Update on Gout and Hyperuricemia

J. F. Baker; H. Ralph Schumacher

Disclosures

Int J Clin Pract. 2010;64(3):371-377. 

In This Article

Treatment of Acute Gout

Current published guidelines, including those of EULAR, suggest the use of oral colchicine or non-steroidal anti-inflammatory drugs (NSAIDs) as the first-line systemic treatment for acute gout[20] (Table 1). The use of oral prednisolone (35 mg daily) has recently been shown to be comparably effective to Naproxen 500 mg twice daily in a randomised trial[21] and is often preferred for polyarticular gout. As patients frequently have comorbidities associated with hyperuricemia and gout, risks and benefits of these systemic treatments should be considered in the individual patient. For instance, uncontrolled diabetes and active infection are often contraindications for systemic corticosteroids, while NSAIDs should be avoided in patients with chronic kidney disease. High doses and hourly use of colchicine should be avoided, if possible, because of high frequency of toxicity. However, use of this medication at low doses (0.6 mg 2–3 times daily) is widely accepted and may be sufficient for some patients, although the efficacy of this approach has not been demonstrated in controlled trials.

An alternative to systemic treatment is intra-articular injection, which is considered safe and effective. This modality has not been well studied, but in one uncontrolled trial, all 19 patients receiving intra-articular depot corticosteroid injections improved within 48 h.[22] This approach is less favoured when multiple joints are involved, or a site is involved that is not easily amenable to aspiration. Systemic and intra-articular steroids should be avoided if septic arthritis is suspected.

Physicians should also include patient education regarding lifestyle in the plan for prevention of subsequent flares. Patients should be encouraged to lose weight and counselled to avoid excessive consumption of animal purines, high-fructose sweeteners and alcohol. In a minority of patients, these interventions may be enough to lower SUA levels and to prevent further attacks of gout.

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