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
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
- 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
For additional information about medications, dosages and side effects, click here.