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what is the treatment for acute gout?

Answer

The treatment for acute gout involves several options, including non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, colchicine, and interleukin-1 inhibitors. The choice of treatment depends on patient factors and preferences, as well as the severity of the flare.

NSAIDs

Corticosteroids

Colchicine

Interleukin-1 inhibitors

  • When to consider: Interleukin-1 inhibitors, such as canakinumab, rilonacept, or anakinra, may be considered in patients who have not responded adequately to standard treatment of acute gout
  • Guidelines recommendation: The European League Against Rheumatism (EULAR) 2017 guidelines recommend initiating IL-1 inhibitors for the treatment of flares in patients with frequent flares and contraindications to colchicine, NSAIDs, and corticosteroids (oral and injectable)

Prophylaxis

In conclusion, the treatment of acute gout involves a combination of anti-inflammatory medications, with the choice of treatment depending on the patient's specific circumstances, including comorbidities, contraindications, and preferences. NSAIDs, corticosteroids, and colchicine are first-line therapies, while interleukin-1 inhibitors are reserved for patients who do not respond to or cannot tolerate these treatments. Prophylaxis against acute attacks is also recommended when initiating or adjusting urate-lowering therapy to prevent future flares.

References

1

Gout

Medical management

Guidelines

Anti-inflammatory therapy

Pathway
EULAR 2017