What are options for the treatment of acute gout?

Updated: Jan 26, 2021
  • Author: Bruce M Rothschild, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Acute treatment of proven crystal-induced arthritis is directed at relief of the pain and inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, colchicine, adrenocorticotropic hormone (ACTH) , and anakinra are treatment options. The choice is based primarily on whether the patient has any concomitant health problems (eg, renal insufficiency or peptic ulcer disease). Colchicine, a classic treatment, is now rarely indicated.

In patients with a gout flare, the multicenter open-label randomized CONTACT trial found no significant difference in pain relief over 7 days with naproxen versus low-dose colchicine. However, naproxen caused fewer side effects. In CONTACT, adults with a gout flare (n = 399) received either naproxen, 750 mg immediately then 250 mg every 8 hours for 7 days, or low-dose colchicine, 500 mcg three times per day for 4 days. During days 1–7, diarrhea (45.9% vs 20.0%) and headache (20.5% vs 10.7%) were more common in the colchicine group than the naproxen group but constipation was less common. [136]

When comorbid conditions limit the use of NSAIDs or colchicine, a preferred option may be an intra-articular steroid injection, particularly when a large, easily accessible joint is involved. Septic arthritis must be reasonably excluded.


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