The treatment of gout involves both the management of acute flares and long-term urate-lowering therapy.
Management of acute flares
- Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs are commonly used to treat acute gout. They can be initiated at maximum dose, with the choice of drug depending on patient preference, renal function, and comorbidities, if not contraindicated
- Colchicine: Colchicine can be initiated within 12 hours of flare onset at a loading dose of 1 mg followed one hour later by 0.5 mg on day 1 . It can also be used as a prophylactic treatment at a dose of 0.5–1 mg/day, reduced in renal impairment
- Corticosteroids: Corticosteroids, either oral, intraarticular, or intramuscular, can be used based on patient factors and preferences . They are recommended for patients with contraindications to or not tolerating colchicine
- Interleukin-1 inhibitors: Interleukin-1 inhibitors can be considered for the treatment of flares in patients with frequent flares and contraindications to colchicine, NSAIDs, and corticosteroids
Long-term urate-lowering therapy
- Urate-lowering therapy: Long-term lowering of serum urate to less than 360 μmol/L leads to crystal dissolution and ultimately suppression of flares . This approach is essential for effective gout management
Lifestyle interventions
- Lifestyle interventions: Although lifestyle interventions are often recommended in the management of chronic gout, the evidence from trial data of the benefits and safety of using lifestyle interventions for treating acute gout attacks is limited
In conclusion, the treatment of gout involves a combination of managing acute flares with anti-inflammatory agents and long-term urate-lowering therapy. The choice of treatment should be individualized based on patient factors and preferences.