Reduction of inflammation

The first step in treating acute gout flare is the reduction of inflammation.

The common problem in gout therapy is, that all drugs used might cause severe side effects

Many patients with gout have comorbidities

Therefore, the treatment concept needs to carefully balance the efficacy and the risks

Standard medicines prescribed for pain and inflammation for gout are:

  • Nonsteroidal anti-inflammatory drugs:

    NSAIDS are available in over-the-counter dosing as ibuprofen and naproxen sodium, as well as more-powerful prescription NSAIDs such as indomethacin or celecoxib. Many patients with gout have contraindications to NSAIDs (e.g. hypertension, chronic kidney disease, gastropathy).
    A major concern with NSAIDs is their toxicity on the gastronintestinal tract. NSAIDs use is associated with an increased risk of gastrointestinal bleeding and may have cardiovascular toxity.

  • Colchicine

    Usually most effective for gout treatment when taken within the first 12 hours of an acute flare. For the first 2 days of treatment co-therapy with NSAIDs can be considered to compensate the delayed onset of pain reduction.

    Colchicine dosing schedule is to take 1.2 mg immediately, followed by 0.6 mg an hour later, with ongoing antiinflammatory therapy until the flare resolves.

    The drug’s effectiveness may be offset, however, by side effects such as nausea, vomiting and diarrhea, especially in high and frequent dosing. Inappropriate dosing of colchicine occurred frequently and was related to toxicity and death.

  • Glucocorticosteroids

    Cortisone can be taken orally or injected and quickly suppresses the inflammation of an acute gout flare.

    It is important to note that gout flares often occur when a patient first starts taking medications to lower uric acid levels. Patients can help prevent flares when starting these medications by also taking low-dose colchicine or NSAIDs.

Main inflammation symptoms caused by acute gout flare are pain, tenderness on palpation, swelling and redness.

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colchicine

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GOUT treatment

Pain management

There are several options given to provide gout pain relief. It is important to prescribe medicines which eliminate the inflammation as well.

Lowering uric acid levels

The treatment of gout aims to relieve pain and inflammation during attacks, and lower uric acid levels in the blood.

Treatment guidelines

Role of colchicine for acute gout flare & prevention gout treatment.

Optimal colchicine dosages

To reduce number of adverse events American College of Rheumatology 2020 Guideline for the Management of Gout recommend to use colchicine in low dosages.

  1. Ahern MJ, Reid C, Gordon TP, McCredie M, Brooks PM, Jones M. Does colchicine work? The results of the first controlled study in acute gout. Aust NZ J Med 1987;17:301–4.