominal cramps or diarrhea. Example: Colcrys
- Glucocorticosteroids – Taken orally or injected, glucocorticosteroids quickly suppress the inflammation of an acute flare. Dose packs are a useful approach. The NPO hospitalized patient will require intra-articular corticosteroids, or intravenous/intramuscular injections. In this case, 0.5 - 2.0 mg/kg may be sufficient. Examples: Medrol, Deltasone (prednisone), Kenalog
- Nonsteroidal anti-inflammatory drugs (NSAIDs)* – Taken orally at prescription dosages and continuing treatment until the flare subsides is a well-established approach, if not contraindicated. Examples: Celebrex, Indocin, Motrin, Naprosyn, Tivorbex
A uric acid level of 6.0 mg/dL or less is the target goal for most patients with hyperuricemia and gout. This level may need to be lower in those who have a large urate burden, such as those with tophi or erosions as identified through x-rays.
- Allopurinol – Taken orally, allopurinol decreases the body’s production of uric acid. This medication is the most commonly used urate-lowering drug, and the usual first choice for urate-lowering therapy. It is also recommended for patients with a history of kidney stones or tophi. Dose escalation is recommended. Examples: Lopurin, Zyloprim
- Febuxostat – This medication is taken orally and decreases the body’s production of uric acid. It can be taken by people with mild to moderate kidney or liver disease. Example: Uloric
- Lesinurad - Taken orally, this medication should be taken in combination with another drug, such as allopurinol or Uloric. It treats high uric acid level in people with gout who are already taking a urate-lowering therapy. Example: Zurampic
- Pegloticase – Pegloticase is an intravenous infusion of an enzyme used to dissolve gout crystals in advanced and difficult to control gout. Example: Krystexxa
- Probenecid – Taken orally, this medication increases the kidneys’ ability to remove uric acid from the body. It is not recommended if there is a history of kidney stones or renal impairment. Examples: Benemid, Probalan