The treatment for an acute gout flare involves the use of anti-inflammatory agents, with the choice of agent depending on patient factors and preferences.
First-line therapy
- Colchicine: Colchicine is recommended as a first-line therapy for acute gout flares. The EULAR 2017 guidelines suggest initiating colchicine within 12 hours of flare onset at a loading dose of 1 mg followed 1 hour later by 0.5 mg on day 1 . The ACR 2020 guidelines also recommend low-dose colchicine when colchicine is the chosen agent
- Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs are commonly used to treat acute gout. The BSR 2017 guidelines recommend initiating an NSAID at maximum dose as first-line therapy, with the drug choice depending on patient preference, renal function, and comorbidities, if not contraindicated . A systematic review found no evidence that corticosteroids and NSAIDs have different efficacy in managing pain in acute gout, but corticosteroids appear to have a more favorable safety profile for selected adverse events
- Corticosteroids: Corticosteroids, available as oral, intra-articular, or intramuscular preparations, are recommended by the ACR 2020 guidelines as first-line therapy for gout flares . A systematic review found that systemic corticosteroids might be safe alternatives to NSAIDs and colchicine for acute gout
Alternative therapies
- Interleukin-1 inhibitors: In patients with frequent flares and contraindications to colchicine, NSAIDs, and corticosteroids, the EULAR 2017 guidelines suggest initiating IL-1 inhibitors for the treatment of flares . A study found that canakinumab 150 mg was probably superior to triamcinolone acetonide 40 mg in terms of pain relief, resolution of joint swelling, and achieving a good treatment response at 72 hours following treatment, but was probably associated with an increased risk of adverse events
Effective management of an acute gout flare involves prompt initiation of appropriate anti-inflammatory therapy tailored to the patient's individual factors, such as comorbidities and medication tolerance.