What are the ACR guidelines for managing gout flares?

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

  • For treatment of a gout flare, first-line therapy with colchicine, NSAIDs, or glucocorticoids (oral, intra-articular, or intramuscular) is strongly recommended over interleukin-1 (IL-1) inhibitors or adrenocorticotropic hormone (ACTH). Given similar efficacy and a lower risk of adverse effects, low-dose colchicine over high-dose colchicine is strongly recommended when colchicine is the chosen agent.
  • Using topical ice as an adjuvant treatment over no adjuvant treatment is conditionally recommended for patients experiencing a gout flare.
  • Using an IL-1 inhibitor over no therapy (beyond supportive/analgesic treatment) is conditionally recommended for patients experiencing a gout flare for whom the above anti-inflammatory therapies are ineffective, poorly tolerated, or contraindicated.
  • For patients who are unable to take oral medications, treatment with glucocorticoids (intramuscular, intravenous, or intra-articular) is strongly recommended over IL-1 inhibitors or ACTH.

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